Present view of the professional control of health insurance company in conditions of the public insurance system

Overview

Revision physicians deal with evaluation of substantiation, purposefulness, effectiveness and the level of reimbursement from the resources of health insurance for provided medical services to policyholders by contractual providers within the framework of executed professional control. Revision physicians monitor the extent of fulfilment expected medical goals and the effectiveness of financial resources in the diagnostic therapeutic process. The authors with long-term experience in the activity of revision physicians thereby present their view of evolution of changes in this area of professional activities of revision medicine.

Keywords:

legislation – policyholder – public health insurance – health insurance company – defrayable – contractual relation – payer – provider of medical services and health care – medical documentation – control – revision – reimbursement and accounting of provided services – quality of services – revision report – financial settlement between the provider and payer of the health care