요양급여 청구 자율점검 사례 모음집
- Type
- Book
- Issued Date
- 2024-06
- Publisher
- 건강보험심사평가원
- Table Of Contents
- Part 1. 자율점검제
1. 자율점검 개요 ···································································· 4
2. 자율점검 절차 ···································································· 6
Part 2. 자율점검 사례
1. 기본진료료
• 모자동실 입원료 ···································································12
• 사회복지시설 입소자에 대한 원내 직접조제 ······························ 14
• 촉탁의 원외처방전 교부 당일 진찰료 청구 ································ 15
2. 검사료
• 검사료 중복청구(1) ······························································ 18
• 검사료 중복청구(2) ······························································ 20
• 유방생검-절개생검 ······························································ 21
• 관절천자-치료목적 ······························································ 22
3. 영상진단 및 방사선치료료
• 방사선 영상진단 판독료 ·························································26
• 측두하악관절촬영 ·································································28
4. 주사료
• 정맥내 일시 주사 ··································································30
5. 마취료
• 정맥마취-부위(국소)마취 · ······················································34
• 통증자가조절법(PCA) ····························································35
6. 이학요법료
• 작업치료-단순,복합,특수 ·······················································38
7. 정신요법료
• 기질성 정신질환에 실시한 개인정신치료 ···································42
8. 처치 및 수술료
• 산립종절개술 ······································································ 46
• 외이도이물제거술 ································································ 48
• 인·후두소작술 ····································································· 50
• 하지정맥류수술 ··································································· 52
• 트리암시놀론 주사제를 사용한 병변내주입요법 ························· 54
• 흡입배농 및 배액처치 ··························································· 55
• 1회용 전기수술기용 monopolar 전극 및 patient return pad ····· 57
9. 치과 처치·수술료
• 의치 조직면 개조 ································································· 60
• 치과 틀니 진료단계별 중복 청구 ············································· 62
• 치과임플란트 진료단계별 중복 청구 ········································ 64
• 치과임플란트 제거술[1치당]-복잡 · ········································· 66
10. 한방 시술 및 처치료 등
• 건식부항술-주관법 ······························································ 70
• 구술 ··················································································· 72
• 첩약조제 당일 진찰료 및 검사료 ············································· 74
• 한방 일회용 부항컵 구입·청구 불일치 ······································ 75
11. 약국 약제비
• 약국 차등수가 ······································································78
12. 약제 등 구입·청구 불일치
• 의약분업 예외지역 약국 의약품 구입·청구 불일치 ······················ 82
• 한방 급여약제 구입·청구 불일치 ············································· 83
• 조영제(주사제) 구입·청구 불일치 ············································ 85
• 해열진통소염제(주사제) 구입·청구 불일치 ································ 86
• 황반변성 치료제(주사제) 구입·청구 불일치 ······························· 87
• 골격근이완제(주사제) 구입·청구 불일치 ··································· 89
• 부신피질호르몬제(주사제) 구입·청구 불일치 ····························· 91
• 국소마취제(주사제) 구입·청구 불일치 ······································ 93
• 진해거담제(외용제) 구입·청구 불일치 ······································ 95
• 약국 치매치료제 구입·청구 불일치 ·········································· 96
Part 3. 참고자료
• 요양·의료 급여비용 자율점검제 운영 기준································102
• 요양기관 행정처분 감면기준 및 거짓청구 유형 ·························105
• 자율점검 서식(통보서, 결과서 등) · ·········································107
• 자율점검 관련 법령 ·····························································112
- Publisher
- 건강보험심사평가원
- Location
- KOR
- Citation
- 건강보험심사평가원. (2024-06). 요양급여 청구 자율점검 사례 모음집.
- 파일 목록
-
-
Download
요양급여 청구 자율점검 사례 모음집.pdf
기타 데이터 / 3.58 MB / Adobe PDF
-
Items in Repository are protected by copyright, with all rights reserved, unless otherwise indicated.