1. Medical security work report
With the correct guidance and help of the municipal medical security department, with the great attention and strong support of the district committee and government, and with the aim of serving the majority of insured patients, Qi Xin, all the staff of the hospital, worked together to make the medical insurance work in our hospital run healthily and smoothly. First, strengthen the publicity of medical insurance policy.
In order to create a good atmosphere for the whole society to pay attention to and participate in medical insurance, our hospital made full use of the labor security policy publicity day on the eve of May 1 and the labor security publicity week in 10, and took to the streets, communities, enterprises and institutions, schools, taking various forms such as consultation, leaflets, slogans, etc., and vigorously publicized the insured objects, payment methods, medical treatment, and preferential policies for vulnerable groups to participate in medical insurance.
Second, change the work style and establish the service concept.
The purpose of medical insurance work is to serve the majority of insured patients and insured personnel. It should not be an empty slogan. In specific work, we need a team of medical staff who are dedicated, dedicated, honest, efficient and willing to serve the insured patients. Therefore, according to the requirements of the municipal medical insurance, comrades in the whole hospital actively participate in every training and study of the municipal medical insurance, and strive to achieve three goals in terms of ideology, work style and work method through learning and combining with the actual medical insurance work. The purpose of medical insurance work is to ensure that the majority of insured patients get timely treatment, and the medical expenses incurred are reimbursed in time according to the policy, so that the majority of insured personnel can be satisfied through the hard work of medical staff; Change work style and establish service concept. The purpose of medical insurance is to serve the majority of insured patients. Therefore, we believe that it is very common to focus on serving the insured patients and how to provide quality services for the insured patients throughout our work. We adhere to the principles of fairness, justice and openness in our work, be objective and fair, be patient and meticulous, and often work overtime. Sometimes for work, we will work overtime until two or three in the morning. Changing the way of work and establishing the sense of responsibility, medical insurance reform is a brand-new work, and there is no successful experience to learn from directly, which is directly related to the vital interests of the majority of insured patients. Therefore, while studying policy theory seriously, we should learn business knowledge, master relevant policies of medical insurance and improve our business level in the spirit of being responsible for the insured's career and the principle of saving lives and benefiting insured patients.
Three, improve the system, strengthen management, and constantly improve the management level of medical insurance.
The medical insurance work in our hospital is still in the preparatory stage, and the leaders of our hospital attach great importance to it, actively coordinate the telecom companies to open the network, and strive for the construction funds of the network system from the higher authorities to ensure that the medical insurance related equipment is ready as soon as possible. At the same time, our hospital has made great efforts in perfecting the system, strengthening management and optimizing services:
First, publicize the charging items, charging standards and drug prices, and accept the supervision of the group;
The second is to improve the system, standardize the medical insurance service behavior from all aspects of medical work such as admission registration, hospitalization and discharge compensation, and strictly implement the accountability system;
Third, the hospital will continue to carry out the activities of "three Excellence and one satisfaction" (that is, beautiful environment, excellent service and good order to satisfy the people);
Fourth, the awareness of medical insurance service has been strengthened, the work style of medical staff has been changed, and the level of medical insurance management has been effectively improved.
Fourth, strengthen learning and pay attention to connotation construction.
In order to make hospital staff have a deeper understanding and comprehensive grasp of medical insurance policies and systems, our hospital has carried out various learning activities:
First, hold a staff meeting and a middle-level cadre meeting of the whole hospital to explain the new policy of medical insurance, and use the meeting form to deepen everyone's understanding of medical insurance work;
The second is to further improve the learning and training system, and organize employees to learn relevant theories, labor security policies and regulations and medical insurance business knowledge regularly every Friday, which has enhanced the ideological consciousness, business level and various abilities of hospital employees.
2. Medical security work report
In order to further improve the management of basic medical insurance in our hospital, according to the spirit of the document Notice on 20xx Annual Service Quality Assessment of Designated Medical Institutions and Designated Retail Pharmacies with Basic Medical Insurance in zhongmou county, the leaders of our hospital attached great importance to it, set up a leading group for self-inspection of basic medical insurance in our hospital, and actively carried out the self-inspection of basic medical insurance. The summary is as follows: 1. The management system of basic medical insurance is improving day by day.
Our hospital has set up a leading group for basic medical insurance management headed by the dean in charge, defined the division of responsibilities of its members, appointed full-time medical insurance supervisors at each central site, promptly found all kinds of medical insurance violations, strictly controlled the medical insurance assessment indicators formulated by the social security department, formulated the Interim Measures for the Management of Basic Medical Insurance in Sanguanmiao Town Central Hospital, standardized the management of basic medical insurance, and implemented the reward and punishment system. Medical insurance work is linked to the annual assessment of medical ethics and performance pay of medical staff.
