医院结算系统与医保通用接口设计.docVIP

医院结算系统与医保通用接口设计 　　摘要：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，医保管理机构要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，医院费用结算系统需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结算清单作为业务继续的费用凭证。 　　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：1009-3044（2015）24-0071-03 　　The Design of Hospital Costs Settlement System And Medicare Common Interface 　　ZHANG Shi-yi，HUANG Jian-qi，HU Rui-lin 　　（The Eye Hospital of Wenzhou Medical University，Wenzhou 325000，China） 　　Abstract： The healthcare industry is a very special professional industry which can be easily affected by national policies and the medical process is often affected by fluctuations in national policies. The expense settlement system reflects that a hospital has a rather simple cash flow management process. But once it is closely connected to medical services， the process will become very complex. As the health insurance becomes more and more popular， the health insurance management authority requires that a hospital’s expense settlement system must be consistent with health insurance system and real-time online transaction is available for both. While the health insurance policy and technical solution vary in different areas and there may exists multiple health insurance settlement systems in the same area， a hospital’s expense settlement system needs a channel to connect with multiple health insurance systems. Through the analysis of current patient treatment service， the expense settlement system should not be the core of the hospital management system and all the services related to medical treatment should be separated from the settlement system. The settlement system’s sole purpose is to provide expense settlement service for other systems，and provide settlement list as the payment voucher for follow-up services after the settlement is done. 　　Key words： hospital；