针对医疗机构的几大热点问题的医保基金审计思路探析
发布时间：2019-03-04 15:03
【摘要】：随着社会保障制度的不断发展和完善,我国在医疗保险基金政策实施范围已经实行了城乡全覆盖,涵盖了针对城镇职工的"城镇职工基本医疗保险基金";针对城镇居民的"城镇居民基本医疗保险基金";针对农村百姓的"新型农村合作医疗基金";以及针对各种急病大病的"城乡大病医保基金,城乡医疗救助基金和疾病应急救助基金"等六种、四大类。医保基金面广量大、涉及责任主体部门多,不仅在管理上是一个难题,在审计方面也存在诸多难点。当前我国正着力建立以电子数据分析为依托,"总体分析、发现疑点、分散核查、系统研究"的新型审计方式开展审计,这种方式在针对医疗机构的医保基金审计中尤为有效,基本能解决过去我们通过传统的手工查错纠弊审计难以发现的不规范行为,促使医疗机构收费更加合理、医保基金使用更加透明、内部管理更加科学规范。本文系对当前医疗机构的医保基金几大热点问题的进行了审计思路探析。
[Abstract]:With the continuous development and improvement of the social security system, the implementation scope of the medical insurance fund policy in our country has already implemented the urban and rural full coverage, covering the "urban workers basic medical insurance fund" for urban workers; "Urban residents basic Medical Insurance Fund" for urban residents, "New Rural Cooperative Medical Fund" for rural residents, and "New Rural Cooperative Medical Fund" for rural residents; There are six categories, four categories, such as the urban and rural medical insurance fund, the urban and rural medical aid fund and the disease emergency relief fund, which are aimed at all kinds of acute and serious diseases. Medical insurance fund is a difficult problem not only in management, but also in audit. At present, China is working hard to establish a new audit mode based on electronic data analysis, "overall analysis, discovery of doubts, decentralized verification, systematic research," which is particularly effective in the audit of health insurance funds for medical institutions. It can basically solve the irregularity behavior that we can't find through the traditional manual checking and correcting malpractice audit in the past, and make the charge of medical institution more reasonable, the use of medical insurance fund more transparent, and the internal management more scientific and standardized. This paper analyzes several hot issues of medical insurance fund audit.
【作者单位】： 江苏省海门市审计局;
【分类号】：F842.684;R197.1;F239.4
[Abstract]:With the continuous development and improvement of the social security system, the implementation scope of the medical insurance fund policy in our country has already implemented the urban and rural full coverage, covering the "urban workers basic medical insurance fund" for urban workers; "Urban residents basic Medical Insurance Fund" for urban residents, "New Rural Cooperative Medical Fund" for rural residents, and "New Rural Cooperative Medical Fund" for rural residents; There are six categories, four categories, such as the urban and rural medical insurance fund, the urban and rural medical aid fund and the disease emergency relief fund, which are aimed at all kinds of acute and serious diseases. Medical insurance fund is a difficult problem not only in management, but also in audit. At present, China is working hard to establish a new audit mode based on electronic data analysis, "overall analysis, discovery of doubts, decentralized verification, systematic research," which is particularly effective in the audit of health insurance funds for medical institutions. It can basically solve the irregularity behavior that we can't find through the traditional manual checking and correcting malpractice audit in the past, and make the charge of medical institution more reasonable, the use of medical insurance fund more transparent, and the internal management more scientific and standardized. This paper analyzes several hot issues of medical insurance fund audit.
【作者单位】： 江苏省海门市审计局;
【分类号】：F842.684;R197.1;F239.4
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