Two, strengthen the study and publicity of basic medical insurance related policies.
Regularly strengthen medical staff's study of basic medical insurance policies, so that they can skillfully publicize the policies and regulations of basic medical insurance to patients and skillfully implement the provisions of basic medical insurance; Set up a medical insurance policy bulletin board in the outpatient hall, and place a medical insurance brochure in places where there are many patients, so that patients can know the policies and regulations of basic medical insurance in time.
Three, strictly implement the basic medical insurance designated medical institutions medical service agreement.
Our hospital strictly implements the contents of the medical service agreement of the designated medical institutions of basic medical insurance, hangs the plaque of "designated medical institutions of basic medical insurance" at the entrance of the hospital according to the regulations, sets up the medical insurance flow chart in the outpatient hall to facilitate the insured to see a doctor, and sets up the basic medical item charges and the medical charges clearly marked on the drug price bulletin board in the outpatient hall; Clinical medical personnel should check the identity of the insured according to the regulations to prevent fraudulent insurance; Accelerate the construction of computer charging system in central site and outpatient medical insurance leader inquiry system to realize computerization and networking of medical insurance management and medical charges; Strictly require medical personnel to use drugs rationally, and it is strictly forbidden to "prescribe drugs by car" for others; According to the provisions of the implementation of admission standards and transfer, referral standards.
Fourth, improve the complaint supervision mechanism.
Establish a complaint supervision mechanism, set up a basic medical insurance complaint mailbox, handle all kinds of basic medical insurance complaints in a timely manner, severely deal with all kinds of violations of basic medical insurance, and implement reward and punishment measures.
Fifth, there is a problem.
1. Some medical staff don't understand the policies related to outpatient medical insurance thoroughly. In the future, individual medical staff will strengthen their study of medical insurance policies.
2. Some clinicians' outpatient medical insurance prescriptions are not standardized, mainly because of the bad habit of omitting basic items of prescriptions and modifying prescriptions. The management of medical insurance prescriptions will be strengthened in the future.
Suggestions on medical insurance by intransitive verbs.
It is suggested that the medical insurance reimbursement procedure is simpler and more convenient.
3. Medical security work report
In the past 20xx years, all the staff of our hospital have closely focused on the purpose of running the hospital, United and forged ahead, and made concerted efforts with Qi Xin to continuously improve the medical level, optimize the medical environment and improve the service attitude. The social and economic benefits of the hospital have been steadily improved, and gratifying achievements have been made in all work. Under the leadership of the medical insurance leading group, with the active support and cooperation of medical insurance staff at all levels and all medical staff, the medical insurance work in our hospital has been carried out smoothly. Over the past year, * * * has received xx outpatient visits from medical insurance patients; Xx hospitalizations. The medical staff of the whole hospital warmly received the medical insurance patients, and won the recognition and praise of the patients with superb medical skills, excellent service and reasonable fees. There was no medical insurance dispute, no complaint, no medical errors and accidents in the hospital throughout the year, which was well received by patients. First, strictly implement management regulations and take the initiative to accept social supervision:
According to the adjustment of medical insurance policy, this year our hospital further improved and revised the medical insurance management system to adapt to the new policy. At the same time, in order to minimize the mistakes in the work, the Medical Insurance Department, together with the Accounting Department, the Finance Department, the Quality Control Department and the Medical Department, implements the "five-hall joint review" of medical insurance data, and forms a verification notice with the verification of reimbursement materials, so that medical personnel can dynamically grasp the relevant situation and make timely rectification to ensure the quality of medical insurance work. Under the leadership of the medical insurance leading group and the medical insurance department, all medical staff abide by rules and regulations, standardize operations, strictly implement various medical insurance management regulations, and have no illegal operations. Prescriptions and medical records are true, accurate, timely and complete, and adhere to reasonable treatment, reasonable examination, rational drug use and treatment due to illness; When using or implementing drugs and medical treatment items outside the catalogue, they can fulfill the obligation of informing, obtain the consent of patients and their families, and sign an informed consent form to file with the medical records; No arbitrary charges and escalation charges; There is no phenomenon of breaking down service times and charging; The admission criteria can be strictly mastered, and the coincidence rate of admission diagnosis is over 98%. There are no phenomena such as hanging bed hospitalization, unreasonably shortening or prolonging hospitalization days, hanging bed hospitalization, and impersonating hospitalization. Standardize the referral procedures outside the city, handle the referral and transfer procedures for patients who meet the conditions of referral and transfer in time, and transfer 5 people outside the city this year. The referral rate outside the city, drug costs and out-of-catalogue drugs at their own expense are all controlled within the scope stipulated by the policy.
