Medical network - December 19 people beyond the treatment will say goodbye to "run errands for reimbursement. The ministry of human resources and social security, ministry of finance released by regarding the basic medical insurance settlement is directly across the province long-distance medical hospitalization medical expenses work notice, clear by the end of the basic elements of a nationwide network, start across the province relocated retiree hospitalization medical expenses directly settlement work; In 2017 began to gradually solve provinces relocated retiree hospitalization medical expenses directly settlement, expanded to conform to the stipulations of the referral by the end of long-distance medical hospitalization medical expenses directly and settlement. Combining with the local household registration and residence permit system reform, gradually will be different personnel and long stay resident foreign workers into the different ground treatment in hospital medical expense coverage directly to settle.
Settlement is directly long-distance medical treatment is the basic principle of specification, and step by step, go to a doctor in an orderly way, and unified management. In the future, ginseng protect personnel to pay only in accordance with the provisions, shall be borne by the individual cost of medical treatment of be in hospital, other expenses by orgnaization of agency of medical treatment to the medical establishment that decide a dot to pay after checking according to the agreement. Adhere to the first across the province, after the province first hospital outpatient service, first relocated after referral referrals, supplementary insurance after basic health care, in combination with the practical situation of local information system construction, priority unicom long-distance medical concentrated area, steadily promoting direct settlement work; Adhere to the combined with the integration of urban and rural medical insurance system, combined with the classification system of propulsion, establish reasonable referral treatment mechanism, guide the orderly ginseng protect personnel to go to a doctor; Adhere to the basic medical insurance long-distance medical policies, processes, the method of payment is basically stable, unified incorporate long-distance medical treatment to orgnaization of agency of negotiations with the medical establishment that decide a dot consultation, total control, intelligent monitoring, health care doctors, medical service quality supervision and management services.
Long-distance medical treatment directly settle what process? "Notice" clearly, turn out, ginseng protect personnel to long distance across the province before, should be to ginseng protects agency orgnaization register. Ginseng to orgnaization of agency of according to local regulations for ginseng protect personnel should deal with different ground put on record formalities, establish a long-distance medical record personnel and implement dynamic management. Ginseng to orgnaization of agency of the long-distance medical personnel information reported to the human resources and social security orgnaization of social insurance agency, the formation of the national library of long-distance medical record staff, for a doctor to get information. In terms of settlement, ginseng protect personnel to long-distance medical discharge settlement, the orgnaization of agency of medical treatment to the categories of fees according to the national list, the long-distance medical personnel in the hospital medical treatment information via national long-distance medical billing system real-time transmission to orgnaization of agency of ginseng, ginseng to agency orgnaization according to the categories of cost is calculated according to local regulations. "Notice" requirement to strengthen the comprehensive coordination across the province at the same time, the province of undue delay more funding, ministry-level agencies can suspend the province long-distance medical direct settlement services across the province. Provincial agencies responsible for the coordination and supervision as a whole the area promptly turned over long distance across the province for medical treatment and clearing funds in advance.
There are differences in health care around the treatment? Based on the "notice", long distance across the province medical execution in principle to pay limits and the relevant provisions of the basic medical insurance (drug catalogue, diagnosis and treatment projects and medical services standard). As a whole of fund of insurance of primary medical treatment to fu biao, pay scale and highest pay limitation, in principle, implementation of ginseng land policy.
Long-distance direct settlement, cash management has always been a difficulty. "Notice" clear, the inter-provincial long-distance medical fees pay part in the regional medical insurance fund settlement after the first shall be paid in advance. Ministry-level agencies according to the usual inter-provincial long-distance medical insurance funds payment amount of the prepaid amount. Degree of prepaid amount to pay money for two months. Inter-provincial long-distance medical liquidation in accordance with the unified ministry and distribution, level of province, liang liquidation, full liquidation by the month.
Our country will build platform for long-distance medical billing support directly. Ministerial agencies for formulation and implementation of the national long distance and settlement business processes, standards, the long-distance medical data management and application of inter-provincial long-distance medical treatment fund in advance and settlement management, check for cost allocation, intelligent monitoring, operation monitoring, cross-regional business synergy and dispute processing and other functions. At the same time to speed up the social security card issued.
Around the "notice" is put forward, social security card as ginseng protect personnel to inter-provincial long-distance medical identification and direct clearing, the only to have different medical personnel demand first hairpin, establishing the mechanism of card services across the province. According to the national provinces with card technology solutions and unified interface specification, complete with environmental transformation, authentication by credit card support across the province. |
