Kunming City Implement National Medical Insurance Flight Inspection Feedback

On September 1st, the Kunming Medical Security Bureau held the "2022 National Medical Insurance Flight Inspection and Rectification Work Arrangement". According to the feedback from the National Medical Insurance Bureau's flight inspection team "Maintain the safety of the medical insurance fund and keep the people's" life -saving money ".

Medical insurance flight inspection "inverted two and a half years"

From August 29th to 30th, the National Medical Insurance Administration's flight inspection team entered the Kunming Municipal Medical Security Bureau Municipal Medical Insurance Administration to launch a flight inspection and randomly randomly inspected "two and a half years".

The inspection team is divided into 4 groups: comprehensive management, insurance information, review and settlement, and fund finance. By consulting materials, discussions and exchanges, on -site inquiry and demo, etc., focusing on internal control construction, institutional function integration, medical insurance audit settlement, treatment dialing clearing settlement Wait for 38 aspects to conduct inspections.

The inspection team retracted the original vouchers of 5 medical insurance personal accounts in 2020, showing accurate, complete records, and rigorous review; The national medical insurance platform has been verified, all of which meet the standards; in the 200 clinic slow special disease declaration forms, 40 copies are selected for inspection. By checking the medical record materials, inspection of test materials and diagnostic certificates, the display meets the criteria of slow special disease identification standards. , Terminal on time; 50 medical records for maternity insurance treatment reviews are selected for inspection, showing that the account records and list materials are relatively complete, and the time for settlement is relatively timely.

The results of Kunming medical insurance reform have been affirmed

After a comprehensive and deadly inspection, experts in the inspection team believed that Kunming's medical insurance service policy was relatively complete. For outpatient chronic diseases and special diseases, since 2020, Kunming City has issued nine policy documents to further strengthen supervision and standardized management. Formation acceptance has improved the efficiency of service service; Kunming's maternity insurance treatment review and a series of policy documents have been introduced to fully protect the medical insurance rights and interests of insured personnel.

In terms of the supervision and management of the medical insurance fund, Kunming organizes the daily and centralized publicity activities every year in Kunming to carry out the use of self -examination and self -correction activities for medical insurance funds in designated medical institutions to recover the results of the medical insurance fund's loss. Social supervisors of famous medical insurance and strengthen fund supervision. Strengthen the publicity and training of designated pharmaceutical institutions. Since 2020, it has carried out centralized training on medical insurance fund supervision, medical insurance treatment review review, medical insurance treatment policy, and medical insurance information platform business operations to guide designated medical institutions to regulate the use of medical insurance funds.

The inspection team also affirmed the results of the deepening of medical insurance paid reform in Kunming. Kunming promoted the reform of total prepaid and DRG (grouping according to the diagnosis of the disease), and promptly introduced relevant policy documents to strictly control the unreasonable and fast growth of medical insurance costs, and effectively improve the effectiveness of medical insurance funds. In addition, the quality of the service service is good as a whole, and the Kunming medical insurance service standard system has been established to clearly specify the work processes and job work standards of medical insurance; successively introduced the regulation and reimbursement specifications of different places, and the gates in the province are slow. Special disease record process, etc.

Placing and improving the level of fund supervision and improvement

The inspection team also proposed the problems existing in the work of Kunming in the medical insurance office. For example, the management regulations of the medical insurance office are not systematic and improved, and the management procedures for the management of medical insurance for urban and rural residents are not formulated; the internal control system is not complete, and the risk prevention and control mechanism is incomplete; The pharmaceutical institution carried out an agreement to perform the annual assessment work; the management of medical insurance doctors was not standardized, and the relevant policy documents were not introduced to the management of medical insurance physicians.

In response to these issues, the Kunming Medical Insurance Authority promptly formulated the "Rectification Plan on Implementing the Rectification of National Medical Insurance Flight Inspection Feedback", carefully compared with rectification opinions, issued relevant measures, and was responsible for the personnel. At the work arrangement meeting, members of the Kunming Medical Security Bureau and the person in charge of the relevant office also focused on the "Regulations on the Supervision and Management of the Medical Security Fund".

Yan Xiaoling, Secretary of the Party Group and Director of the Kunming Medical Security Bureau, said that the bureau attaches great importance to the problems found in the national medical insurance flight inspection. The problem is combined with the establishment of a long -term mechanism to establish and improve various rules and regulations, and form a long -term working mechanism of mutual connection and supporting facilities. It will urge the medical institutions to be inspected to do a good job of follow -up processing of various issues, and obtain a good effect of "once, a shock, one -time, and standardized batch" by using a point with a point with a point with a dot. Joint supervision with departments such as health and health, public security, market supervision and other departments, and conduct in -depth publicity activities for the "admission to the hospital" in medical insurance policies, continuously improve the standardization, scientific and refined level of medical insurance fund supervision, and resolutely adhere to the red line and bottom line of the security of the fund. Essence

Kunming Daily Reporter: Liao Jingrong

Edit: Zhang Jie

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