In order to better accept the supervision of the society, our hospital has set up "complaint boxes" in outpatient and inpatient departments, published the report telephone number, collected the opinions and suggestions of patients in time, and continuously improved the medical insurance management in our hospital.
Two, strengthen the study of policies and regulations, do a good job in medical insurance knowledge propaganda:
In order to make the medical staff familiar with and understand the medical insurance policies and regulations, and serve the insured patients more comprehensively, the hospital used the time of holding the staff meeting and morning meeting of the whole hospital to carry out medical insurance knowledge learning for many times and timely convey the new medical insurance policies and regulations. On October 8th, 65438/KLOC-0, the Medical Insurance Department organized a medical insurance policy training for all hospital staff, so that all medical staff could understand and be familiar with the policy and better serve the insured patients. In order to improve the service awareness of medical staff, the hospital has also organized many knowledge tests on medical insurance policies and standardized services, prescription management, and application of antibacterial drugs, and the test results have reached the standard. At the same time, the hospital updated the contents of the medical insurance knowledge bulletin board in time, and publicized the medical treatment process and the main inspection, treatment and drug charging standards to employees and patients to facilitate patients to seek medical treatment; Medical insurance managers often visit wards to answer the questions of insured patients, so that the majority of insured patients have a better understanding of medical insurance and a clearer direction when seeing a doctor.
Third, strengthen the publicity of medical insurance and expand the influence of hospitals among the insured population;
In order to let the insured know that our hospital is a designated medical insurance service unit, realize the advantages of our hospital in technology, talents, service and price, and let the insured patients with eye diseases enjoy more professional medical services, the hospital takes the opportunity of physical examination, conference and free clinic to distribute popular science propaganda materials, expand the hospital's foreign exchange and cooperation and influence, improve the hospital's recognition among the medical insurance insured people, and let more insured people accept our professional, efficient and high-quality eye specialist services.
Over the past year, under the correct leadership of the Municipal Labor and Social Security Bureau and the Medical Security Bureau, and with the efforts of the staff of the whole hospital, through the above activities, our hospital's medical insurance work has made certain achievements and its social influence has gradually increased. More and more insured patients come to the hospital for treatment, which has been recognized by the medical insurance management department. However, medical insurance management is a difficult, meticulous and policy-oriented work. While making achievements, some work needs further improvement.
It is planned to carry out medical insurance from the following aspects:
First, strengthen contact with the medical insurance bureau, strictly implement various medical policies and regulations, operate according to the service agreement of designated medical institutions, strengthen the study, training and assessment of medical staff's medical insurance policies and regulations, inform the new medical insurance policies in time, improve service quality, improve medical environment and service attitude, and actively cooperate with the work of the medical insurance bureau.
The second is to further enrich and improve the hospital medical insurance management system and job responsibilities, and set up a medical insurance publicity column according to the needs and new medical insurance regulations, so that the insured can keep abreast of the new medical insurance information.
Third, standardize the operation process, appropriately supplement some commonly used drugs or inspection equipment according to clinical needs, and meet the needs of patients for medical treatment as much as possible.
Fourth, increase publicity, further expand the external influence of the hospital, strive to sign a service agreement with the county (city) medical insurance bureau, take advantage of the hospital's talents, services, prices, technology and other advantages to provide professional ophthalmic medical services for more insured people, and organize regular internal service quality inspections in accordance with relevant regulations to find problems and make timely and effective rectification.
Five, call on all staff to pay attention to medical insurance work, actively support medical insurance work, and strive for "A" level designated medical institutions.
4. Medical security work report
In 20xx, under the great attention of the leaders of our hospital, according to the work plan arranged by the Medical Insurance Bureau, and the general idea of "grasping the spirit, thoroughly understanding the policy, vigorously publicizing, steadily advancing, and paying close attention to implementation", we earnestly carried out various tasks. Through the joint efforts of medical staff in our hospital, our medical insurance work has achieved certain results. At present, the work of our medical insurance department is summarized as follows: First, leaders attach importance to it and vigorously publicize it.
