Make the insurer's medical treatment at different places -interpret the new rules of new rules for direct settlement of cross -provinces and different places

Xinhua News Agency, Beijing, July 26th.

Xinhua News Agency reporter Peng Yunjia, Mu Tiecheng, Gu Tiancheng

The State Medical Insurance Bureau and the Ministry of Finance issued the "Notice on Further Doing a Basic Medical Insurance Cross -Provincial Different Place Different Settlement Work" on the 26th, and the direct settlement of direct settlement of cross -provinces has a "new guide".

What impact will the new rules on the insured? The relevant person in charge of the National Medical Insurance Bureau and medical insurance experts answered.

Efforts to solve the blocking point of medical treatment at different places, difficult points

As of the end of June 2022, hospitalization and ordinary outpatient costs were fully covered across provinces. 5 kinds of outpatient disease -related treatment costs such as anti -excretion therapy are directly settled across provinces ... In recent years, the direct settlement coverage of cross -provincial medical treatment directly expands.

Data Map: Zou Jun (left), chief physician of the Ophthalmology Department of the Tenth People's Hospital of Shanghai, checked the patient. Xinhua News Agency reporter Chen Jianli

The person in charge of the Medical Security Management Center of the National Medical Insurance Bureau introduced that with the reform of the deep water zone, the localization of localization in the deep water zone has entered the deep water zone, and the differences in registered management, medical management, payment scope, and payment policies have been prominent. Experience.

Focusing on the urgency of medical treatment in different places, the new rules systematically sort out and integrate the previous policies, and strive to cracked the scope of the record personnel narrow and the time limit for the record. The proportion of reimbursement after the filing of the province's temporary medical treatment is low.

The new regulations clearly stated that before the end of 2025, the direct settlement rate of hospitalization expenses across provinces was increased to more than 70%. The number of ordinary outpatient internet -wide network -integrated pharmaceutical institutions was realized. Treatment costs will be gradually incorporated into the scope of cross -provincial direct settlement.

In addition, for key areas such as filing management, payment policies, settlement processes, fund management, and fund supervision, the formulation of a unified nationwide regulatory framework and definition of the national unified nationwide.

Long Xuewen said that the new regulations unified the direct settlement policy of hospitalization, ordinary outpatient and outpatient slow special diseases, and implemented the fund payment policy of the "medical land catalog and the place of participation in insurance". Card "medical treatment service process for medical treatment.

There is a "new guide" for medical settlement in different places

In order to distinguish the types of insured persons to go out for medical treatment, enjoy the treatment of medical insurance, guide the reasonable and orderly medical treatment, and the medical insurance to go out to the medical personnel for record management. Who can apply for medical treatment in a different place? What materials are required for filing? What are the expansion of settlement costs? These can find "answers" in the new regulations.

The new rules further standardize the filing policy for different places, and the scope of the medical record personnel in different places expand to inter -provincial emergency personnel and non -emergency diagnosis and unprepared personnel. Except for the emergency rescue personnel of different places, it is deemed to have recorded and does not need to submit the materials. Other personnel need to provide medical insurance electronic vouchers, valid identity documents or social security cards, filing forms and other proof materials.

This shows that cross -provincial medical settlement settlement has been expanded to every insured person who goes out to seek medical treatment.

Data map: Pharmacy staff of the New Hospital of Fengjie County People's Hospital in Chongqing take medicine for patients. Xinhua News Agency reporter Wang Quanchao Photo

Wang Zhen, director of the Public Economics Research Office of the Chinese Academy of Social Sciences, believes that the new regulations start from the actual needs of the insured person to seek medical treatment abroad, unifying the medical record policy and streamlined processing procedures, etc. This is important for solving the medical treatment point and difficulties of the masses. significance.

In order to allow the masses to "run less legs" as much as possible, the new regulations will unify the validity period of the filing. During the validity period, the insured can meet and enjoy the direct settlement service at the medical place. Essence

It is worth noting that the new rules will be included in the direct settlement scope of cross -provincial medical treatment expenses for emergency rescue expenses, inspection and treatment costs for the treatment of drugs during hospitalization, and incorporating third -party liabilities in accordance with the regulations of medical ground management. At the same time, insured personnel are allowed to apply for medical treatment and enjoy cross -provincial direct settlement services before discharge.

At present, all regions have opened online medical insurance service platform APPs, national medical treatment applets, and small procedures for the State Council client.

To the greatest extent to protect the rights and interests of the insured

Whether it is the types of new filing personnel, the scope of direct settlement of medical treatment in different places, or setting up the validity period of the filing, and opening online filing services, to the greatest extent to protect the rights and interests of the participants' foreign medical treatment, it has become the biggest highlight of the new rules.

"Let the masses work simple, and the settlement of the medical treatment is clear, that is, the original intention." Long Xuewen said that in the early stage of the pilot, the solution of the medical settlement policy of different places was from "none" to "yes". From the continuous expansion, the new policy must solve from "having" to "excellent", so that more people can rest assured to see the doctor when they go out.

In order to further facilitate the masses to handle cross -provincial medical care business, notifying that it will clearly establish a mechanism for coordinating the problem of medical place and the place of insurance, improve the efficiency of collaborative disposal of regional issues, and promote information sharing such as medical insurance policies and stopping announcements.

For cross -provincial medical participants who are discharged from the hospital at their own expenses, the filing procedures shall be made in accordance with regulations, and the medical insurance can be reimbursed in accordance with the regulations of the insurance place.And relying on designated pharmaceutical institutions to upload information on medical expenses for self -funded personnel, and explore the provision of provincial handmade reimbursement online processing services."These measures are all for the people, so as to facilitate the people to seek medical treatment as much as possible." Lu Bei, director of the Medical Insurance Price Office of Fuwai Hospital of the Chinese Academy of Medical Sciences, said that it has introduced a unified cross -provincial medical treatment policy and established a national information platform. It will also streamline medical institutions.Settlement work improves the efficiency of medical insurance costs for patients with different places.

The "Basic Medical Insurance Cross -Provincial Different Places Direct Circular Settlement Regulations" are issued simultaneously to regulate medical management, prepaid money management, medical expenses settlement, review and inspection and other content.Relevant policies will be officially implemented from January 1, 2023.

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