5 medical security work reports

#report# Introduction Work report is a report that reports the work status, practices, experience and problems of the unit, department and region to the superior authority. The following is a medical security work report compiled by None, welcome to read!

1. Medical security work report

With the correct guidance and help of the municipal medical security department, and with the great attention and strong support of the district committee and district government, in order to serve the majority of For the purpose of ensuring the insured patients, all the hospital staff work together to make the medical insurance of our hospital run healthily and smoothly.

1. Strengthen the publicity of medical insurance policies

In order to create a good atmosphere for the whole society to pay attention to and participate in medical insurance, our hospital makes full use of the Labor and Social Security Policy Publicity Day on the eve of May Day During the Labor and Social Security Publicity Week in October, we took to the streets, communities, enterprises and institutions, and schools to use various forms such as consultations, leaflets, slogans, etc. to discuss the insured objects, payment methods, and payment methods of medical insurance. Medical benefits and preferential policies for insurance coverage for needy groups were vigorously publicized.

2. Change work style and establish service concept

The purpose of medical insurance work is to serve the majority of insured patients and the majority of insured persons, and it should not become an empty sentence slogan, in specific work we need a team of medical staff who are dedicated, dedicated, honest, efficient and willing to serve insured patients. Therefore, in accordance with the requirements of the municipal medical insurance, all comrades in the hospital actively participate in every training and study of the municipal medical insurance. , through study, combined with the actual situation of medical insurance work, strive to achieve three changes in ideological concepts, work style, and working methods, and establish three concepts, that is, changing ideological concepts, establishing an overall concept, understanding the general situation, taking into account the overall situation, and keeping up with the times. pace. The purpose of medical insurance is to ensure that insured patients receive timely treatment when they are sick, and that medical expenses incurred are reimbursed in a timely manner in accordance with policy regulations. Through the hard work of medical staff, the majority of insured personnel are satisfied; changing work styles , establish a service concept. The purpose of medical insurance work is to serve the majority of insured patients. Therefore, we take serving insured patients as the center, and how to provide high-quality services to insured patients runs through the work. We adhere to fairness, justice and openness in our work. Principles, objectivity and fairness, patience and meticulousness, it is common to work overtime, sometimes until two or three o'clock in the night for work; change working methods, establish a sense of responsibility, medical insurance reform is a brand new work, and it has not been successful Our experience can be directly used for reference, and is directly related to the vital interests of the majority of insured patients. Therefore, while carefully studying the policy theory, we are responsible for the cause and the insured persons, in the spirit of not only saving people and treating diseases, but also allowing the insured to benefit. We must adhere to the principle of protecting the interests of patients and work hard to learn business knowledge so that we can master the relevant policies of medical insurance and improve our business level.

3. Improve the system, strengthen management, and continuously improve the level of medical insurance management

Our hospital’s medical insurance work is still in the preparatory stage. The hospital leaders attach great importance to this and actively coordinate with telecommunications companies to open the network. , seek funds from relevant higher-level departments to establish network systems to ensure that medical insurance-related equipment is ready as soon as possible. At the same time, our hospital is working hard to improve the system, strengthen management, and optimize services:

First, the charging items, charging standards, and drug prices are announced to the public and accepted supervision by the masses;

The second is to improve the system, standardize the medical insurance service behavior from admission registration, hospitalization, discharge compensation and other medical work aspects, and strictly implement the accountability system;

The third is to continue to carry out the "three excellences and one excellence" in the hospital "Satisfy" (that is, beautiful environment, high-quality service, good order, so as to satisfy the people) activities;

The fourth is to strengthen the awareness of medical insurance services, change the work style of medical staff, and effectively improve the quality of medical insurance Work management level.