In order to standardize the diagnosis and treatment behavior, control the unreasonable increase of medical expenses, and ensure the healthy and sustainable development of medical management with low-cost and high-quality services, the leading group of our hospital attaches great importance to it, unifies its thinking, clarifies its objectives, and strengthens its organization and leadership. A leading group for medical insurance work was set up, which was specifically taken care of by the business dean. Each clinical department has set up a working group with the director as the team leader and the head nurse as the deputy team leader, which is responsible for the overall management of undergraduate medical insurance, focusing on the specific implementation of the undergraduate medical insurance system and the implementation of the reward and punishment system.
In order to make the broad masses of cadres and workers have a deeper understanding and comprehensive grasp of the new medical insurance policy and system, we have extensively carried out publicity, education and learning activities:
First, the staff meeting of the whole hospital and the meeting of middle-level cadres were held to explain the new medical insurance policy, and the meeting form was used to deepen everyone's understanding of medical insurance work.
The second is to hold medical insurance knowledge training classes, blackboard newspapers, and distribute publicity materials to improve employees' operational ability in daily medical insurance work.
The third is to strengthen hospital information management, which can be more standardized and convenient through medical insurance software management. The occurrence of errors is greatly reduced. The fourth is to publicize the medical insurance policy through TV special episodes, so that the majority of medical insurance personnel, urban residents, students and other friends can truly understand the benefits of participating in insurance, understand the operation mode of hospitals, and actively participate in medical insurance activities.
Second, effective measures and strict rules and regulations.
In order to make medical insurance patients "clearly see a doctor and clearly consume", our hospital:
First, the flow chart of medical insurance benefits is announced outside the hospital, so that the insured patients can see at a glance. And arrange full-time medical guidance in the lobby, responsible for providing medical insurance policy advice to relevant patients.
Second, it is equipped with computer touch screen and electronic display screen to announce the charging items, charging standards and drug prices to the public and accept the supervision of the group.
The third is to fully implement the "one-day list system" for hospitalization expenses, requiring patients or their families to sign the list, and implementing the system of public disclosure of medical insurance accounts and consciously accepting supervision. Let inpatients clearly understand the consumption. When the leaders came to the hospital for examination, they fully affirmed it.
Fourth, in order to further strengthen the responsibility and standardize the medical service behavior, we should standardize the medical insurance service behavior from three aspects: admission registration, hospitalization and discharge compensation, strictly investigate the responsibility and deal with the responsible person seriously.
Fifth, the hospital staff implement the service and credit card system, which is civilized and polite, excellent in service and excellent in technology, and is well received by patients.
In order to pay close attention to the medical insurance work, the hospital combined with the actual work:
First, our hospital has formulated rules and regulations for the management of medical insurance services, and regularly evaluates the work plan of medical insurance services (service attitude, medical quality, cost control, etc.). ), and regularly evaluate and formulate improvement measures.
Second, strengthen ward management, often patrol wards, publicize bedside policies, solicit opinions from patients, solve problems in time, check whether there is bed hanging, check whether there is an impostor, and check whether hospitalized patients have two certificates and one card. The medical insurance department will not approve patients who do not meet the hospitalization conditions. Strengthen the supervision and management of department fees and medical personnel's diagnosis and treatment behavior, supervise and inspect, deal with it seriously in time, and report the exposure.
Third, improve service attitude and medical quality.
The new medical insurance system has brought unprecedented opportunities and challenges to the development of our hospital. It is precisely because of the correct understanding of the medical insurance work that all the cadres and workers in the hospital are actively involved in this work, working hard, performing their duties and responsibilities.
Our department regularly goes to the ward to attend the morning meeting, conveys the new policy in time, and feeds back the medical quality problems found in the audit process of the medical insurance bureau. Content, understand the clinical medical staff's thoughts on the medical insurance system, communicate and coordinate in time, require all medical staff to master the medical insurance policies and business, standardize the diagnosis and treatment process, check reasonably, use drugs rationally, put an end to irregular behaviors such as random inspection, big prescription and human feelings, and hand over unqualified medical records to responsible doctors for revision in time. By paying close attention to medical quality management and standardized operation, the unreasonable charging behavior of medical care has been purified, the awareness of medical staff management and medical insurance has been improved, the medical quality has been improved, and a good medical environment has been provided for the insured.
