医院结算系统与医保通用接口的设计.pdfVIP

ISSN 1009-3044 E-maü : xsj l@ ComputerKno wledge and TI邵阳ology电脑知识与技术 http://www.命lZS. Vo l.J 1, No.24 , August 20 15 Tel:+86-551 65690964 医院结算系统与医保通用接口的设计 张师毅，黄建琪，胡睿麟 (温州医科大学附属HR视光医院，浙江温州1 32500) 捕要:医疗行业是一个受国家政策影响较大并有很强专业性的特殊行业，经常会因国家政策变动而影响医疗流程。 费用 结算系统体现的医院对现金流的管理其业务流程相对简单，一旦与医疗业务联系过于紧密，其业务流程将变得非常复杂。 在外部随着医保的普及， 医保管理机构妾求医院费用结算系统必须与医保系统进行实时在线交易，而各地医保政策、技术 方案不尽相同并且出现同一地区存在多套医保结算系统， 医院费用结算系统常同时与多个医保系统实现对接。 通过对现 就诊业务的分析，费用结算系统不应是医院管理系统核心组织者，所有与医疗行为相关的业务应该从结算系统中分离出 来。 结算系统唯一的职责是为其他了系统提供费用结算服务， 并为相关的业务系统提供给算清单作为业务继续的费用凭 iiE.。 关键词:医院;费用结算;医保 中图分类号: TP311 文献标识码:A 文章编号: 1 ∞9 3伺4(2015)24 0071 0 3 The Design 0 1 Hωpital Costs Sett1 ement System And Medicare Common Interface ZHANG Shi-yi ,HUANG Jian-qi,HU Rui-lin (The Eye Hospita1 of Wenzhou Medica1 University,Wenzhou 325000,China) Abstract: The healthcare industry is a very special professional industry whichωn be easily affected by national policies and the medical process is often affected by fluctuations in national poü cies. The expense settlement system reflects that a ho spital has a rather simple cash flow management process . But once it is closely connected to medica1 sen..jces, the process w山 become very complex. As the health insu r-ance becomes more and more popular, the health insurance management authOlity reφJires that a hos- pi tal s expense settlement system must be consistent with health insurance system and real-time online transaction is available for both. ~月Ihile the health insurance policy and technical solution v副f in ilifferent 缸eas and there may exists multiple health insur- ance settlement systems in the same 缸ea， a hospital s expense settlement system needs a