Mianzhu City social security center multiple measures to maintain the safety of industrial injury funds


Sichuan Economic network Deyang news (Yuan Yuhong reporter Zhong Zhengyou) industrial injury insurance fund is the cornerstone of the life of the industrial injury insurance system, in order to maintain the stability of the industrial injury insurance fund, recently, Mianzhu City social security center to pressure itself, to receive industrial injury insurance treatment and other special verification,Comprehensive measures have been taken to solve the problems such as high hospitalization frequency, long hospitalization time and unreasonable reimbursement of medical expenses, which have achieved good social effects.Attach great importance to improve the mechanism.The center regularly held special work meetings, related staff to the work of the new problems, new situation launched a positive discussion, clear work direction.At the same time, it also transferred the backbone of each unit and set up a special working group headed by the leader in charge, which was responsible for special rectification of new problems and new situations found in the inspection and the implementation of measures.Special sorting and filing.Members of the working group firstly compared the medical expense reimbursement documents, hospitalization lists and medical records with the Price of Medical Service Items in Deyang City (2021 edition) (No. 58 of Deyang Medical Insurance) in detail.Then the drug items reported and the list of drugs are in line with the “industrial injury insurance regulations” provisions of the scope of reimbursement for special review, but also on the application for industrial injury insurance treatment of industrial injury personnel whether to achieve industrial injury identification conditions for verification.After a series of checks, the working group will find doubtful data into a special ledger for follow-up work.Invite the team, conduct a review.The working group invited professionals from Mianzhu People’s Hospital four times, and formed a four-member expert group to conduct a special review of the doubtful and large amount of data found in the review.The expert group reviews the inspection items first and examines whether the inspection site belongs to the scope of work-related injury.They then reviewed the types of treatment, duration, range of diseases, and repeated use and abuse of adjuvant therapy.Follow-up to the rational use of drugs and hospital charges are reasonable for a special inspection.Finally, according to the above audit data, the expert group made an examination table of work-related injury medical records and submitted it to the working group for processing.Hold talks and fulfill rights and responsibilities.The working group held talks with the designated hospitals in Mianzhu city.In the meeting, the working group first required each hospital to provide the relevant procedures of accounting, hospitalization, transfer, transfer and expense settlement for the injured personnel.The working group required each hospital to provide the medical diagnosis documents of the inpatients with work-related injury related to the doubtful data and the list of various expenses during hospitalization according to the examination table of work-related injury Medical Records and doubtful data provided by the expert team. The above-mentioned data were used as supporting materials for comparison and verification by the working group one by one.At the same time, the working group also requires hospitals to report to the center if they have doubts about their data when applying for hospitalization again, and to apply for hospitalization after examination.Interview personnel, strengthen control.The working group first of all to each work-related injury designated hospital responsible person for an interview, request its should earnestly implement the work-related injury insurance operation process, strengthen to the work-related injury insurance personnel readmission supervision strength, but also should strengthen internal management, standardize the operating mode of the unit internal personnel.Next, the working group also had an interview with the head of the unit that declared doubtful data, and the scope that the unit that asks inductrial injury to submit an expense account should submit an expense account in accordance with the provisions of laws and regulations should submit an expense account according to the facts, and ask its self-check self-correction and make rectification report to hand in the center.After interview, submit an expense account unit principal expresses will submit an expense account in strict accordance with laws and regulations henceforth inductrial injury insurance.Through the above measures, the center does not meet the scope of industrial injury insurance reimbursement of sichuan Mianzhu Jinquan Iron and Steel Co., LTD., Sichuan Ronghong Science and Technology Development Co., LTD., and other four units of medical expenses deduction of more than 1.32 million yuan, to maintain the safety of industrial injury insurance fund.Declaration: The copyright of this article belongs to the original author, if there is a source error or infringement of your legitimate rights and interests, you can contact us through the mailbox, we will promptly deal with.Email address: jpbl@jp.jiupainews.com

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