医疗保险管理制度.pdf

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1、out city created, and care masses life, focus work, in-depth investigation, more out boutique masterpiece, makes we of research results more to into led of decision vi sion, more to in national some has effect of newspaper Shang publishe d, for advance work, and publicity changde play due of role. T

2、hird, information submitted to be pragmatic. Quick and timely. The anci ents said: for the time system; statement back for the time being, nothing. Therefore, the submission of information to do “four“, that is, find the probl em faster, editorial writing, send and read faster approval and feedback

3、to implement quickly. To be true and accurate. True mainly reflect the full picture of events, one i s one, two, this is the life of the information. Accuracy is primarily qualitative and quantitative questions, quantitative objective of publicQualitative logic. To be relia ble and useful. We submit

4、 information to have access to decision-making, to guide and pr omote the work and solve practical problems. Mixed cum. On the negative information and emergency information, rapid escalation in strict accorda nce with the procedures, firm, newspaper, newspapers, never late, fail to report, false cl

5、aim and skimming. Investee 2. supervision and insist on, around and protecting their interests to touch the truth, seek practical results. Adhere to peopl e-oriented, the most important thing is to realize, safeguard and develop the fundamental interests of the overwhelming majority of the people. W

6、e carry out inspection, so m ust go deep among the masses, go dee p into the realities, always pay attention to the peoples livelihood, to grasp the public sentiment, and earnestly safeguard the benefit, addressing the masses are most concer ned about and reflecting the strongest issues, efforts to

7、solve the probl em of decisions implemented and not implemented. One is to stick to principles. Right of inspection is one of the most important pow ers of the Office, should not only dare to use, but also with caution. So-called dared to use, is t o hold a number of important issues, bold supervisi

8、on over supervision, track inspection, problems are not solved do not pass, the blame does not hold did not miss, dissatisfaction of the masses di d not miss, the real right of supervision authority, with the benefits. Call with caution, is supervising departments shoul d strengthen the consciousnes

9、s of authorized strictly according to pr ocedure, preventing the supervision and excessive to prevent addi ng burden to grass-roots. To this end, the supervision Department of the Party Committee of supervision must be under city and County party Committee Secretary-General (Office). Second, we shou

10、ld focus on. Is the Governor, those related to the globalEvent, Governor the protracte d difficult, strong Governor during emergency urgent. Not having special departments in charge of the General Governor, under the normal procedure can do good things not Governor, not aut horized by County leaders

11、, not t he Governor. Third is to solve the problem. The purpose of supervision, to resolve the problem. o a dhere to and further improve the eelings survey, by looking up public sentiments to find probl ems. Problems will increase its special supervision, set up accounts, hold on to it. We should co

12、nscientiously implement the leading contracting matters, secured, had an answer to everything, the n settles rate of 100%. Have an impact on some of the outstandi ng issues, supervision departments and information components together, play the supervisory role of the news media to promote problem so

13、lving. Investee 3. insist on a daily run, around the practice of truth catching efficiency, focus specification. To give full play to the party Office around connecting, coordinati ng internal and exter nal features, contact, rally at all levels, to motivate every aspect, adhere to the truth, streng

14、thening standardized management to achi eve coherent, efficient and effective functioning of the daily work of the Party Committee. Is proce ssing messages should strive to streamline, standardize and qualit y. Streamlining is to control the number of messages, compress messages, reducing procedures

15、, improve message handling efficiency. Specifications, is to strictly enforce the ban issued by the Communist party authorities in document handling regulations and provincial and m uni cipal regulations, conscientiously strengthen and improve communications management to ensure that party documents

16、 orderly. High quality, is to improve the quality of message processing, it is necessary t o accurately implementing the intention of the Party Committee, clearance, good communications, poli cy program close d, ensuring that there is no error. Second meeting schedul ed to ensure thorough, safe and

17、efficient. Any arrangements for the meetings and events, carefully arranged, item-by-item interface implemented, sure. To vigorously streamline meetings, activities, num ber of pressure reduction, scale to ensure that leadership emerged from the General Conference a nd entertainment services, focus

18、on big things, matters. Third, re cepti on services should lay stress on humane, personal, cultural and human. Reception and w ork directly with people, reception services directly affecting the Office of party Committee The image of the region. At the same time strengthening the constructi on of li

19、 brary, improve the reception conditions, more human-oriented, personal, cultural work into the recepti on, a little more huma n needs, a little more human care more humane atmosphere, and constantly improve the service, improve the quality of service. Meanwhile, to further pay special attention to

