扶风医保六大硬核举措筑牢内控防线 推动医保经办工作高质量发展

Core Insights - The article emphasizes the focus of the Fufeng County Medical Insurance Administration Center on enhancing internal control management in the medical insurance sector, aiming for "risk prevention, efficiency improvement, and service optimization" [1] Group 1: Institutional Foundation - The establishment of a "full-process standard" internal control framework has been prioritized, detailing processes for insurance registration, fund settlement, medical assistance, audit management, and financial payments, thereby clarifying responsibilities and risk control measures [3] Group 2: Technological Empowerment - A "real-time warning" regulatory model has been developed through an intelligent monitoring platform that dynamically tracks key processes in medical insurance operations, significantly improving risk management efficiency and accuracy [4] Group 3: Process Optimization - An "efficient operation" internal control mechanism has been implemented, focusing on reducing steps, compressing timelines, and enhancing service quality, with a notable reduction in processing time for high-frequency services to 3 days [4] Group 4: Workforce Strengthening - Regular internal control training sessions have been conducted to enhance compliance awareness and responsibility among staff, creating a professional team well-versed in policies and procedures [4] Group 5: Cross-Internal Audit - A dual-track internal audit mechanism has been established to ensure the completeness and timeliness of business operations, with a recent special audit identifying and rectifying 13 issues promptly [5] Group 6: Policy Promotion - Proactive outreach to enterprises and industrial parks has been conducted to educate on medical insurance policies, helping to standardize processes and reduce operational risks, resulting in 21 companies enrolling 286 employees [5]