Summary of the personal year-end work of the medical insurance center

In 2009, it was a very meaningful year for me. It can also be said that in my life, this memory is even more difficult to erase. First of all, I would like to take this opportunity to thank the leaders of the department, thank the leaders for their trust in me, and give me a very good opportunity to exercise. In April of this year, I accepted the department arrangement and went to the medical insurance center to work and study. For almost a year, because of my inseparable relationship with my job, as me personally, I am not only very willing, but also cherish this opportunity, from April 1st. Up to now, although it is less than a year, it has already experienced spring, summer, autumn and winter in another environment. Now the body and mind are more mature, and there are more misses in the department. At the same time, I feel more about the hospital and the medical insurance center. A little more different responsibilities.

In the new environment, I also defined new directions and goals for myself: try to reduce the refusal of our hospital, and at the same time, master the medical insurance policy. In order to achieve this direction and goal, I also made a small plan, strive to accumulate in the work, learn more in the study, and find more feedback.

It has been eight months since I arrived at the medical insurance center. The work is intense and fulfilling. Every month, it is essential to arrange overtime work, and sometimes there will be a continuous day of continuous work, including noon and evening. The work is hard and busy, and the main job is to conduct an outpatient bill review for all designated medical institutions involved in Beijing. From the end of April 1st, my work review is as follows: a total of about 15,251 person-times of auditing and manual returning, the amount involved in the audit is about 35.43 million yuan, and the total number of bills reviewed is about 460,000, the highest single day. The number of reviews reached more than 350. In addition to the review of basic medical insurance, sometimes the center will arrange for me to review the Haidian medical insurance bills submitted by the designated medical institutions or to help the review team to conduct a random inspection of the reviewed bills.

Some of the colleagues working in the medical insurance center are from various hospitals . Everyone gets along well with each other and often learns and discusses each other according to the different characteristics of each hospital . This makes me work and work on other hospital related departments. The program also has more understanding. In the audit work, because the bills are booked and submitted by individuals, the audit and discovery problems are also random compared to the designated medical institutions. At the same time of review, I pay great attention to the various situations in the audit and focus on accumulating relevant The clinical knowledge and policies related to health care, and more importantly, the various causes of refusal. Including super price charges, non-self-pointing, over-dosing, over-limit charges, self-funded drugs, changing medication routes, date of outpatient bills and hospitalization dates, non-clinical diagnosis necessary medical treatment items, partial congenital disease treatment costs, etc. The kind of refusal was registered and summarized. The most important thing is to carry out timely summarization and reporting for all kinds of refusal problems that have occurred in our hospital. The problems involved in our hospital include over-limit medical treatment projects, over-limit medications, over-dosing, and departmental super-price charges. After each central meeting and small faculty meeting, the hospital’s interest is notified during the meeting. I will promptly provide feedback on relevant information, and insist on a written report on the work of the department in charge of medical insurance work every Thursday. No matter whether it is windy or rainy, I have never stopped. I think I will continue to regard it as a A task and responsibility to take it seriously and complete it.

In view of the large number of undelivered items in the outpatient bills of our hospital, in order to reduce the contradiction between the patients and the hospital due to the refund of the order and delay of reimbursement, and to avoid unnecessary disputes, I also specially consulted the center audit team leader and the network engineer of the center. Relevant personnel, summed up the reasons, and timely contact and communicate with the staff of the hospital's medical insurance office, and try to help solve various hidden dangers in the work, and try to avoid becoming a card because the current expenses are not uploaded or returned. The chargeback caused by no uploading information. Whether it is a refusal to pay for a hospital or a refusal to pay a patient, the reason for the refusal is basically the same. For a large fee refusal or a refusal caused by a doctor’s repeated mistakes, sometimes I will contact the relevant department in time. The telephone reminder informs the relevant doctor that he hopes that it can attract enough attention and avoid the rejection of repeated reasons, which is also appreciated by doctors. During the severe period of the pandemic, the central group meeting proposed a combination of individual Chinese medicine decoctions that were not reimbursed. On Thursday, I also informed the leaders of this information in a timely manner. The medical insurance director also timely issued the files to the relevant departments. Be prepared to prevent refusal. Sometimes I will also use the convenient conditions for returning to hospital on Thursday to help Curry and the Medical Insurance Office bring some important application materials or files, actively help colleagues to contact the applicants of the application materials, coordinate and receive relevant fax materials, etc. .

In the eight months, from the initial exploration, study, to the work to find problems, timely feedback, to the current reduction in the number of refusals, from the diversification of the refusal to the current refusal is relatively simple, looking at the center Colleagues have also reflected less and less on the refusal of our hospital. I am also very happy and gratified.

In order to better grasp the relevant policies of medical insurance, make full use of the practice and experience of this work, and better combine theory and practice, this year I also took advantage of the rest time to participate in the labor and social security professional classes, hope Through systematically studying the social five risks, improve yourself, better do the work of the department, and do your job well. During the work of the medical insurance center, I also used the rest time to check some related policies, read a lot of information, analyze the reasons for the refusal, and wrote a paper on how to prevent the refusal of fixed medical institutions.

I will be able to return to the "home" at the end of February next year. During the remaining three months of work and study, I will work harder to learn the relevant policies, and cooperate with the medical insurance center to complete the peak work, and hand over the hospital and department to me. The task is completed, I hope to go back to the hospital early, and work with my colleagues to work in the new year's department building work faster and better.

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