20、the daily work of the other Office System. Confidential work responsibility system for leading ca dres to implement se curity as a leader, to improve the confidentiality of classified personnel, especially leading cadres, strengthening party and Government focus on vital sectors of security manageme

21、nt, to advance privacy management standardization, modernization of security techniques as a means of administration according to law and se curity enforcement, ensure the safety of the party and State secrets. Confidential work to meet the demands of new technology development 医疗保险管理制度、措施 目录 1、医疗保险

22、管理制度 2、医保工作制度及管理措施 3、医保工作定期总结分析制度 4、医保工作信息反馈制度 一、医疗保险管理制度 (一)机构管理 1建立医院医保管理小组,由组长负责(组长由副院长担任), 不定期召开会议,研究医保工作。 2、设立医院医保办公室(以下简称“医保科”) ,并配备 2 名专 职管理人员,具体负责本院医疗保险工作。 3贯彻落实市社保局有关医保的政策、规定。 4监督检查本院医保制度、管理措施的执行情况。 5及时查处违反医保制度、措施的人和事,并有相关记录。 6、加强医疗保险的宣传、解释,设置“医疗保险宣传栏”,正确 及时处理参保病人的投诉(已设置投诉箱),保证医疗保险各项工作 的正常开

23、展。 (二)医疗管理制度 1严格执行首诊负责制,不推诿病人,接诊时严格核对医疗 证 、卡与参保人员本人相符,发现就诊者身份与所持医疗证、IC 卡不符时,应扣留医疗保险证,及时报告医院医保科,医院医保科及 时上报市医保中心。 2、诊疗时严格遵循“因病施治,合理检查,合理治疗,合理用 药,合理收费”的原则。 3药品使用需严格掌握适应症。 4收住病人时必须严格掌握入院标准,杜绝冒名住院、分解住 out city created, and care masses life, focus work, in-depth investigation, more out boutique masterpiec

24、e, makes we of research results more to into led of decision vi sion, more to in national some has effect of newspaper Shang publishe d, for advance work, and publicity changde play due of role. Third, information submitted to be pragmatic. Quick and timely. The anci ents said: for the time system;

25、statement back for the time being, nothing. Therefore, the submission of information to do “four“, that is, find the probl em faster, editorial writing, send and read faster approval and feedback to implement quickly. To be true and accurate. True mainly reflect the full picture of events, one i s o

26、ne, two, this is the life of the information. Accuracy is primarily qualitative and quantitative questions, quantitative objective of publicQualitative logic. To be relia ble and useful. We submit information to have access to decision-making, to guide and pr omote the work and solve practical probl

27、ems. Mixed cum. On the negative information and emergency information, rapid escalation in strict accorda nce with the procedures, firm, newspaper, newspapers, never late, fail to report, false claim and skimming. Investee 2. supervision and insist on, around and protecting their interests to touch

28、the truth, seek practical results. Adhere to peopl e-oriented, the most important thing is to realize, safeguard and develop the fundamental interests of the overwhelming majority of the people. We carry out inspection, so must go deep among the masses, go dee p into the realities, always pay attent

29、ion to the peoples livelihood, to grasp the public sentiment, and earnestly safeguard the benefit, addressing the masses are most concer ned about and reflecting the strongest issues, efforts to solve the probl em of decisions implemented and not implemented. One is to stick to principles. Right of

30、inspection is one of the most important pow ers of the Office, shoul d not only dare to use, but also with caution. So-called dared to use, is t o hold a number of important issues, bold supervision over supervision, track inspection, problems are not solved do not pass, the blame does not hold did

31、not miss, dissatisfaction of the masses di d not miss, the real right of supervision authority, with the benefits. Call with caution, is supervising departments shoul d strengthen the consciousness of authorized strictly according to pr ocedure, preventing the supervision and excessive to prevent ad

32、ding burden to grass-root s. To this end, the supervision Department of the Party Committee of supervision must be under city and County party Committee Secretary-General (Office). Second, we should focus on. Is the Governor, those related to the globalEvent, Governor the protracted difficult, stron

33、g Governor during emergency urgent. Not having special departments in charge of the General Governor, under the normal procedure can do good things not Governor, not authorized by County leaders, not t he Governor. Third is to solve the problem. The purpose of supervision, to resolve the problem. o

34、adhere to and further improve the2 eelings survey, by looking up public sentiments to find probl ems. Problems will increase its special supervision, set up accounts, hold on to it. We should conscientiously implement the leading contracting matters, secured, had an answer to everything, the n settl

35、es rate of 100%. Have an impact on some of the outstandi ng issues, supervision departments and information components together, play the supervisory role of the news media to promote problem solving. Investee 3. insist on a daily run, around the practice of truth catching efficiency, focus specific

