医保基金智能监管平台构建与应用
wf（2022）
Abstract
为确保医保基金合理、规范使用,以医保政策性要求为依据,利用信息化手段,构建了医保基金智能监管平台.通过构建医保审计规则库与知识库,开展医保智能审核,以事前提醒、事中监管、事后稽核方式,实现了全过程实时监管,减少了违规医疗行为发生,提高了医保基金的使用效率.完善规则库分层级管理,建立多模型融合监控体系,提高智能监管系统与临床诊疗系统的集成水平等,应是医保基金智能监管的发展方向.
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Key words
Medical Insurance Fund,Intelligent Supervision,Supervision Platform,Closed-Loop Management,Informatization
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