Medical Insurance Online Auditing System Design And Realization

With the changing times and the upgraded computer technology, people’s mind and thetransaction handling mode of industry is imperceptibly influenced. The center uses the existingcomputer network, database, and management software technology of Medicare. In accordancewith the requirements of function and performance of the medical insurance online audit, thedata structure of which program can normally manipulate information has been implemented.The goal of "reasonable control, standardized management, control growth, promoted service"has been attained, which has replaced the former work modes of random inspecting medicalrecord by manpower, setting the average expenses and non-quantizing assessment, etc.The thesis researches the innovation and the exploration of online auditing system, whichaim to solve the following problems.(1) Costs are accounted by the computer according to the setting rules. The statistic costshave to be audited. If problems are found, the problematic costs will be deducted accordingly.Then the medical records will be random inspected according to related problems again andfurther audited.(2) Take full advantage of OA system and interact with hospitals. Communicate timely inorder to prevent and control the unreasonable costs and behaviors.(3) Evaluating the hospital quantificationally.(4) Set grey and black lists for the insured or medical institutions. A punishmentmechanism to the insured and medical institutions has to be established.(5) Establishing the flexible decision-making database, and replacing the old managementmethod to share the information. The staff can search, analyze and statistic the system at anytime. This database can discover the deeper problems within in the medical insurance, so thatto offer the reliable information for scientific policy-making and further enhancing the level ofexecutive power and services as well.Online auditing system which is introduced in this paper has been applied to the actualwork successfully. It has achieved the expected requirements and obtained good effects. Practicehas proved that this system greatly improves the management level and work efficiency of auditstaff in our center.