36、ation. To give full play to the party Office around connecting, coordinati ng internal and external features, contact, rally at all levels, to motivate every aspect, adhere to the truth, strengthe ning standardized management to achi eve coherent, efficient and effective functioning of the daily wor

37、k of the Party Committee. Is proce ssing messages should strive to streamline, standardize and qualit y. Streamlining is to control the number of messages, compress messages, reducing procedures, improve message handling efficiency. Specifications, is to strictly enforce the ban issued by the Commun

38、ist party authorities in document handling regulations and provincial and m uni cipal regulations, conscientiously strengthen and impr ove communications management to e nsure that party documents orderly. High quality, is to improve the quality of message processing, it is necessary t o accurately

39、implementing the intention of the Party Committee, clearance, good communications, poli cy program close d, ensuring that there is no error. Second meeting schedul ed to ensure thorough, safe and efficient. Any arrangements for the meetings and events, carefully arranged, item-by-item interface impl

40、emented, sure. To vigorously streamline meetings, activities, num ber of pressure reduction, scale to ensure that leadership emerged from the General Conference a nd entertainment services, focus on big things, matters. Third, re ception services should lay stress on humane, personal, cultural and h

41、uman. Reception and w ork directly with people, reception services directly affecting the Office of party Committee The image of the region. At the same time strengthening the constructi on of library, improve the reception conditions, more human-oriented, personal, cultural work into the recepti on

42、, a little more huma n needs, a little more human care more humane atmosphere, and constantly improve the service, improve the quality of service. Meanwhile, to further pay special attention to the daily work of the other Office System. Confidential work responsibility system for leading ca dres to

43、implement se curity as a leader, to improve the confidentiality of classified personnel, especially leading cadres, strengthening party and Government focus on vital sectors of security management, to advance privacy management standardization, modernization of security techniques as a means of admi

44、nistration according to law and se curity enforcement, ensure the safety of the party and State secrets. Confidential work to meet the demands of new technology development2 院、挂名住院和其它不正当的医疗行为;住院用药必须符合医保有关 规定,使用自费药品必须填写自费药品患者同意书,检查必须符合病 情需要。 5出院带药严格按规定执行。 (三)药房管理制度 1严格执行国家发改委制定公布的药品零售价格,按医院药品 采购供应制度采

45、购药品。 2、公布本院所使用的药品价格及一次性医用材料价格,接受监 督。 3确保医疗保险药品备药率达标,不得串换药品。 (四)财务管理制度 1认真查对参保人员的医保病历、IC 卡,把好挂号、收费关, 按市医保中心医保费用管理的要求,准确无误地输入电脑。 2配备专人负责与市医保中心医保费用结算和衔接工作,并按 医保规定提供相关资料。 3新增医疗项目及时以书面形式向市医保中心上报。 4严格执行医保中心的结报制度,控制各项相关指标,正确执 行医疗收费标准。 5对收费操作上发现的问题,做到及时处理,并有相关处理记 录。 6参保人员出院结帐后,要求查询收费情况,医保窗口和财务 室做到耐心接待,认真解释,

46、不推诿。 (五)信息管理制度 1当医保刷卡出现错误时,窗口工作人员及时通知医保科,由 窗口工作人员利用读卡程序来检查卡的质量,如卡有问题,告知持卡 人到市医保中心查询。 2当医保结算出现问题时,窗口工作人员及时通知医保科,由 out city created, and care masses life, focus work, in-depth investigation, more out boutique masterpiece, makes we of research results more to into led of decision vi sion, more to in na

47、tional some has effect of newspaper Shang publishe d, for advance work, and publicity changde play due of role. Third, information submitted to be pragmatic. Quick and timely. The anci ents said: for the time system; statement back for the time being, nothing. Therefore, the submission of informatio

48、n to do “four“, that is, find the probl em faster, editorial writing, send and read faster approval and feedback to implement quickly. To be true and accurate. True mainly reflect the full picture of events, one i s one, two, this is the life of the information. Accuracy is primarily qualitative and

49、 quantitative questions, quantitative objective of publicQualitative logic. To be relia ble and useful. We submit information to have access to decision-making, to guide and pr omote the work and solve practical problems. Mixed cum. On the negative information and emergency information, rapid escalation in strict accorda nce with the procedures, firm, newspaper, newspapers, never late, fail to report, false claim and skimming. Investee 2. supervision and insist on, around and protecti ng their interests to touch the truth, seek practical results. Adhere to peopl e-orien

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