IV. Strengthen learning and focus on connotation construction

In order to enable hospital employees to have a deeper understanding and comprehensive mastery of medical insurance policies and systems, our hospital has carried out various forms of learning Activities:

First, convene hospital-wide staff meetings, middle-level cadre meetings, etc. to explain the new medical insurance policy and use the meeting format to deepen everyone’s understanding of medical insurance work;

The second is to further improve The learning and training system regularly organizes employees to learn relevant theories, labor security policies and regulations, and medical insurance business knowledge every Friday, which has strengthened the ideological awareness, professional level and various abilities of hospital employees.

2. Medical Security Work Report

In order to further improve the various management tasks of our hospital’s basic medical insurance, according to the "About the Basic Medical Insurance Designated Medical Institutions and Designated Retail Pharmacies in Zhongmu County In accordance with the spirit of the document "Notice on Conducting the Service Quality Assessment in 20xx", the leaders of our hospital paid attention to it and established a leading group for self-examination of basic medical insurance in the health center to actively carry out self-examination of basic medical insurance. This is summarized as follows:

1. The basic medical insurance management system is becoming increasingly perfect.

Our hospital has established a basic medical insurance management leading group headed by the dean in charge, which clearly defines the division of responsibilities among members. Full-time medical insurance monitors are designated at each center site to promptly discover various medical insurance violations and strictly enforce Control various medical insurance assessment indicators formulated by the social security department, formulate interim measures for the management of basic medical insurance at the Sanguanmiao Town Central Health Center, standardize various management tasks of basic medical insurance, implement the reward and punishment system, medical insurance work and medical ethics and medical ethics of medical staff Annual appraisals are linked to performance pay.

2. Strengthen the study and publicity of policies related to basic medical insurance.

Regularly strengthen the study of basic medical insurance-related policies by medical staff, so that they can skillfully promote the various policies and regulations of basic medical insurance to patients and skillfully implement the various provisions of basic medical insurance; Set up a medical insurance policy bulletin board in the outpatient hall, and place medical insurance brochures in places where there are many patients, so that patients can keep abreast of various policies and regulations of basic medical insurance.

3. Strictly implement all contents of the medical service agreement of designated medical institutions of basic medical insurance.

Our hospital strictly implements all contents of the medical service agreement for designated medical institutions designated by basic medical insurance, hangs a "Designated Medical Institution for Basic Medical Insurance" plaque at the entrance of the hospital as required, and sets up a flow chart for medical insurance treatment in the outpatient hall. , to facilitate medical treatment for insured persons, basic medical item charges and drug price bulletin boards are set up in the outpatient hall to clearly mark medical charges; clinical medical staff verify the identity of insured persons in accordance with regulations to prevent insurance fraud; and are stepping up the construction of computers at each center site The charging system and the outpatient medical insurance leadership query system realize the computerization and networking of medical insurance management and medical charges; medical staff are strictly required to use drugs rationally and are strictly prohibited from "prescribing drugs" for others; admission and admission standards and transfer and transfer standards are implemented in accordance with regulations.

4. Improve the complaint supervision mechanism.

Establish a complaint supervision mechanism, set up a basic medical insurance complaint mailbox, handle various complaints about basic medical insurance in a timely manner, seriously deal with various violations of basic medical insurance, and implement reward and punishment measures.

5. There are problems.

1. Some medical staff do not have a thorough understanding of the relevant policies of outpatient medical insurance. In the future, individual medical staff will be targeted to strengthen their study of medical insurance policies.

2. Some clinicians issue outpatient medical insurance prescriptions irregularly, mainly due to missing basic prescription items and the bad habit of modifying prescriptions. In the future, the management of medical insurance prescriptions will be strengthened.

6. Suggestions on medical insurance.

It is recommended that the medical insurance reimbursement process be simpler and more convenient.

3. Medical security work report

In 20xx, all employees of our hospital closely focused on the purpose of running the hospital, united and worked hard to continuously improve medical standards and optimize medical care. environment, improved service attitude, the hospital's social and economic benefits have steadily increased, and various tasks have achieved gratifying results.

