Excluding medical expenses insurance designated hospitals accounting treatment

Abstract: Medicare excluded (chargeback is a common problem, the designated hospitals accounting treatment is no uniform method of individual actions, resulting in non-uniform accounting caliber The new hospital accounting system did not elaborate, this paper considers the need for a variety of Excluding the cost of health insurance for unified accounting treatment.

Keywords: hospitals, health insurance costs excluded, accounting treatment

Introduction With the urban basic medical insurance, basic medical insurance for urban residents and the new rural cooperative medical care coverage continues to expand, the number of designated hospitals for Medicare patients increased year by year, but the attendant health care costs are increasing excluded. Various hospitals Excluding costs for Medicare accounting treatment varies, resulting in non-uniform accounting caliber author intends to apply relevant accounting theory, controlled Ministry of Finance, the Ministry of Health to develop a new hospital system requirements, refer to the relevant hospital's accounting treatment of health insurance Excluding the cost of the accounting treatment types and ways of doing a study for reference.

First, the type of health care costs and eliminate the cause of

Because health insurance agencies around the use of health care costs paid in different ways, excluding the cost of health care also varied types can be roughly summarized as the following.

① do not meet the specified medication, examination and treatment. Medicare for certain drugs, treatment programs limited the scope of use, physicians in clinical medicine, medical health insurance policy limits when the failure to perform were excluded.

② medication discrepancies with the disease. Chronic disease clinic, patients of required medical treatment of disease, according to health insurance policy can only use the specified disease medicines, clinics, while the clinician non-prescriptive disease medication (such as hypertension, diabetes and other common ordinary medication, check the project entry requirements diseases expenses.

③ drug overdose on the one hand in the clinical treatment, there is no strict accordance with the insurance policy to control the amount of drugs, on the other hand a few of the medical records of patients insured while dispensing, and clinicians to prescribe medication not authorized to view the last clinic record or previous patient medical records without writing seriously, resulting in excessive medication.

④ price policy fails to charge, for example, charges and reports issued orders or discrepancies. Duplicate charges, beyond the standard charges.

⑤ fraudulent Medicare card dispensing and checking the patient fraudulent Medicare card for treatment, hospital staff did not timely check card or hospital staff person involved in fraudulent Medicare card dispensing, check the insurance sector have been investigated by health insurance funds should be recovered or fine.

⑥ total control over costs. Implement "total prepaid" payment method, the hospital medical expenses exceed the actual total budget targets had been deducted charges.

⑦ all times costs exceed the standard fee. Implementation of "single DRGs" and "fixed settlement", the hospitals were times actual costs exceed settlement standards for non-payment of fees.

⑧ Drug costs exceed the standard proportion in some places designated health care sector to assess the proportion of hospital medicine, hospital medicine when fixed ratio exceeds the specified target, to eliminate or collected fees. Links to free download http://www . hi138.com two, excluding the cost of health insurance accounting treatment
New hospital accounting system, designated hospitals for medical insurance costs were excluded in the "bad debts" and "medical income" and "clearing balance" two detailed accounting subjects, "clearing balance" two detail the accounting subjects hospital settled with health insurance agency , because the hospital charges according to medical services medical receivables recognized in calculating the amount of money and the amount actually paid by health insurance organizations are different, adapted to the needs arising from the difference between the hospital medical income (not including hospital treatment because of irregularities mismanagement by the medical reasons Insurance agencies and those arising from non-payment of hospital treatment because of irregularities cause was mismanagement of health insurance agency irrecoverable receivables protest medical section, shall be recognized as bad debt losses, in the "bad debts" are accounted for.

Excluding costs under Medicare nature and causes of this opinion, the health insurance costs excluded, "Do not conform to testify medication and examination and treatment", "medication discrepancies with the disease", "drug overdose", "price policy fails to charge" and "fraudulent Medicare card dispensing and examination and treatment should be investigated to recover fees and fines" belongs hospital treatment due to irregularities caused by mismanagement reasons, should be recognized as bad debt losses, in the "bad loss" in accounting, hospitals occurred The cause was non-payment of medical insurance agencies and medical payments receivable can not be collected, in accordance with the amount of non-payment, debit bad debt losses, credits receivable medical models - × × health insurance agency. "total control over costs," " costs exceed standard costs were times "," drug costs exceed the standard scale "three violations are not hospital treatment caused by mismanagement reasons, but belongs to the hospital in accordance with the medical services fees receivable recognized in calculating the amount of money and medical insurance The difference between the amounts recognized institutions should "medical income" and "clearing balance" two details are accounted hospitals occur above reasons are excluded medical insurance agencies and medical payments receivable can not be collected, in accordance with the amount removed by mind medical income (outpatient revenue, hospital revenue - settlement difference between the credit receivable medical models - × × health insurance agency.

Third, the proposal

3.1 hospital accounting system stipulates that "clearing balance" two detailed account balance at the end of the month to be apportioned to the other two details of subjects, "clearing balance" is not the end of the balance, is not reflected in the financial statements The author believes that this approach is wrong, not a true reflection of each designated hospitals were excluded costs of medical insurance amount, medical income does not reflect the real situation. peacetime should be retained "clearing balance" account balances and conduct reflected in the financial statements, to the end of the year settlement and other subjects together with transfers.

3.2 hospital accounting system, hospitals adopt the accrual basis of accounting. Hospital to hospital patients in the accounting period for the actual costs incurred as a medical income, and health insurance agencies generally settled with the hospital until next month, so that the formation the accounting period of the medical income clearing balance to the next accounting period before consumption, ie intertemporal consumption settlement, conflict with the accrual, the impact of a true reflection of the current medical income, these two points suggest departments Uniform regulations.


[1] Yang Xiaoyun. Talking about health care costs excluded. Health Economics Research .2010, (9:45-46.

[2] hospital accounting system. Ministry of Finance, Ministry of Health, May 2011.

[3] Wang Jianguo, Wang Lihua, Zhang Yuqin, Tang Xianglin. Talking about the financial management of designated hospitals for medical insurance reform measures [J]. Labour and Social Security World, 2009, (10 Links to free download http://eng.hi138.com

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