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On the morning of August 24, Li Jun, a cadre of the Fund Supervision Department of the State Medical Insurance Bureau, put on a dark blue work card printed with the words "flight inspection" and walked quickly into the fourth conference room
of the Second Affiliated Hospital of Kunming Medical University in Yunnan Province.
of the Second Affiliated Hospital of Kunming Medical University in Yunnan Province.
Picking up a medical record from the long table with the "Medical-Orthopedic Group" logo, Li Jun looked around, in the conference room of more than 100 square meters, there were six or seven similar long tables, dozens of staff of the National Medical Insurance Flight Inspection Team were busy in a tense and orderly manner, and the sound of keyboards, footsteps, and discussions came and went
.
.
On the first day of officially entering the designated medical institution under inspection, the task of the flight inspection team was to "check the use of the hospital's medical insurance fund for two and a half years"
.
For Li Jun, who participated in the flight inspection of the National Medical Insurance Fund for the 8th time, the relevant inspection points have been clearly understood - look at the cost list, the first page of the medical treatment case, look at the surgical record, look at the consumables label, find loopholes in the comparison, and find suspicious points
.
.
For Li Jun, who participated in the flight inspection of the National Medical Insurance Fund for the 8th time, the relevant inspection points have been clearly understood - look at the cost list, the first page of the medical treatment case, look at the surgical record, look at the consumables label, find loopholes in the comparison, and find suspicious points
.
"6 nails, 1 fusion device, 2 connecting rods.
.
.
" With the assistance of doctors in the hospital, Li Jun opened the patient's X-ray and carefully checked the quantity and specifications of surgical consumables
.
At the other end of the long table, two orthopedic team members are discussing
a medical record.
"There is a description in the surgical record, why was it not charged in the end?" A team member pointed to the record and said
.
"Also, the diagnosis on the first page of the case includes abnormal coagulation function, but the corresponding treatment is not reflected in the diagnosis and
treatment record.
" Another team member said, "This may affect the number of points of DRG (Medicare Disease Diagnosis Related Group) and thus increase Medicare payments, but the existing materials do not yet support the conclusion that further understanding is needed
.
" ”
.
.
" With the assistance of doctors in the hospital, Li Jun opened the patient's X-ray and carefully checked the quantity and specifications of surgical consumables
.
At the other end of the long table, two orthopedic team members are discussing
a medical record.
"There is a description in the surgical record, why was it not charged in the end?" A team member pointed to the record and said
.
"Also, the diagnosis on the first page of the case includes abnormal coagulation function, but the corresponding treatment is not reflected in the diagnosis and
treatment record.
" Another team member said, "This may affect the number of points of DRG (Medicare Disease Diagnosis Related Group) and thus increase Medicare payments, but the existing materials do not yet support the conclusion that further understanding is needed
.
" ”
While the two were discussing, a member of the collection group picked up a stack of materials and trotted to the long table of the finance group: "We found a problem and need the support of the financial comrades!" ”
A clear division of labor and mutual cooperation is the know-how
for flight inspection teams to work efficiently.
At the meeting of the flight inspection point in the afternoon of the previous day, Song Chengling, deputy leader of the flight inspection team, introduced the work arrangement - the establishment of a comprehensive policy guarantee group, a medical group (under the comprehensive group, orthopedic group, an intracardiac group), a collection group, an information group, a financial group and other groups, and one-on-one to determine the hospital contact person, focusing on different key points to carry out inspections
.
for flight inspection teams to work efficiently.
At the meeting of the flight inspection point in the afternoon of the previous day, Song Chengling, deputy leader of the flight inspection team, introduced the work arrangement - the establishment of a comprehensive policy guarantee group, a medical group (under the comprehensive group, orthopedic group, an intracardiac group), a collection group, an information group, a financial group and other groups, and one-on-one to determine the hospital contact person, focusing on different key points to carry out inspections
.
"Please help extract the data
that charges both the ultrasonic high-frequency surgical integrated system usage fee and the special knife fee for complex surgery.
" The prompt sounded, and the data team member received a request
from the inner group.
After skillfully entering the code in the system, the team member saw that there were more than 100 similar cases, and he extracted the relevant data, made a table and sent it to the heart group to provide reference for further analysis
.
that charges both the ultrasonic high-frequency surgical integrated system usage fee and the special knife fee for complex surgery.
" The prompt sounded, and the data team member received a request
from the inner group.
After skillfully entering the code in the system, the team member saw that there were more than 100 similar cases, and he extracted the relevant data, made a table and sent it to the heart group to provide reference for further analysis
.
"Are you involved in the follow-up surgery?" "How do I determine the consumables actually used during surgery after surgery?" Combined with the doubts found in the inspection, each team invited doctors and nurses from different professional fields into the conference room to conduct targeted inquiries in order to carry out follow-up research and judgment
.
.
As night fell, the members of the flight inspection team entered the canteen
.
After dinner, a focused seminar awaited them
.
.
After dinner, a focused seminar awaited them
.
