up to date!Jiangsu urgent injuries, serious injuries, and insured persons can be reimbursed at the hospital for rescue in the emergency department

Author:Jiangsu News Time:2022.08.02

The reporter was informed that the Jiangsu Provincial Medical Security Bureau and the Jiangsu Provincial Health and Health Commission have recently issued the "Notice on Doing a good job in the protection of medical expenses for diagnosis and medical expenses of the critical and serious injuries", which clarifies the eligible urgent crisis and serious injuries. The expenses of insurers can be reimbursed in accordance with the hospital for emergency rescue, and the policy will be implemented from September 1, 2022.

It is understood that during the fine adjustment of the Jiangsu Provincial Medical Insurance Bureau to conduct a fine -tuning activity of "I am worried about medical insurance around me," and found that the reimbursement policies in different regions in different regions in the province have a large difference in reimbursement policies. According to outpatient treatment, some can even be reimbursed. In this regard, the party group of the Provincial Medical Insurance Bureau will "uniformly regulate the province's basic medical insurance for emergency rescue medical expenses treatment policies, ensure the reimbursement of emergency expenses, and reduce the burden of emergency medical expenses for the people participating in the insurance." First, through in -depth investigations, the relevant policies are clarified, the "Notice" issued this time clarified the four aspects of the scope of urgency and serious injuries and treatment guarantee policies.

Speaking of serious injuries, refers to the diseases that may increase or even endanger life if they do not treat the condition in a timely manner. The symptoms, signs, and diseases meet the criteria for critical critical serious injuries. The urgent crisis and severe injuries and diseases that need to be urgently treated are implemented in accordance with the "Standards and Specifications for Diagnosis and Treatment of Urgent Survival" (National Health Office Medical Fa [2013] No. 32).

In terms of treatment guarantee policy, the "Notice" clearly states that the emergency treatment of designated medical institutions to level 1 of endangered patients and critical patients at level 2 shall implement emergency rescue at the door (emergency) clinic, which meets the medical expenses of the basic medical insurance fund payment. Enjoy treatment according to the hospital payment policy.

The emergency treatment of a designated medical institution to the emergency treatment of level 3 is clearly required to observe the hospital (emergency) diagnosis, and the medical expenses that meet the scope of the basic medical insurance fund after observation of the hospital Treatment; if the hospital is not directly transferred to the hospital after observation, enjoy the treatment according to the outpatient payment policy.

The "Notice" requires that designated medical institutions shall implement classification and cure for patients in accordance with the "Standards and Conditions for Urgent Survival and Conditions for Urgent Cure". It is necessary to regulate the management of medical records and rescue records. After the consent of the patients or their legal agents, the insured patients (urgent) diagnosis hospital observe the medical records and the record of serious injuries and diseases and rescue records. At the same time, it is necessary to do a good job of data with the medical insurance information system to facilitate insured personnel to swipe the card settlement treatment in a timely manner. The medical security department will also improve the information system and increase the audit and inspection of relevant medical expenses such as observation of the door (urgent) diagnosis and emergency rescue. The health department shall supervise the guidance of medical services and processes for the specifications (emergency) diagnosis of designated medical institutions to ensure that patients with serious injuries and serious injuries get timely treatment.

In addition, the "Notice" also made it clear that those who participated in the insured patients due to sudden crisis were seriously injured and rescued, and those who were close to the door (urgent) of non -basic medical insurance medical institutions (urgent) rescue should be implemented with reference to this notice.

Jiangsu Provincial Medical Security Bureau Jiangsu Province Health and Health Committee

Regarding the crisis and serious injuries, insured persons

Door (emergency) notice of medical expense protection work

The district and municipal medical security bureau and the health and health committee:

In order to ensure the treatment of medical security in a timely manner at the door (urgent) diagnosis and treatment, in accordance with Article 28 of the Social Insurance Law and other provisions, the door of the crime serious injuries and the insured person (emergency) The work notice of medical expenses is as follows:

1. Clarify the scope of jealousy and critical serious injuries

2. Clear treatment guarantee policy

(1) The emergency treatment of a designated medical institution to the endangered patient and the critical patients at the level 2 shall be implemented in the medical insurance fund for the implementation of emergency rescue at the door (urgent) consultation, and enjoy the treatment of basic medical insurance funds, and enjoy the treatment in accordance with the inpatient payment policy.

(2) Specific medical institutions emergency treatment to level 3 of emergency treatment, which clearly needs to be observed in the hospital (emergency) diagnosis, and directly transferred to hospital after observation of the hospital, which meets the medical expenses of the basic medical insurance fund payment. Payment policies enjoy treatment; if they do not transfer to the hospital after observation, they will enjoy treatment according to the outpatient payment policy.

3. Related work measures

(1) Standardize diagnosis and treatment services. The designated medical institutions shall implement classification and cure for patients in accordance with the "Standards and Specifications for Diagnosis and Treatment of Urgent Survation and Conditions for Emergency treatment. It is necessary to regulate the management of medical records and rescue records. After the consent of the patients or their legal agents, the insured patients (urgent) diagnosis hospital observe the medical records and the record of serious injuries and diseases and rescue records. At the same time, it is necessary to do a good job of data with the medical insurance information system to facilitate insured personnel to swipe the card settlement treatment in a timely manner.

(2) Strengthen departmental coordination. The medical security department should improve the information system, improve the agreement with designated medical institutions, strengthen the management of medical insurance settlement, and increase the audit and inspection of relevant medical expenses such as observation of the door (urgent) diagnosis and emergency rescue. The health department shall supervise the guidance of medical services and processes for the specifications (emergency) diagnosis of designated medical institutions to ensure that patients with serious injuries and serious injuries get timely treatment.

4. For patients with other related matters, patients who participated in the insurance were seriously injured and rescued. If they were diagnosed with urgent rescue at the door (urgent) at the door of non -basic medical insurance, they were implemented with reference to this notice.

This notice will be implemented from September 1, 2022.

Jiangsu Provincial Medical Security Bureau

Jiangsu Province Health and Health Committee

July 11, 2022

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