ICS03.080.99 CCSC02DB4401 广州市地方标准 DB4401/T218—2023 按病种分值医保支付工作规范 Specificationformedicalinsurancepaymentof diagnosis-interventionpacket 2023-06-10发布 2023-07-10实施 广州市市场监督管理局发布 DB4401/T218—2023 I目  次 前言.................................................................................III 1范围................................................................................1 2规范性引用文件......................................................................1 3术语和定义..........................................................................1 4基本原则............................................................................3 5总体要求............................................................................3 5.1机构设置........................................................................3 5.2制度管理........................................................................3 5.3信息系统建设与数据管理..........................................................3 6协议管理............................................................................3 7预算管理............................................................................4 7.1区域总额预算指标的确定原则......................................................4 7.2区域总额预算指标的组成..........................................................4 7.3区域总额预算指标的确定..........................................................4 8病种目录库..........................................................................4 8.1病种目录库的病种................................................................4 8.2病种目录库的病种分值.............................................................4 8.3病种目录库异常病种的处理.........................................................5 8.4病例入组........................................................................5 8.5分值计算........................................................................5 8.6特殊项目加成分值.................................................................6 9DIP系数.............................................................................6 9.1定点医疗机构系数.................................................................6 9.2基层病种系数....................................................................6 9.3床日病种系数....................................................................6 10费用结算和审核.....................................................................6 10.1费用结算内容...................................................................6 10.2费用结算的方法..................................................................7 10.3费用审核........................................................................7 10.4病例评审........................................................................7 11监管和考核..........................................................................8 11.1监管要求........................................................................8 11.2监管方式.......................................................................8 11.3考核............................................................................8 12协商机制...........................................................................9 DB4401/T218—2023 II12.1协商方式.......................................................................9 12.2评议...........................................................................9 12.3其他方式.......................................................................9 13DIP信息系统.........................................................................9 13.1系统构成.......................................................................9 13.2功能要求.......................................................................9 附录A（资料性）年度清算指标计算规则..................................................11 附录B（资料性）DIP入组规则...........................................................15 附录C（资料性）病例分值计算方法......................................................18 附录D（资料性）定点医疗机构系数设置规则..............................................20 附录E（资料性）病种系数设置规则......................................................23 附录F（资料性）病例评审抽样数量......................................................24 参考文献.............................................