Design And Implementation Of Medical Insurance Audit Feedback System For Hangzhou First People's Hospital

Recently, the population under the medical insurance system is increasing, while a comprehensive reform of the health insurance system is occurring. Medicare audit fully embedded in the hospital HIS system. Hangzhou First People's Hospital, the largest first-class general municipal hospital, avoidlessly have some problems, such as repeatly or frequently seek for medical care, excessive drug use, irrational drug use and so on. So the supervision and management of health insurance do alone with limited human resources was difficult to accomplish. In order to safeguard the vital interests of the insured, guaranteed health insurance fund to use real place, so that the insured can really enjoy the protection of health insurance, in order to eliminate the condition that violate the health care system, such as abuse of drugs, repeated dosage, over investigate, doctors and health care sectors need to collaborate, and the Medicare audit feedback between health insurance office and doctors is an important part to complete the health care reform, and therefore effective health care audit feedback system is extremely valuable, which is to be discussed in this article content.This article focuses on the validity of the Medicare audit feedback system used in Hangzhou First People's Hospital. After the introduction of new medical insurance verification system used by the Hangzhou medical insurance Bureau, the hospital medical insurance office turn the medicare audit feedback from the traditional manual mode to the paperless mode used now. This study based on the traditional Medicare audit feedback process of Hangzhou First People's Hospital, to analyzed the whole feedback processes. We found that, the medicare program correctly perform with the mutual cooperation between the Office and the Medicare physician, first the health insurance office offer supervision, than the doctors give reasonable explanations to the questions the office found.The medicare audit feedback system described in this article, detailed divided into four modules:the login module, select module, edit module, data import and export modules. Each module interconnected and worked alternately, using the same C/S architecture like the hospital's HIS system. The system is develop by.NET framework, running on SQL SERVER database.The practical application of the system, significantly improve the regulatory capacity of the medical insurance office, to the behavior of violation of the health care system, but also give opportunity to the doctors to explan the inadequacies of medical information system, "Let the rule of machine and man coexist", to reduce the burden on doctors in health insurance statistics.