Under the leadership of the medical insurance work leading group, and with the active support and cooperation of medical insurance staff at all levels and all medical staff, the medical insurance work of our hospital has been carried out smoothly. In the past year, *** outpatient visits to medical insurance patients have been received; xx number of hospitalizations. All medical staff in the hospital warmly welcome medical insurance patients and win recognition and praise from patients with their superb medical skills, high-quality services and reasonable fees. Throughout the year, the hospital did not have a single dispute over "medical insurance", received no complaints, and had no medical errors or accidents. It was unanimously praised by patients.

1. Strictly implement management regulations and actively accept social supervision:

According to the adjustment of medical insurance policies, our hospital has further improved and revised the medical insurance management system this year to adapt to the new policies. At the same time, in order to minimize errors in the work, the Medical Insurance Department, together with the Accounting Department, the Finance Department, the Quality Control Department, and the Medical Department, conducted a "five-party review" of the medical insurance data, jointly checked the reimbursement materials, and formed an inspection report for the medical staff to Personnel can dynamically grasp relevant situations and make timely corrections to ensure the quality of medical insurance work. Under the leadership of the Medical Insurance Leading Group and the Medical Insurance Department, all medical staff abide by laws and regulations, operate in a standardized manner, strictly implement various medical insurance management regulations, and there are no violations or illegal operations. The writing of prescriptions and medical records is true, accurate, timely and complete, and adheres to rational treatment, reasonable examination, rational use of drugs, and treatment according to the disease; when using or performing drugs and diagnosis and treatment items outside the catalog, the obligation to inform and obtain the consent of the patient and their family members shall be fulfilled. An informed consent form is signed and filed with the medical record; there is no random billing or escalation of charges; there is no splitting of service times and splitting of charges; the admission and admission standards can be strictly controlled, so that the admission and admission diagnostic compliance rate reaches more than 98%, and there is no hanging bed for hospitalization. There were no unreasonable shortening or extension of hospitalization bed days, no hanging bed hospitalization, and no imposter hospitalization. Standardize the out-of-city referral procedures and timely handle referral procedures for patients who meet the conditions for referral and transfer. This year, 5 people have been transferred to outside the city for medical treatment. The out-of-city referral rate, drug costs, and self-paid drugs outside the catalog are all controlled within the scope of the policy. .

In order to better accept the supervision of the society, our hospital has set up a "complaint box" in the outpatient and inpatient departments, announced the reporting hotline, and collected patients' opinions and suggestions in a timely manner to continuously improve the medical insurance management of our hospital. .

2. Strengthen the study of policies and regulations and promote medical insurance knowledge:

In order to familiarize medical staff with and understand medical insurance policies and regulations so as to provide more comprehensive services to insured patients, the hospital held a During the hospital-wide staff meeting and morning meeting, the study of medical insurance knowledge was carried out many times, and new policies and regulations of medical insurance were communicated in a timely manner. On October 8, the Medical Insurance Department organized a medical insurance policy training for all hospital employees to enable all medical staff to understand the policy, become familiar with it, and better serve insured patients. In order to improve the service awareness of medical staff, the hospital also organized multiple knowledge tests on medical insurance policies and standardized services, prescription management and antibacterial drug application, and the test results all met the standards. At the same time, the hospital promptly updates the content of the medical insurance knowledge bulletin board to publicize the medical treatment process and main examination, treatment, drug charging standards, etc. to employees and patients to facilitate patients' medical treatment; medical insurance managers also often visit the wards in person to answer questions of insured patients. Let the majority of insured patients have a fuller understanding of medical insurance and have a clearer direction when seeking medical treatment.

3. Strengthen the publicity of designated medical insurance and expand the influence of the hospital among insured people:

In order to let the majority of insured people understand that our hospital is a designated service unit for medical insurance, recognize that we The hospital's technology, talents, services, prices and other medical advantages allow insured eye disease patients to enjoy more professional medical services. The hospital uses opportunities such as physical examinations, conferences, and free clinics to distribute popular science promotional materials, expand the hospital's external exchanges, collaboration and influence, and improve The hospital's recognition rate among the people insured by medical insurance is to allow more insured people to receive our hospital's professional, efficient and high-quality ophthalmology services.