On the morning of August 24, Li Jun, a cadre of the Fund Supervision Department of the State Medical Insurance Bureau, put on a dark blue work card printed with the words "flight inspection" and walked quickly into the fourth conference room
of the Second Affiliated Hospital of Kunming Medical University in Yunnan Province.
of the Second Affiliated Hospital of Kunming Medical University in Yunnan Province.
Picking up a medical record from the long table with the "Medical-Orthopedic Group" logo, Li Jun looked around, in the conference room of more than 100 square meters, there were six or seven similar long tables, dozens of staff of the National Medical Insurance Flight Inspection Team were busy in a tense and orderly manner, and the sound of keyboards, footsteps, and discussions came and went
.
.
On the first day of officially entering the designated medical institution under inspection, the task of the flight inspection team was to "check the use of the hospital's medical insurance fund for two and a half years"
.
For Li Jun, who participated in the flight inspection of the National Medical Insurance Fund for the 8th time, the relevant inspection points have been clearly understood - look at the cost list, the first page of the medical treatment case, look at the surgical record, look at the consumables label, find loopholes in the comparison, and find suspicious points
.
.
For Li Jun, who participated in the flight inspection of the National Medical Insurance Fund for the 8th time, the relevant inspection points have been clearly understood - look at the cost list, the first page of the medical treatment case, look at the surgical record, look at the consumables label, find loopholes in the comparison, and find suspicious points
.
"6 nails, 1 fusion device, 2 connecting rods.
.
.
" With the assistance of doctors in the hospital, Li Jun opened the patient's X-ray and carefully checked the quantity and specifications of surgical consumables
.
At the other end of the long table, two orthopedic team members are discussing
a medical record.
"There is a description in the surgical record, why was it not charged in the end?" A team member pointed to the record and said
.
"Also, the diagnosis on the first page of the case includes abnormal coagulation function, but the corresponding treatment is not reflected in the diagnosis and
treatment record.
" Another team member said, "This may affect the number of points of DRG (Medicare Disease Diagnosis Related Group) and thus increase Medicare payments, but the existing materials do not yet support the conclusion that further understanding is needed
.
" ”
Diseases and diseases.
.
" With the assistance of doctors in the hospital, Li Jun opened the patient's X-ray and carefully checked the quantity and specifications of surgical consumables
.
At the other end of the long table, two orthopedic team members are discussing
a medical record.
"There is a description in the surgical record, why was it not charged in the end?" A team member pointed to the record and said
.
"Also, the diagnosis on the first page of the case includes abnormal coagulation function, but the corresponding treatment is not reflected in the diagnosis and
treatment record.
" Another team member said, "This may affect the number of points of DRG (Medicare Disease Diagnosis Related Group) and thus increase Medicare payments, but the existing materials do not yet support the conclusion that further understanding is needed
.
" ”
While the two were discussing, a member of the collection group picked up a stack of materials and trotted to the long table of the finance group: "We found a problem and need the support of the financial comrades!" ”
A clear division of labor and mutual cooperation is the know-how
for flight inspection teams to work efficiently.
At the meeting of the flight inspection point in the afternoon of the previous day, Song Chengling, deputy leader of the flight inspection team, introduced the work arrangement - the establishment of a comprehensive policy guarantee group, a medical group (under the comprehensive group, orthopedic group, an intracardiac group), a collection group, an information group, a financial group and other groups, and one-on-one to determine the hospital contact person, focusing on different key points to carry out inspections
.
for flight inspection teams to work efficiently.
At the meeting of the flight inspection point in the afternoon of the previous day, Song Chengling, deputy leader of the flight inspection team, introduced the work arrangement - the establishment of a comprehensive policy guarantee group, a medical group (under the comprehensive group, orthopedic group, an intracardiac group), a collection group, an information group, a financial group and other groups, and one-on-one to determine the hospital contact person, focusing on different key points to carry out inspections
.
"Please help extract the data
that charges both the ultrasonic high-frequency surgical integrated system usage fee and the special knife fee for complex surgery.
" The prompt sounded, and the data team member received a request
from the inner group.
After skillfully entering the code in the system, the team member saw that there were more than 100 similar cases, and he extracted the relevant data, made a table and sent it to the heart group to provide reference for further analysis
.
that charges both the ultrasonic high-frequency surgical integrated system usage fee and the special knife fee for complex surgery.
" The prompt sounded, and the data team member received a request
from the inner group.
After skillfully entering the code in the system, the team member saw that there were more than 100 similar cases, and he extracted the relevant data, made a table and sent it to the heart group to provide reference for further analysis
.
"Are you involved in the follow-up surgery?" "How do I determine the consumables actually used during surgery after surgery?" Combined with the doubts found in the inspection, each team invited doctors and nurses from different professional fields into the conference room to conduct targeted inquiries in order to carry out follow-up research and judgment
.
.
As night fell, the members of the flight inspection team entered the canteen
.
After dinner, a focused seminar awaited them
.
.
After dinner, a focused seminar awaited them
.
