Application Research Of Knowledge Mapping In Medical Insurance Fund Audit

According to the “13th Five-Year Plan”,the National Audit Office issued the “13th Five-Year National Audit Work Development Plan”,which plans to use medical insurance as the key audit object and propose to strengthen the audit of the operation and management of the medical insurance fund to ensure medical care.The insurance fund is safe and compliant.However,with the reform of the medical insurance system,the coverage rate of medical insurance in China has been continuously improved,and the amount of medical data has increased exponentially.At present,the frontline staff of the auditing organization is less developed,the traditional auditing technology method has encountered bottlenecks,and the audit risk has intensified.On May 23,2018,at the first meeting of the Central Audit Committee,General Secretary Xi Jinping put forward the requirement of “Strengthen the examination of science and technology and strengthen the construction of audit information technology”.The rise of knowledge map technology provided a new solution for this research.Ideas.Knowledge maps can express information about entities in the real world and associations between entities in a more intuitive way.In this paper,the research on the improvement of technical methods in the current medical insurance fund audit is carried out.Combined with the characteristics of knowledge map,the application advantages of knowledge map technology in medical insurance fund audit are analyzed.The construction process and knowledge map of knowledge map are studied.Application in the audit of medical insurance funds.Firstly,this paper takes the audit of medical insurance fund of H province as an example,combines the business process of medical insurance and the content of medical insurance fund audit,proposes eight entities related to medical insurance fund audit,and defines the relationship between eight entities.A conceptual model of knowledge maps for medical insurance fund audits was constructed.Secondly,this paper introduces constraints,uniquely corresponding instances of entities,and constructs a pattern layer of knowledge maps for medical insurance fund audits.Thirdly,this paper takes the medical insurance data of H province as the data source,obtains the examples needed by the data layer,and uses the Neo4 j graph database to store the obtained instances.The auditors can perform visual operations and analysis through the graph database.In practical application,based on the medical insurance fund audit knowledge map,this paper studies the knowledge map in the case of insurance coverage,repeated insurance,decomposition of hospitalization,application of medical insurance card,super drug catalog reimbursement,and case-based payment for reimbursement.The audit analysis ideas and the audit process finally show the visualization results of the audit questions.Compared with the traditional auditing method,the knowledge map can visualize the complex relationship between entities.The auditors can find the audit trails through the analysis of complex relationships,thus further auditing,thus saving the time for determining the audit focus in the early stage.Improve audit efficiency.The main contributions of this paper are:(1)proposed a knowledge map model for medical insurance fund audit;(2)using the knowledge map for medical insurance fund audit to analyze five types of problems in medical insurance fund audit;(3)The basic knowledge map is realized by using Neo4 j.l.