Over the past year, under the correct leadership of the Municipal Labor and Social Security Bureau and the Municipal Medical Insurance Bureau, with the efforts of all hospital employees, our hospital has achieved certain results in the medical insurance work by carrying out the above activities , the social influence has gradually increased, more and more insured patients come to the hospital for treatment, and it has been recognized by the medical insurance management department.

However, medical insurance management is a difficult, detailed and policy-oriented job. While achievements have been made, some tasks still need to be further improved.

It is planned to carry out medical insurance work from the following aspects:

1. Strengthen contact with the Medical Insurance Bureau, strictly implement various medical policies and regulations, and follow the "Designated Medical Institution Service Agreement" "Operation, strengthen the study, training and examination of medical insurance policies and regulations for medical personnel, promptly notify new medical insurance policies, improve service quality, improve the medical environment and service attitude, and actively cooperate with the various tasks of the Medical Insurance Bureau.

2. Further enrich and improve the hospital’s medical insurance management system and work responsibilities, and set up a medical insurance bulletin board according to needs and new medical insurance regulations so that insured persons can learn new medical insurance information in a timely manner.

3. Standardize operating procedures and appropriately supplement some commonly used drugs or examination equipment according to clinical needs to meet the medical needs of patients as much as possible.

Fourth, increase publicity efforts, further expand the hospital’s external influence, strive to sign service agreements with county (city) medical insurance bureaus, and use the hospital’s talents, services, prices, and technical advantages to provide more insured people Provide professional ophthalmic medical services, and in accordance with relevant regulations, organize regular internal service quality inspections to identify problems and make timely and effective rectifications.

5. Call on all employees to pay attention to medical insurance, actively support medical insurance, and strive to become an "A" designated medical institution for medical insurance.

4. Medical Security Work Report

In 20xx, under the great attention of the leaders of our hospital, in accordance with the work plan arranged by the Medical Insurance Bureau, we followed the "grasp the spirit, thoroughly understand the policy, vigorously publicize, With the overall idea of ??"progressing steadily and paying close attention to implementation", we have carried out various tasks seriously. Through the joint efforts of all the medical staff in the hospital, the medical insurance work of our hospital has achieved certain results. The work of the medical insurance department of our hospital is summarized as follows:

1. Leaders attach great importance to it and publicize it vigorously

In order to standardize diagnosis and treatment behavior, control the unreasonable increase in medical expenses, and ensure the healthy and sustainable development of medical management with low prices and high-quality services , the leadership team of our hospital attaches great importance to it, unifies its thinking, clears its goals, and strengthens its organizational leadership. A leading group for medical insurance work was established with the responsibility of the business dean. Each clinical department has accordingly established a working group with the department director as the team leader and the head nurse as the deputy team leader to be responsible for the overall management of undergraduate medical insurance, focusing on the specific implementation of the undergraduate medical insurance system and the implementation of the reward and punishment system.

In order to enable the majority of cadres and workers to have a deeper understanding and comprehensive grasp of the new medical insurance policies and systems, we have carried out extensive publicity, education and learning activities:

First, hold Hospital-wide staff meetings, middle-level cadre meetings, etc. explain the new medical insurance policy and use the meeting format to deepen everyone's understanding of medical insurance work.

The second is to organize medical insurance knowledge training courses, blackboard newspapers, and distribute promotional materials to enhance employees' ability to operate daily medical insurance work.

The third is to strengthen hospital information management and make it more standardized and convenient through medical insurance software management. The occurrence of errors is greatly reduced. The fourth is to promote the medical insurance policy through TV specials, so that the majority of medical insurance personnel, urban residents, students and other friends can truly understand the benefits of insurance, understand the hospital's operating model, and actively participate in medical insurance activities.

