2022年20xx年医院医保科年终工作总结 .pdf

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1、20XX年医院医保科年终工作总结本年度的医保工作在市社保局(医保管理中心)的监督指导下，在院领导领导班子的关心支持下，通过医院医保管理小组成员和全院职工的共同努力，各项医保工作和各种医保规章制度都日趋完善成熟，并已全面步入正规化系统化的管理轨道。根据安阳市城镇基本医疗保险定点医疗机构分级管理暂行办法 的规定和一年来的不懈努力院组织医保管理小组对20XX 年度的医院基本医保工作进行了全面的自查，20XX年 12 月至今年 11 月，全院门诊刷卡人次2093 人次，住院40 人次，对存在的问题进行逐一分析并汇报如下：一、医疗保险基础管理1、本院成立了由“一把手”负总责，业务院长具体抓，各临床科室主

2、任组成的基本医疗保险管理组织责医院医保工作的全面管理、制度具体实施及奖惩制度的落实工作。2、各项基本医疗保险制度健全，相关医保管理资料具全，并按规范管理存档。3、医保管理小组定期组织人员分析医保享受人员各种医疗费用使用情况，如发现问题及时给予解决的医保管理情况抽查中如有违规行为及时纠正并立即改正。4、医保管理小组人员积极配合市医保中心对医疗服务价格和药品费用的监督、审核、及时提供需要查阅的医疗档案和有关资料。二、医疗保险业务管理医疗保险业务管理：1、严格执行基本医疗保险用药管理规定，严格执行医保用药审批制度。2、基本达到按基本医疗保险目录所要求的药品备药率。3、抽查门诊处方、出院病历、检查配药

3、情况都按规定执行。4、严格执行基本医疗保险诊疗项目管理规定。5、严格执行基本医疗保险服务设施管理规定。三、医疗保险费用控制：文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8

4、T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:

5、CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 H

6、W3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 Z

7、B8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编

8、码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1

9、 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H51、严格执行医疗收费标准和医疗保险限额规定。2、本年度门诊人均费用略高于医保病人药品比例控制的范畴。3、参保人员个人自费费用占医疗总费用的比

10、例控制在20%以内。4、每月医保费用报表按时送审、费用结算及时。四、医疗保险服务管理：1、本院设有就医流程图，设施完整，方便参保人员就医。2、药品、诊疗项目和医疗服务设施收费实行明码标价，并提供费用明细清单。3、对就诊人员进行身份验证，杜绝冒名就诊和冒名住院等现象。4、对就诊人员要求需用目录外药品、诊疗项目事先都证求参保人员同意。5、对就诊人员要求处方外配药的，医生开出外配处方，加盖外配章后由病人自主选择购药。6、严格掌握医保病人的入、出院标准，医保办抽查10 例门诊就诊人员，10 例均符文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4

11、Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O

12、4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G

13、8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9

14、T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O

15、4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W

16、7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6

17、B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5合填写门诊就诊记录的要求7、经药品监督部门检查无药品质量问题。五、医疗保险信息管理：1、本院信息管理系统能满足医保工作的需要，今年医院在人、财、物等方面给予了较大的投入。2、日常维护系统较完善，新政策出台或调整政策及时修改，能及时报告并积极排除医保信息系统故障统的正常运行。3、对医保窗口工作人员加强医保政策学习，并强化操作技能。4、本院信息系统医保数据安全完整。5、与

18、医保中心联网的前置机定时实施查毒杀毒。六、医疗保险政策宣传：1、本院定期积极组织医务人员学习医保政策，及时传达和贯彻有关医保规定，并随时抽查医务人员对医保管理各项政策的掌握、理解程度。2、采取各种形式宣传教育，如设置宣传栏、责任医生下乡宣传、发放宣传资料等。文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY

19、6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3

20、I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8

21、T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:

22、CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 H

23、W3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 Z

24、B8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5由于医

25、保管理是一项难度大、工作要求细致、政策性强的工作，这就要求我们医保管理人员和全体医务人员在提高自身业务素质的同时，加强责任心，并与医保中心保持联系，经常沟通，使我院的医疗工作做得更好七、下一步工作要点1、加强就医等各项服务的管理优质化，建立积极、科学、合理、简便、易行的工作程序，方便于民2、做好与医保局的协调工作。3、加强对医院医务人员的医保政策宣传，定期对医务人员进行医保工作反馈文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4

26、Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8

27、H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T

28、4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4

29、O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7

30、G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B

31、9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5文档编码:CY6B9T4Y6M1 HW3I7O4O4Z10 ZB8T4W7G8H5