After the patient is discharged from the hospital, the medical insurance staff will conduct settlement and review the hospitalization medical records. Review the accuracy of routine items in case registration, such as name, age, etc.; first, check whether the registration items, doctor's signatures, etc. are complete. Review medical history records for continuity. Review the consistency of disease course, medical orders, and checklists. Review the rationality of medical records, such as the rationality of diagnosis, medication, and charges.

The full name of the Medical Insurance Center is the Medical Insurance Service Center. The Municipal Medical Insurance Service Center is a public welfare deputy bureau-level institution managed by the Municipal Medical Insurance Bureau. It generally has offices in various districts to provide services to the majority of insured persons. Provide convenient, fast and efficient medical insurance services.

Medical insurance review system:

1. After the patient is discharged, the medical insurance staff will conduct settlement and review the hospitalization medical records;

2. Review routine items of medical record registration Accuracy, such as: name, age, gender, time of admission, etc., check the registration items, disease course, documents, doctor's order signatures, nursing records, etc. are all incomplete;

3. Review the continuity of the disease course records. The diagnosis of the disease must be consistent before and after, and the diagnosis must conform to the changing characteristics of the disease outcome, whether there is misuse of drugs and irrational use of drugs, whether there are excessive and repeated examinations, whether there are unreasonable and repeated charges, etc.;

4. Review the course of the disease, Consistency of medical orders and checklists. There should not be any phenomena such as people taking medicines without medical advice, and examinations without records;

5. The rationality of medical records must be reviewed. The rationality of medical records mainly refers to the rationality of diagnosis, medication, and charging.

Legal basis:

"Social Insurance Law of the People's Republic of China"

Article 28

Comply with basic medical care The insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance fund in accordance with national regulations.

Article 29

The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit .

The social insurance administrative department and the health administrative department should establish a medical expense settlement system for medical treatment in other places to facilitate insured persons to enjoy basic medical insurance benefits.