This series of operations of national medical insurance. The tall explanation, three or five papers is enough, is actually the central idea, and the charging standard is clear.
This is not the first time that the national medical insurance bureau has made a big statement. As early as 201October, 2020, the National Medical Insurance Bureau issued the Notice on Implementing the 15 Medical Insurance Information Business Coding Standard, clearly requiring the full implementation of the national medical insurance information business coding standard.
At the macro level, the full implementation of medical insurance coding standards is conducive to the formation of a "common language" for national medical insurance information data exchange, the realization of national medical insurance information interconnection and data mutual recognition, the possibility of carrying out medical insurance big data analysis, and the decision-making support for medical insurance financing, treatment guarantee, payment system, drug consumables bidding and procurement, fund supervision and other policy-making.
However, at the micro level, public hospitals and even provincial and municipal medical insurance bureaus are under great pressure to meet the standards. Due to different coding rules, most of the original hospital codes of medical consumables correspond to multiple product specifications of the same consumables, while the granularity of medical insurance codes is finer, and one code only corresponds to one product specification of the same consumables. Therefore, hospitals should complete the splitting of hospital codes before as many as 1 1 10,000 medical insurance codes are all mapped to hospital codes.
In addition to the huge workload, the working mode of manual coding and manual drawing in hospitals will inevitably lead to missing and wrong pairs, and the efficiency and accuracy of drawing will be greatly tested.
Implementation difficulty:
The pressure of medical insurance bureaus in various provinces and cities comes more from the lack of supervision channels. There are many subordinate hospitals, and the progress, completion rate and accuracy of each hospital are different. It is difficult for provincial and municipal medical insurance bureaus to grasp the progress of hospitals in real time, which hinders the supervision and effective promotion of standardization work.