医保基金智能监管规则和知识点

Search documents
国家医保局发布第一批医保基金智能监管规则和知识点 推动医保基金监管关口前移
Ren Min Ri Bao· 2025-05-25 21:57
Core Insights - The National Healthcare Security Administration (NHSA) has publicly released the first batch of intelligent supervision rules and knowledge points for medical insurance funds, aiming to enhance the regulation of medical insurance funds through a proactive reminder system [1][2]. Group 1: Intelligent Supervision Implementation - The intelligent supervision system is designed to identify and alert medical personnel of any violations during the prescription process, addressing issues before they escalate [1]. - The NHSA allows all designated medical institutions to access and utilize the intelligent supervision system for free, enhancing the efficiency and accuracy of preemptive reminders [1]. Group 2: Knowledge Base and Rules - The first batch of intelligent supervision rules includes over 10,000 detailed knowledge points across five categories, such as gender-specific drug usage and pediatric-specific medical services [1]. - The NHSA will continuously track, evaluate, and improve the knowledge base to ensure its scientific validity and accuracy [1]. Group 3: Dynamic Updates and Integration - Provincial healthcare departments are required to dynamically update their intelligent supervision systems based on the latest knowledge points and codes [2]. - Designated medical institutions are encouraged to integrate the intelligent supervision knowledge base into their own information systems to eliminate non-compliant behaviors at an early stage [2].