医院病案、结算清单质控

为提高结算清单质控通过率，将部分质控规则前置，在医疗机构结算清单上传时即予以相应质控违规提示，医疗机构应及时修改并重新上传。医疗机构按照医保信息业务编码贯标应用要求和结算清单填写规范，及时、准确、完整填写、上传结算清单并纳入相关考核管理。1、结算清单采集：采集上传医疗机构结算清单、病案首页等信息2、结算清单质控：明确规则内容和对应违规提示语，归属规范性、合理性、完整性三类，其中关联DRG入组规则，提示影响分组结果

To improve the pass rate of quality control (QC) for medical settlement lists, some QC rules are pre-applied during the upload process. Corresponding QC violation prompts will be issued immediately when medical institutions upload their settlement lists, and the medical institutions shall modify and re-upload the lists in a timely manner. Medical institutions shall fill out and upload the medical settlement lists in a timely, accurate and complete manner in accordance with the standard-compliant application requirements for medical insurance information business coding and the filling specifications of medical settlement lists, and incorporate such work into relevant assessment and management systems.
1. Medical Settlement List Collection: Collect and upload information such as medical settlement lists and medical record front pages of medical institutions.
2. Medical Settlement List Quality Control: Clarify the rule contents and corresponding violation prompt texts, which are classified into three categories: standard compliance, rationality and completeness. Some of these rules are associated with DRG grouping rules, and the corresponding prompts will notify that such violations may affect the grouping results.