In the process of handling medical insurance procedures for employees, our window staff actively publicized to every insured employee/resident, explained the relevant regulations, policies and subsidies of medical insurance, carefully answered all kinds of questions raised, took pains to explain policies and tried their best to provide services. Try not to let an insured patient or family member leave with dissatisfaction and doubts. Always put "providing quality and efficient services for insured patients" in the first place. In the process of medical insurance operation, the majority of insured and participating patients are most concerned about the compensation of medical expenses. Based on the service tenet of "convenience, efficiency, honesty and standardization", the staff of our department strictly controlled the customs and operated in a friendly way, and implemented one-stop service. The medical subsidy expenses were cashed on the spot, which greatly improved the satisfaction of participating in the insurance.
Four. work summary
Through the concerted efforts of Qi Xin, the staff of our department and the relevant staff of our hospital, we worked hard and sincerely served the patients, and successfully completed all the tasks determined at the beginning of the year. In 20xx, 2,486 medical insurance patients were admitted to our hospital, with medical expenses totaling 20.66 million yuan, reimbursement of 1 1.6 million yuan, 590,000 yuan at its own expense, 5 people above 1 10,000 yuan, and chronic disease outpatients 126 people, with an amount of 78,000 yuan.
In the process of carrying out medical insurance in our hospital, with the strong support of the leaders and staff of the medical insurance bureau, under the correct leadership of the leaders of our hospital and with the strong cooperation of the medical staff of the whole hospital, the medical insurance work has been carried out smoothly. In the future work, we should strictly control the policy, start with the details, conscientiously sum up experience, constantly improve various systems, carefully handle the relationship between internal operation mechanism and external window service, standardize business procedures, simplify procedures, strive to provide more and better services for medical insurance personnel, and strive to push the medical insurance work in our hospital to a new height and make contributions to the smooth development of medical insurance work in the county. Although some achievements have been made in the work of 20xx, there are still some shortcomings, but we are convinced that in the new year, with the strong support of the Medical Insurance Bureau and the correct leadership of hospital leaders, the medical insurance work will be better completed and the medical insurance personnel in the county will be benefited.
5. Medical security work report
I am mainly responsible for medical insurance in the hospital. It's been a year now, and the time is very short. I have nothing to say. I will report my work income this year to you. Since 1 .20xx65438+1October1,there have been 1272 outpatient transactions in our hospital, including 5 hospitalizations, 49 settlements and 2 hospitalizations. Inpatients involved in Daxing, Dongcheng, Xuanwu, Chaoyang and Chongwen counties, and 46 cases have been successfully settled. 3 Unsettled transaction: the fee is 242,765,438+0.34 yuan. There is no refusal to pay the settlement fee, the data of outpatient hospitalization of medical insurance patients is uploaded accurately, and there is no feedback information of garbage data.
2.5438+1Since it started to work in June, the hospital medical insurance system has been running normally. In April, due to system reasons, the medical insurance stand-alone machine could not work normally. Please contact Shouxin Company in time to repair the system, carefully find the cause of the problem, and install anti-virus software in time. In xx years, the medical insurance system in our hospital was updated and installed 13 times in time, and the medical insurance system in our hospital was upgraded in time at the first time of each latest update. During this period, the his system of the hospital was reformed in May, and the interface of medical insurance outpatient hospitalization was successfully completed, and then the direct his input of medical insurance patients was imported into the medical insurance work computer.
3. Cooperate with the medical insurance center to do a good job of uploading and distributing, and solve the problems in the work in time. In xx, I participated in the conference training organized by the municipal two-level medical insurance center for 6 times. On September 23rd, at the training meeting on implementing credit cards, I got back two card readers, three SIM card machines and a medical insurance card trial card. Credit cards will be introduced in suburban counties early next year.
In xx, Qu Ying Social Security Center was inspected twice. On September/October/4th, xx, 2004, Director Yan and his party supervised and inspected the medical insurance work in our hospital from the aspects of medical record quality, price, charge management and the use of medical insurance system, which affirmed the work of the hospital and pointed out the shortcomings in the work. After the inspection, make serious rectification according to the problems raised by the supervision team and submit the rectification report to the district medical insurance center. On June 10, xx, 15 District Social Security Center inspected the medical insurance situation in our hospital, and spoke highly of the hospital's participation in employee social insurance.
4. Medical insurance is a tedious job, from the drug list to the diagnosis and treatment list to the list of service facilities, every item needs to be carefully checked. Thanks to all my colleagues for their help, it was your who helped to make the medical insurance work go smoothly. In xx years, the hospital staff were trained in medical insurance knowledge from the aspects of medical insurance policy, patients admitted to our hospital, medical insurance reimbursement requirements and medical insurance precautions.