2. Effective measures and strict rules and regulations

In order to enable medical insurance patients to “clearly seek medical treatment and clear consumption”, our hospital:

First, in The medical insurance treatment flow chart and hospitalization instructions for medical insurance patients were published outside the hospital, making it clear to insured patients. A full-time medical guide is arranged in the hall to provide consultation on medical insurance policies to relevant patients.

Second, it is equipped with computer touch screens and electronic display screens to publish charging items, charging standards, and drug prices to the public, and accept supervision by the masses.

The third is to comprehensively implement the "one-day list system" for inpatient expenses, and require patients or their family members to sign the list, implement a public disclosure system for medical insurance accounts, and consciously accept supervision. Allow inpatients to consume clearly. When the leaders came to the hospital for inspection, they were fully affirmed.

Fourth, in order to further strengthen responsibilities and standardize medical service behavior, medical insurance service behavior should be standardized from three aspects: admission registration, hospitalization, and discharge compensation, and accountability should be strictly pursued and relevant responsible persons should be dealt with strictly.

Fifth, the hospital employees provide services and use the card swiping system, which is well received by patients for their civility, courtesy, high-quality service, and excellent technology.

In order to ensure the medical insurance work is fast and solid, the hospital combines the actual work:

First, our hospital has formulated management rules and regulations for medical insurance services, and has regular evaluations of medical insurance services (service attitude) , medical quality, cost control, etc.) work plan, conduct regular evaluations, and formulate improvement measures.

The second is to strengthen ward management, frequently inspect the ward, publicize bedside policies, solicit opinions from patients, solve problems in a timely manner, check whether there is a phenomenon of hanging beds, check whether there is a phenomenon of imposters, check whether inpatients With or without two certificates and one card, the Medical Insurance Department will not approve patients who do not meet the hospitalization requirements. Strengthen the supervision and management of department charges and the diagnosis and treatment behavior of medical staff, supervise inspections, deal with them promptly and seriously, and report and expose them.

3. Improve service attitude and improve medical quality

The new medical insurance system has brought unprecedented opportunities and challenges to the development of our hospital. It is precisely because there is a plan for medical insurance work With a correct understanding, all the cadres and workers of the hospital are actively involved in this work, work hard, and perform their duties and responsibilities without complaint.

Our department regularly attends morning meetings in the ward to promptly convey new policies and provide feedback on medical quality issues discovered during the review process by the Medical Insurance Bureau. content, understand clinical medical staff’s thoughts on the medical insurance system, communicate and coordinate in a timely manner, and require all medical staff to be proficient in medical insurance policies and business, standardize the diagnosis and treatment process, achieve reasonable examinations, rational use of medications, and eliminate random examinations, large prescriptions, favor prescriptions, etc. If irregularities occur, unqualified medical records will be handed over to the responsible doctor for correction in a timely manner. By paying close attention to medical quality management and standardizing operations, unreasonable medical charging behavior has been purified, medical staff's awareness of management and medical insurance has been improved, medical quality has been improved, and a good medical environment has been provided for insured persons.

During the process of handling employee medical insurance procedures, our window staff actively publicized and explained the relevant regulations, policies, and various subsidy measures for medical insurance to every insured employee/resident, and carefully Answer all kinds of questions raised, take the trouble to explain policies, and provide services to the best of your ability. We strive to ensure that no insured patient or family member leaves with dissatisfaction and doubts. We always put "providing high-quality and efficient services to insured patients" as our top priority. During the operation of medical insurance, the majority of insured and participating patients are most concerned about the issue of medical expense compensation. In line with the service tenet of "convenience, efficiency, integrity, and standardization", the staff of our department strictly control, operate in a friendly manner, implement one-stop service, and cash out medical subsidy fees on the spot, which greatly improves insurance satisfaction.

IV. Work Summary

Through the joint efforts of the staff of our department and the relevant staff of the whole hospital, they work conscientiously and sincerely serve the patients, and successfully completed all the tasks set at the beginning of the year. task. In 20xx, our hospital admitted 2,486 patients with medical insurance, with a total medical expense of 20.66 million yuan, reimbursement of 11.6 million yuan, self-pay of 590,000 yuan, 5 patients with more than 10,000 yuan, and 126 outpatients with chronic diseases, with an amount of 78,000 yuan. , greatly reducing the burden of medical treatment on the masses.

