{
  "format": "audit-dossier-v1",
  "generated_at": "2026-06-03T07:55:31Z",
  "question": "把以上依据整理成审核要点清单。 的适用条件和例外情况是什么？",
  "answer": "问题：把以上依据整理成审核要点清单。 的适用条件和例外情况是什么？\n当前回答由检索依据直接组成，未生成无引用结论。\n目录依据：\n- …。 （3）事前提醒接入机构数量。事前提醒接入二级以上定点医疗机构数超过50%，并逐年提高。 （4）事前提醒遵从率。合理应用事前提醒规则，事前提醒在定点医药机构端遵从率保持在合理水平；不断提升提… [C2]\n- …承受能力，选择费率确定方式。 （一）固定费率法，依据历史数据测算并预测，事先确定费率，原则上在一个清算周期内保持固定不变。 （二）浮动费率法，年初按照上一年度费率等因素确定初始费率，依据当年实… [C3]\n风险案例依据：\n- …⼊电脑，经相关软件编辑，并按设定间期记录20⼩时以上⾎压，打印报告。（项⽬精髓：动态⾎压监测仪 +报告） 现在临床上很多医师下医嘱“监测⾎压6h”（实际⼈⼯测量或者⼼电监护仪测量），不能收这个… [C1]",
  "confidence": "high",
  "confidence_label": "高",
  "fallback_used": true,
  "fallback_label": "检索直出",
  "review_gate": "可进入人工复核",
  "review_notice": "该导出为审计线索和人工复核底稿，不替代正式审计结论。",
  "review_checklist": [
    "核对引用片段是否完整覆盖问题。",
    "打开原文确认条款上下文。",
    "检查目录、规则、法规版本是否适用。",
    "确认是否还需 HIS 原始凭证补证。"
  ],
  "source_collections": [],
  "citation_count": 3,
  "basis_group_count": 2,
  "basis_groups": [
    {
      "evidence_type": "catalog_basis",
      "title": "目录依据",
      "items": [
        {
          "citation_id": "C2",
          "chunk_id": "6d2d3ab5-3c7a-567f-bef8-b20b02fca032",
          "snippet": "…。 （3）事前提醒接入机构数量。事前提醒接入二级以上定点医疗机构数超过50%，并逐年提高。 （4）事前提醒遵从率。合理应用事前提醒规则，事前提醒在定点医药机构端遵从率保持在合理水平；不断提升提…",
          "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/6d2d3ab5-3c7a-567f-bef8-b20b02fca032",
          "locator": {
            "type": "paragraph",
            "line_end": 50,
            "line_start": 1,
            "title_path": [],
            "page_number": null,
            "source_path": "医保目录/国家医疗保障局办公室关于开展智能监管改革试点的通知.txt",
            "window_count": 2,
            "window_index": 0,
            "article_number": null,
            "parent_article_number": null
          },
          "index_version_key": "full-rebuild-20260531142344",
          "source_package_version_key": "source-package-real-data-kimi-20260531"
        },
        {
          "citation_id": "C3",
          "chunk_id": "cc67398d-eb40-5350-aebb-e49dd893caf0",
          "snippet": "…承受能力，选择费率确定方式。 （一）固定费率法，依据历史数据测算并预测，事先确定费率，原则上在一个清算周期内保持固定不变。 （二）浮动费率法，年初按照上一年度费率等因素确定初始费率，依据当年实…",
          "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/cc67398d-eb40-5350-aebb-e49dd893caf0",
          "locator": {
            "type": "paragraph",
            "line_end": 58,
            "line_start": 5,
            "title_path": [],
            "page_number": null,
            "source_path": "医保目录/国家医疗保障局关于印发《医疗保障按病种付费管理暂行办法》的通知c.txt",
            "window_count": 3,
            "window_index": 1,
            "article_number": null,
            "parent_article_number": null
          },
          "index_version_key": "full-rebuild-20260531142344",
          "source_package_version_key": "source-package-real-data-kimi-20260531"
        }
      ]
    },
    {
      "evidence_type": "risk_case_basis",
      "title": "风险案例依据",
      "items": [
        {
          "citation_id": "C1",
          "chunk_id": "81416ced-74de-519f-b8eb-0f9d5b215635",
          "snippet": "…⼊电脑，经相关软件编辑，并按设定间期记录20⼩时以上⾎压，打印报告。（项⽬精髓：动态⾎压监测仪 +报告） 现在临床上很多医师下医嘱“监测⾎压6h”（实际⼈⼯测量或者⼼电监护仪测量），不能收这个…",
          "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/81416ced-74de-519f-b8eb-0f9d5b215635",
          "locator": {
            "type": "paragraph",
            "line_end": null,
            "line_start": null,
            "title_path": [],
            "page_number": 12,
            "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
            "window_count": 3,
            "window_index": 2,
            "article_number": null,
            "parent_article_number": null
          },
          "index_version_key": "full-rebuild-20260531142344",
          "source_package_version_key": "source-package-real-data-kimi-20260531"
        }
      ]
    }
  ],
  "citations": [
    {
      "citation_id": "C1",
      "marker": "[C1]",
      "evidence_type": "risk_case_basis",
      "source_collection": "risk-negative-list",
      "chunk_id": "81416ced-74de-519f-b8eb-0f9d5b215635",
      "snippet": "…⼊电脑，经相关软件编辑，并按设定间期记录20⼩时以上⾎压，打印报告。（项⽬精髓：动态⾎压监测仪 +报告） 现在临床上很多医师下医嘱“监测⾎压6h”（实际⼈⼯测量或者⼼电监护仪测量），不能收这个…",
      "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/81416ced-74de-519f-b8eb-0f9d5b215635",
      "locator": {
        "type": "paragraph",
        "line_end": null,
        "line_start": null,
        "title_path": [],
        "page_number": 12,
        "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
        "window_count": 3,
        "window_index": 2,
        "article_number": null,
        "parent_article_number": null
      },
      "index_version_key": "full-rebuild-20260531142344",
