现代医院2025，Vol.25Issue(4)：556-559,4.DOI:10.3969/j.issn.1671-332X.2025.04.017
DRG入组分析驱动的医保结算清单质量控制优化策略
Optimization strategies for quality control of medical insurance payment lists driven by DRG assign-ment analysis
摘要
Abstract
Background Medical insurance payment lists are important evidence for health insurance settlement and the basis for reasonable DRG payments.However,there are currently many quality control defects that affect the correct DRG assign-ment and the reasonable payment of medical insurance funds.Methods This paper adopts a case analysis approach,combined with clinical knowledge,coding specifications,and mapping relationships,to analyze the quality defects of the current medical insurance payment lists in the hospital.Results This paper proposes refined management strategies and suggestions,including strengthening information construction,improving the professional level of quality control personnel,improving the data quality of the front-end medical record homepage,optimizing the mapping relationship of the dictionary library,carrying out clinical com-munication and training,and establishing a closed-loop quality control system for medical insurance payment lists.These strate-gies effectively improve the data quality of medical insurance payment lists and the accuracy of DRG assignment.Conclusion The management of medical insurance payment lists involves multiple links,departments,and technologies and needs continuous improvement to support hospital refined management.关键词
医保结算清单/质控/案例/DRGKey words
Medical insurance payment lists/Quality control/Case/DRG分类
医药卫生引用本文复制引用
闫学丽,左煌,孔德莹..DRG入组分析驱动的医保结算清单质量控制优化策略[J].现代医院,2025,25(4):556-559,4.基金项目
陕西省创新人才推进计划-科技创新团队(2022TD-58) （2022TD-58）
陕西省自然科学基础研究青年项目(S2023-JC-QN-1422) （S2023-JC-QN-1422）
