Medical insurance management work responsibility book
The responsibility for medical insurance management is to conscientiously implement the spirit of the superior archives and relevant regulations, strengthen the management of medical insurance, standardize the medical insurance medical behavior, better serve the insured patients, maximize the basic medical needs of the insured, and ensure medical insurance. To manage the completion of various work tasks, and to formulate this responsibility book in combination with the actual work of medical insurance in our hospital.
I. Responsibility Objectives 1. Conscientiously implement the basic medical insurance policy provisions of the higher level, enhance the sense of responsibility, strictly implement the work program, implement all tasks, implement the disease treatment, reasonably check, rationally use the medicine, and strictly enforce the charging standard. All-round medical services for the insured personnel.
2. Strictly inspect the insured personnel to be admitted to the hospital, and accept the department to fill in the "Ningyang County Urban Workers Basic Medical Insurance Hospitalization Review Form", carefully review whether the insured personnel are in conformity with the person and the certificate, and issue an outpatient medical record. The medical insurance fund is not admitted to the hospital for admission to the basic medical insurance fund. The medical expenses incurred have been handled by the receiving department.
3. Strictly implement the relevant provisions of the "Shandong Province Basic Medical Insurance Drug List", "Shandong Province Urban Employee Basic Medical Insurance Medical Treatment Project Catalogue" and "Shandong Province Urban Employee Basic Medical Insurance Service Facilities Project Scope". When the insured person needs to use drugs other than the Drug List and the medical insurance facilities that are not covered by the basic medical insurance during the hospitalization period, he must fill out the “Certificate of Non-payment of Medical Insurance Co-ordination Funds”. Explain the reason for use and sign the patient or family member before using it. Otherwise, the expenses incurred will be borne by the collection department. The cost of medicines outside the “catalog” should be controlled within the total drug cost of the insured patient.
4. The positive rate of inspection of large-scale instruments and equipment of the insured personnel must meet the requirements of the higher authorities. The positive rate of examination ≥, the positive rate of magnetic resonance examination ≥, the positive rate of mA × x-ray examination ≥, the positive rate of over-test ≥.
5. Strictly implement the referral procedures for referral transfer. If the patient is in need of referral and transfer to the hospital due to illness, the patient and department director should submit the referral and transfer opinions, and fill out the “Return of the Urban Workers Basic Medical Insurance Referral Transfer Form”. ", after the examination and approval of the medical insurance department of the hospital, the dean of the division of labor agreed to sign and report to the county medical insurance office for approval. To transfer to a hospital, you must set up a hospital for medical insurance.
6. Strict special disease outpatient diagnosis and treatment procedures For patients who hold the "Basic Medical Insurance Special Disease Outpatient Medical Record" issued by the county medical insurance department, the full-time physicians approved by the relevant professional examinations must carefully examine the relevant documents of the insured personnel. Due to the treatment of the disease, rational use of drugs to achieve the human and the card, the disease and the drug, the drug and the amount of compliance, each prescription is generally controlled within two weeks, and each time the condition of the visit, examination and treatment, medication, etc. The special disease outpatient medical records are detailed in the use of drugs other than the "Drug List" and the medical care facilities that do not pay for the funds. In the medical service facilities, the reasons should be explained to the patients, and the patients should be given special diseases. The outpatient medical record can be used after signing the agreement. Special prescriptions and checklists for special disease clinics must be used for medication and various examinations.
7. Do a good job in the medical management services of retired personnel.
Carefully fulfill the service agreement signed with the medical insurance agency to ensure the medical needs of the retired personnel, standardize medical behavior, and achieve treatment due to illness, reasonable inspection, and rational use of drugs. It is strictly forbidden to falsify, ask for drugs or repeat inspections.
8. Do a good job in medical management services for insured persons in different places.
Strictly follow the management regulations of superiors and hospitals, do a good job in selecting medical management services for foreign insured persons in designated hospitals in our hospital, provide retest prescriptions, check treatment notices for outpatient medication, examination and treatment, and detail the condition and treatment. Recorded in the outpatient medical records, hospitalization and other matters are strictly implemented in accordance with the regulations of our county and hospital.
9. Strictly implement various policy provisions and various work procedures. Carefully write medical records, not allowed to be altered or forged, and the current medical history should be described accurately and in detail. All kinds of examination and treatment and medication are prescribed. The temporary medication should explain the reason for medication in the course record. Discharged medicine can only bring the treatment of the disease related to the condition, the acute disease does not exceed the amount of the day, the chronic disease does not exceed the maximum amount, the Chinese herbal medicine does not exceed the dosage, and is recorded in the medical record. Otherwise, the cost will be borne by the department.
Second, inspection and implementation of the above responsibility objectives, the hospital medical insurance department will take the combination of daily inspections and regular, irregular inspections. Regularly check every quarter. As one of the year-end assessment criteria, the inspection results shall be subject to administrative and economic penalties for those responsible for violations of the higher-level and hospital medical insurance regulations, and the transfer of criminal law to the judicial authorities; for the strict implementation of basic medical insurance policies, The hospital is commended for its excellent service quality.
