【医保动态】守护医保基金安全，石狮市医院以科技赋能精准控费

Core Viewpoint - The implementation of an intelligent monitoring and auditing system at Shishi City Hospital aims to enhance the safety and efficiency of medical insurance fund management, ensuring that every investment meets the real needs of patients [1]. Group 1: Patient Care Process Monitoring - The system provides real-time alerts during the prescription process to prevent inappropriate medication and misuse of medical supplies, triggering over 210,000 alerts to correct potential violations before they occur [2]. - Daily data screening during patient hospitalization identifies issues such as excessive testing and duplicate charges, allowing for timely corrections by medical staff [2]. - Post-discharge, the system enables comprehensive audits of medical insurance data to identify any overlooked discrepancies by doctors [2]. Group 2: Continuous System Optimization - The system has adapted to 21 key areas of medical insurance regulation, addressing various violations such as duplicate charges and unauthorized use of non-insured materials, generating over 280,000 alerts [3]. - Ongoing updates to the system are designed to meet real-world needs and align with new policy regulations, enhancing hospital oversight and minimizing unnecessary patient expenses [3]. Group 3: Multi-Dimensional Analysis for Service Standardization - The system analyzes violations across departments and physicians, providing detailed insights into the frequency and financial impact of each violation, which aids in targeted training and corrective measures [4]. - Key metrics such as total medical insurance costs and settlement figures are dynamically tracked to ensure expenses remain within reasonable limits [4]. - The hospital is committed to continuously optimizing the intelligent monitoring system to enhance regulatory precision and efficiency in oversight [4].