      "source_package_version_key": "source-package-real-data-kimi-20260531",
      "score": 0.8359352461959074,
      "metadata": {
        "locator": {
          "type": "paragraph",
          "line_end": null,
          "line_start": null,
          "title_path": [],
          "page_number": 12,
          "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
          "window_count": 3,
          "window_index": 2,
          "article_number": null,
          "parent_article_number": null
        },
        "line_end": null,
        "line_start": null,
        "row_number": null,
        "sheet_name": null,
        "title_path": [],
        "is_windowed": true,
        "page_number": 12,
        "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
        "article_number": null,
        "index_version_key": "full-rebuild-20260531142344",
        "source_collection": "risk-negative-list",
        "source_package_version_key": "source-package-real-data-kimi-20260531"
      }
    },
    {
      "citation_id": "C2",
      "marker": "[C2]",
      "evidence_type": "catalog_basis",
      "source_collection": "medical-insurance-catalog",
      "chunk_id": "6d2d3ab5-3c7a-567f-bef8-b20b02fca032",
      "snippet": "…。 （3）事前提醒接入机构数量。事前提醒接入二级以上定点医疗机构数超过50%，并逐年提高。 （4）事前提醒遵从率。合理应用事前提醒规则，事前提醒在定点医药机构端遵从率保持在合理水平；不断提升提…",
      "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/6d2d3ab5-3c7a-567f-bef8-b20b02fca032",
      "locator": {
        "type": "paragraph",
        "line_end": 50,
        "line_start": 1,
        "title_path": [],
        "page_number": null,
        "source_path": "医保目录/国家医疗保障局办公室关于开展智能监管改革试点的通知.txt",
        "window_count": 2,
        "window_index": 0,
        "article_number": null,
        "parent_article_number": null
      },
      "index_version_key": "full-rebuild-20260531142344",
      "source_package_version_key": "source-package-real-data-kimi-20260531",
      "score": 0.8025802938405405,
      "metadata": {
        "locator": {
          "type": "paragraph",
          "line_end": 50,
          "line_start": 1,
          "title_path": [],
          "page_number": null,
          "source_path": "医保目录/国家医疗保障局办公室关于开展智能监管改革试点的通知.txt",
          "window_count": 2,
          "window_index": 0,
          "article_number": null,
          "parent_article_number": null
        },
        "line_end": 50,
        "line_start": 1,
        "row_number": null,
        "sheet_name": null,
        "title_path": [],
        "is_windowed": true,
        "page_number": null,
        "source_path": "医保目录/国家医疗保障局办公室关于开展智能监管改革试点的通知.txt",
        "article_number": null,
        "index_version_key": "full-rebuild-20260531142344",
        "source_collection": "medical-insurance-catalog",
        "source_package_version_key": "source-package-real-data-kimi-20260531"
      }
    },
    {
      "citation_id": "C3",
      "marker": "[C3]",
      "evidence_type": "catalog_basis",
      "source_collection": "medical-insurance-catalog",
      "chunk_id": "cc67398d-eb40-5350-aebb-e49dd893caf0",
      "snippet": "…承受能力，选择费率确定方式。 （一）固定费率法，依据历史数据测算并预测，事先确定费率，原则上在一个清算周期内保持固定不变。 （二）浮动费率法，年初按照上一年度费率等因素确定初始费率，依据当年实…",
      "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/cc67398d-eb40-5350-aebb-e49dd893caf0",
      "locator": {
        "type": "paragraph",
        "line_end": 58,
        "line_start": 5,
        "title_path": [],
        "page_number": null,
        "source_path": "医保目录/国家医疗保障局关于印发《医疗保障按病种付费管理暂行办法》的通知c.txt",
        "window_count": 3,
        "window_index": 1,
        "article_number": null,
        "parent_article_number": null
      },
      "index_version_key": "full-rebuild-20260531142344",
      "source_package_version_key": "source-package-real-data-kimi-20260531",
      "score": 0.7682115102994193,
      "metadata": {
        "locator": {
          "type": "paragraph",
          "line_end": 58,
          "line_start": 5,
          "title_path": [],
          "page_number": null,
          "source_path": "医保目录/国家医疗保障局关于印发《医疗保障按病种付费管理暂行办法》的通知c.txt",
          "window_count": 3,
          "window_index": 1,
          "article_number": null,
          "parent_article_number": null
        },
        "line_end": 58,
        "line_start": 5,
        "row_number": null,
        "sheet_name": null,
        "title_path": [],
        "is_windowed": true,
        "page_number": null,
        "source_path": "医保目录/国家医疗保障局关于印发《医疗保障按病种付费管理暂行办法》的通知c.txt",
        "article_number": null,
        "index_version_key": "full-rebuild-20260531142344",
        "source_collection": "medical-insurance-catalog",
        "source_package_version_key": "source-package-real-data-kimi-20260531"
      }
    }
  ]
}
