Effective measures for medical insurance fund supervision

Effective measures for the supervision of medical insurance funds include improving hospital medical insurance fund supervision rules and regulations, implementing multi-departmental coordinated supervision, and implementing assessments, rewards and punishments, etc.

Improving hospital medical insurance fund supervision rules and regulations: fully implement the "Regulations on Supervision and Management of the Use of Medical Insurance Funds" and other laws and regulations, establish a medical insurance fund supervision and management committee, raise awareness, strengthen organizational leadership; carry out regular in-hospital Self-examination and self-correction of medical insurance funds shall be carried out, and the long-term mechanism for the supervision of medical insurance funds shall be strengthened. Fund supervision shall be carried out in an unremitting and in-depth manner to further standardize medical service behaviors, build a solid defense line for fund security, and ensure the safe, efficient and rational use of medical insurance funds.

Implement multi-department collaborative supervision: jointly set up a special inspection working group with various departments, issue inspection notices, and assign heads of departments to take responsibility for each department. Through data screening, surprise inspections, and medical record reviews, Supervision and inspection of all clinical medical technology departments in the hospital are fully covered to ensure that there are no blind spots in the supervision and inspection work. For symptomatic and tendentious problems, the crux of the problem is pointed out on the spot and ordered to be rectified immediately. Return visits and inspections are carried out regularly to enhance the deterrent effect of inspections and strictly adhere to the fund Supervise “high voltage lines”.

Implement assessments, rewards and punishments: Combining multi-dimensional indicators such as the list of medical insurance fund violations by medical insurance bureaus at all levels, self-examination and self-correction rules, and hospital comprehensive target management responsibility system assessment, formulate the use of medical insurance funds suitable for hospital development The assessment system conducts monthly evaluations and assessments based on the use of medical insurance funds in each department. The rewards and punishments are reflected in the monthly hospital comprehensive target management responsibility system assessment form.

The effectiveness of medical insurance fund supervision

1. The interests of insured persons are safeguarded and the safety of medical insurance funds is guaranteed

Through multi-department coordinated supervision, the hospital has been improved The medical insurance fund supervision system has strengthened organizational leadership, improved awareness, consolidated the main responsibilities, clarified the division of responsibilities, and improved the assessment reward and punishment system. Through full coverage and high-frequency publicity, a good atmosphere for the supervision of medical insurance funds has been formed; the information system is used to realize the full-process supervision of the use of medical insurance funds. In this way, the interests of insured persons can be effectively protected and the safety of medical insurance funds can be effectively guaranteed.

2. Improved the hospital’s diagnosis and treatment capabilities

By strengthening the supervision of medical insurance funds, the hospital has established a complete set of medical insurance fund supervision measures to enable clinical departments to strictly follow clinical diagnosis and treatment guidelines, Carry out reasonable examination, medication, diagnosis and treatment in accordance with relevant requirements such as clinical technical operating specifications and industry standards. In this way, it can not only prevent the occurrence of fraud and insurance fraud, but also encourage departments to improve their professional capabilities, thereby improving the hospital's comprehensive diagnosis and treatment capabilities and providing better and more efficient medical services to the medical public.

Reference for the above content: Baidu Encyclopedia-Regulations on the Supervision and Management of the Use of Medical Security Funds