During the development of our hospital’s medical insurance work, we received strong support from the leaders and staff of the Medical Insurance Bureau, coupled with the correct leadership of our hospital leaders and the strong cooperation of the entire hospital’s medical staff, the medical insurance work was able to go smoothly. conduct. In the future work, we need to strictly control policies, start with details, carefully summarize experience, constantly improve various systems, carefully handle the relationship between internal operating mechanisms and external window services, standardize business handling processes, simplify procedures, and strive to improve Provide more and better services to medical insurance personnel, strive to push our hospital's medical insurance work to a new height, and contribute to the smooth development of the county's medical insurance work.

Although we have achieved certain results in our work in 20xx, there are still some shortcomings. However, we firmly believe that in the new year, with the strong support of the Medical Insurance Bureau and the correct leadership of the hospital leaders, we will definitely improve the medical insurance aspect. The work is done even better, benefiting health insurance personnel throughout the county.

5. Medical insurance work report

I am mainly responsible for the medical insurance work in the hospital. It has been one year now, and the time is very short. I have no achievements to report. The results of this year's work will be reported to everyone.

1. Since January 1, 20xx, our hospital has had 1,272 outpatient transactions, including 51 hospitalizations, 49 checkouts, and 2 inpatients. The inpatients involved Daxing, Dongcheng, Xuanwu, Chaoyang, and Chongwen. In each district and county, 46 transactions have been successfully settled with a fee of 721,477.37 yuan; 3 transactions have not yet been settled with a fee of 24,271.34 yuan. There is no refusal to pay among the settled expenses, the outpatient and hospitalization data of medical insurance patients are uploaded accurately, and there is no junk data feedback.

2. The medical insurance system in the hospital has been running normally since the start of work in January. In April, due to system reasons, the medical insurance machine was shut down and could not work normally. Contact Capitel Company in a timely manner and repair the system, and search carefully To determine the cause of the problem, install anti-virus software in a timely manner. In XX, the medical insurance system in the hospital was updated and installed 13 times in a timely manner. Each time, the medical insurance system of our hospital was upgraded in a timely manner as soon as possible with the latest update. During this period, the hospital's His system was renovated in May, and the medical insurance outpatient and inpatient interface was successfully completed so that medical insurance patients could directly enter His information and then import it into the medical insurance work computer.

3. Do a good job in uploading and distributing information with the medical insurance center, and be able to solve problems that arise during work in a timely manner. In XX, I participated in 6 conferences and trainings organized by the urban two-level medical insurance center. At the card implementation training meeting on September 23, I received two card readers, three SIM card machines, and a medical insurance card trial card to implement card swiping. Work will begin early next year in suburban counties.

We welcomed the District Social Security Center for two inspections in XX. On September 14, XX, Director Yan from the District Social Security Center and his party inspected the medical insurance work of our hospital from the aspects of medical record quality, prices, charge management, use of the medical insurance system, etc. Supervision and inspection were conducted in several aspects, affirming the work of the hospital and pointing out the shortcomings in the work. After the inspection, we will conscientiously rectify the problems raised by the supervision team and submit the rectification report to the district medical insurance center. On October 15, XX, the District Social Security Center inspected the medical insurance situation of our hospital and gave a high evaluation of the hospital's participation in social insurance for employees.

4. Medical insurance work is a tedious task. From the drug catalog to the diagnosis and treatment catalog to the service facility catalog, each item needs to be carefully checked. Thank you to all colleagues for your help. In order to make the medical insurance work proceed smoothly, in XX, the hospital employees were trained on medical insurance knowledge from several aspects such as medical insurance policies and regulations, patients that our hospital can admit, medical insurance reimbursement requirements, and medical insurance precautions.