It is more convenient to record!New features of outpatient slow special disease across provinces

Today, with the increasingly frequent population flow, the continuous promotion of cross -provincial medical direct settlement has become an important reform measure to improve the medical insurance system and solve the outstanding concerns of the people. Among them, accelerating the outpatient cost of cross -provincial direct settlement is the focus of work in recent years.

According to the latest news from the National Medical Insurance Bureau: The release of public service information of direct settlement of medical security across provinces (49th). As of June 2022, about half of the country's coordinated regions (a total of 208) launched hypertension and diabetes Five outpatient treatment expenses such as malignant tumor outpatient chemotherapy, uremia dialysis, and organ transplantation of anti -exclusion therapy are directly settled in the province.

At the same time, in order to facilitate the insured person to directly settle the five outpatient treatment costs across provinces, the national medical insurance service platform APP adds new inter -provincial clinic slow special disease notifications and other query functions. Participants can download the National Medical Insurance Service Platform APP, click the "Different Land Recruitment" column, and add the "Door Slow Special Notification Letter" and "Gate Slow Special Special Qualification" query function in the "more inquiry of different places". Participants can understand their own existing outpatient slow special disease qualification qualifications and the place of insured on the existing lesbian disease -related expenses across provincial direct settlement policies and processes.

Five types of clinics slow special disease pilot cross -province direct settlement

Basic medical insurance clinic treatment policy includes general outpatient and outpatient slow special diseases. Among them, the outpatient clinic general disease generally refers to some diseases (mainly chronic diseases, major diseases) or treatment methods suitable for treatment in outpatient treatment (mainly chronic diseases, major diseases). These outpatient clinics are generally adopted by the disease according to the disease. The qualifications for the treatment of slow special disease treatment and the selection of medical institutions for medical institutions are required. Chronic diseases are based on limited payment and major illnesses are managed by reference to inpatient treatment.

The National Medical Insurance Administration's "Notice on Accelerating the Course Capital Cross -Provincial Direct Settlement Work" issued by the National Medical Insurance Bureau has clearly stated that it is clear about hypertension, diabetes, malignant tumor outpatient chemotherapy, uremia dialysis, organ transplantation, and postoperative resistance. Five people in the five people, including the demand for large people, and generally carried out slow special diseases in various places, actively promoted the direct settlement of relevant treatment expenses across provinces, and put forward work goals and work requirements. The relevant specific deployment in the "Notice on the Conduct of Conducting the Pilot Related Treatment of Slow Special Diseases Conduct Cross -Provincial Direct Settlement Pilot Work" jointly released by the National Medical Insurance Bureau and the Ministry of Finance was detailed. The scope of diseases and designated medical institutions, on the other hand, specifically specifically regulates cross -provincial direct settlement policies, unified medical settlement rules, improves the construction of information systems, implements responsibilities for medical supervision, and do a good job of prepaying funds and liquidation. At this point, the inter -provincial direct settlement pilot work of the outpatient clinic is fully launched nationwide.

More than half of the nation's overall planning area has started pilots

According to the latest news from the National Medical Insurance Bureau, as of the end of June 2022, about half of the country's overall regions (a total of 208) launched 5 outpatient -related treatment costs for the direct settlement pilot work. Participants can inquire about the opening of the pilot area of ​​direct settlement in the province through the national medical insurance service platform app or website APP or website.

According to the recently released "Basic Medical Insurance Cross -Provincial Different Regulations", at present, the qualifications of the outpatient slow special disease qualifications still need to be completed in accordance with the regulations of the insured place, and the outpatient clinic is directly settled in the outpatient slow special disease. The place of participation has uploaded the qualification information of the medical insurance information platform for the qualification information of the outpatient medical treatment of the medical treatment person in a different place. "Special Disease Accreditation Qualifications" conducts inquiries.

The State Medical Insurance Bureau pointed out that in order to take into account the differences in the scope of diseases in various places, the treatment cost of slow special diseases for outpatient clinics is directly settled and used by the national unified outpatient disease codes and disease names, and other diseases have nothing to do with the treatment of slow special diseases. Medical expenses are settled separately according to ordinary outpatient costs. During the settlement, the scope of payment and relevant regulations of the medical place, including the scope of payment scope of basic medical insurance drugs, medical service items and medical consumables, and the relevant regulations of the medical security fund starting standards, payment ratio, maximum payment limit, etc. Essence

The 3 major difficulties faced by the outpatient slow special disease across provinces

Due to the large differences in policies in various places, compared with hospitalization and ordinary outpatient clinics, the inter -provincial direct settlement of outpatient clinics is more difficult. In this regard, the relevant person in charge of the National Medical Insurance Bureau had publicly stated that the reason why the outpatient clinic was settled directly to the end, mainly because there were three aspects: First, compared with ordinary outpatient clinics, there is also a high frequency of medical treatment. The characteristics of strong timeliness, in order to achieve instant outpatient and instant settlement, need to be "equal"; second, compared with the cost of hospitalization, there are also the characteristics of relatively high costs and high reimbursement ratios. Third, because of its identification standards, identification processes, and medical management, there is a large locality difference in management, so the status quo that can best reflects national medical insurance benefits.

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