定点医院应重视医保经费往来欠款的清理.docVIP

精品论文 参考文献 定点医院应重视医保经费往来欠款的清理 陈富新 （中国人民解放军第401医院崂山分院 山东青岛 266102） 【摘要】 随着国家医药改革的稳步推进，可以说全民医保时代已经到来。在这种大背景下，对现阶段定点医院收治地方医保患者产生的医疗消耗以地方医保部门作为第三方付费结算为主体的保障模式更是一种冲击和考验。因这种结算支付方式大都属于后付制，而且受医院与地方医保经办机构签订医疗服务协议的制约；加之部分住院患者个人自付部分的结账不及时，导致产生大量往来欠款。这些欠款反映在医院财务账面应收账款科目明显呈现出逐年递增的倾向。如果清理不及时，难免会成为贻账和死账，给医院带来资金风险和损失，应该认真加以研究和探讨对策。 【关键词】 医保经费 往来欠款 清理 【中图分类号】R197.32 【文献标识码】A 【文章编号】2095-1752（2013）28-0160-02 Hospitals should pay more attention to health care expenditure arrears clearance between Chen Fu-xin Laoshanbranch,No 401 hospital of PLA, Qingdao 266102, China. 【Abstract】 Along with the steady advancement of medical reform, can be said to universal health care has come of age.In this context, the current fixed-point hospital medical insurance patients from medical consumption to local health departments as the third party security mode of payment settlement as the main body is a kind of impact and test.Because of the payment and settlement methods are paid after the system, but also restricted by the medical service agreement signed hospitals and local health agencies; and the part of inpatient person since the pay part of the bill is not timely, resulting in a lot of business.These arrears is reflected in the hospital financial account receivable account showing a tendency to increase year by year.If not cleaned in time, will inevitably become a ledger and dead, bring financial risks and losses to the hospital, should earnestly study and countermeasures. 【Key words】Medical insurance funds Exchanges Clear 1 产生医保往来欠款的原因分析 1.1后付制结算支付方式给医院医保回款存有不确定性。现阶段在参保患者消耗费用结算上，不管是按医疗服务项目付费，还是按就诊人头或住院次均费用付费，还是按（单）病种和总额付费，大多是实行的先由医院垫支部分医疗费或者直接联网结算为参保患者报销医疗费，参保患者（含住院和门诊大病）在医院只需负担交纳个人自负部分，其它由地方医保经办机构审核后后付，这种后付制结算方式客观上给医院带来应收医保款回款的不确定性。 1.2应收医保款受医院与地方经办机构签订医疗服务协议的制约。双方签订医疗服务协议的内容基本上涵盖了医院医护质量、病历质量、医药计价收费管理等整个医疗行为，不仅从接诊到治疗，还是从入院联网确认到出院结算整个医疗过程都有严格的医疗规范标准和要求约束，而且城镇职工（居民）医疗保险和新农合医疗保险执行不同的药品、诊疗项目和服务标准目录，简称“三个目录”标准，医