| Objective Through the application of the hospital medical insurance intelligent supervision platform,and analysis the structure,function and operation process of intelligent audit system,in order to find the bounced reason and control the deduction risk.Analysis the effect which before and after system implementation,explain the effect,find problems,and put forward the corresponding suggestions.Method Based on the literature review,analysis the data of nurse satisfaction survey which before and after using the system.SPSS19.0 and Excel 2013 are used for data cleaning and analysis.Statistical method include descriptive analysis,correlation analysis and T test.Use the descriptive analysis on the data of the using effect.Result 1)Compared with the first and second satisfaction research,each dimension and total score have significant improvement except system security dimension.2)Analysis the audit data of a Medical Insurance Center find that deductions of three major rules have been reduced since the system worked.From January to November 2017,the hospital be deducted ￥337800,￥31640 in 2018,decreased about 6.34%.3)Among the total hospital income,the proportion of medical insurance patients increased by 22.43%in 2017.Although hospital violation rate are fluctuated and concentrated,it’s generally declining.And realize the “drug restriction” rule is the most prominent,accounting for85.57% of the total violation amount.4)The physiotherapy analysis find that “15 days readmission” rule is more serious,“limited frequency with pneumatic therapy” and “more than three kinds of physiotherapy” rules are better.Conclusion Since system operated,it has basically achieved the goal of reducing refusal risk.There is a greatly difference in satisfaction scores between the pre and post system applications,which is statistically significant.Analysis audit data find that there still have problems,and should be improved rely on enhance training.Figure19;Table15;Reference 45... |
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