This responsibility book shall be signed by the leaders of the First People's Hospital of the County from the date of the year to the date of XX.
I. Responsibility Objectives 1. Conscientiously implement the basic medical insurance policy provisions of the higher level, enhance the sense of responsibility, strictly implement the work program, implement all tasks, implement the disease treatment, reasonably check, rationally use the medicine, and strictly enforce the charging standard. All-round medical services for the insured personnel.
2. Strictly inspect the insured personnel to be admitted to the hospital, and accept the department to fill in the "Ningyang County Urban Workers Basic Medical Insurance Hospitalization Review Form", carefully review whether the insured personnel are in conformity with the person and the certificate, and issue an outpatient medical record. The medical insurance fund is not admitted to the hospital for admission to the basic medical insurance fund. The medical expenses incurred have been handled by the receiving department.
3. Strictly implement the relevant provisions of the "Shandong Province Basic Medical Insurance Drug List", "Shandong Province Urban Employee Basic Medical Insurance Medical Treatment Project Catalogue" and "Shandong Province Urban Employee Basic Medical Insurance Service Facilities Project Scope". When the insured person needs to use drugs other than the Drug List and the medical insurance facilities that are not covered by the basic medical insurance during the hospitalization period, he must fill out the “Certificate of Non-payment of Medical Insurance Co-ordination Funds”. Explain the reason for use and sign the patient or family member before using it. Otherwise, the expenses incurred will be borne by the collection department. The cost of medicines outside the “catalog” should be controlled within the total drug cost of the insured patient.
4. The positive rate of inspection of large-scale instruments and equipment of the insured personnel must meet the requirements of the higher authorities. The positive rate of examination ≥, the positive rate of magnetic resonance examination ≥, the positive rate of mA × x-ray examination ≥, the positive rate of over-test ≥.
5. Strictly implement the referral procedures for referral transfer. If the patient is in need of referral and transfer to the hospital due to illness, the patient and department director should submit the referral and transfer opinions, and fill out the “Return of the Urban Workers Basic Medical Insurance Referral Transfer Form”. ", after the examination and approval of the medical insurance department of the hospital, the dean of the division of labor agreed to sign and report to the county medical insurance office for approval. To transfer to a hospital, you must set up a hospital for medical insurance.
6. Strict special disease outpatient diagnosis and treatment procedures For patients who hold the "Basic Medical Insurance Special Disease Outpatient Medical Record" issued by the county medical insurance department, the full-time physicians approved by the relevant professional examinations must carefully examine the relevant documents of the insured personnel. Due to the treatment of the disease, rational use of drugs to achieve the human and the card, the disease and the drug, the drug and the amount of compliance, each prescription is generally controlled within two weeks, and each time the condition of the visit, examination and treatment, medication, etc. The special disease outpatient medical records are detailed in the use of drugs other than the "Drug List" and the medical care facilities that do not pay for the funds. In the medical service facilities, the reasons should be explained to the patients, and the patients should be given special diseases. The outpatient medical record can be used after signing the agreement. Special prescriptions and checklists for special disease clinics must be used for medication and various examinations.
7. Do a good job in the medical management services of retired personnel.
Carefully fulfill the service agreement signed with the medical insurance agency to ensure the medical needs of the retired personnel, standardize medical behavior, and achieve treatment due to illness, reasonable inspection, and rational use of drugs. It is strictly forbidden to falsify, ask for drugs or repeat inspections.
8. Do a good job in medical management services for insured persons in different places.
Strictly follow the management regulations of superiors and hospitals, do a good job in selecting medical management services for foreign insured persons in designated hospitals in our hospital, provide retest prescriptions, check treatment notices for outpatient medication, examination and treatment, and detail the condition and treatment. Recorded in the outpatient medical records, hospitalization and other matters are strictly implemented in accordance with the regulations of our county and hospital.
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9. Strictly implement various policy provisions and various work procedures. Carefully write medical records, not allowed to be altered or forged, and the current medical history should be described accurately and in detail. All kinds of examination and treatment and medication are prescribed. The temporary medication should explain the reason for medication in the course record. Discharged medicine can only bring the treatment of the disease related to the condition, the acute disease does not exceed the amount of the day, the chronic disease does not exceed the maximum amount, the Chinese herbal medicine does not exceed the dosage, and is recorded in the medical record. Otherwise, the cost will be borne by the department.
Second, inspection and implementation of the above responsibility objectives, the hospital medical insurance department will take the combination of daily inspections and regular, irregular inspections. Regularly check every quarter. As one of the year-end assessment criteria, the inspection results shall be subject to administrative and economic penalties for those responsible for violations of the higher-level and hospital medical insurance regulations, and the transfer of criminal law to the judicial authorities; for the strict implementation of basic medical insurance policies, The hospital is commended for its excellent service quality.
This responsibility book shall be signed by the leaders of the First People's Hospital of the County from the date of the year to the date of XX.
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