The National Medical Insurance Administration implements the reform of "at most once" for medical insurance services

Promote "Internet + medical insurance services" to expand the scope of direct settlement for medical treatment in different places

  News from this newspaper (Reporter Li Danqing) In order to effectively solve the problems of mass medical insurance reimbursement application materials and complicated procedures, the National Medical Insurance Bureau recently issued the "Opinions on Optimizing Convenient Services in the Field of Medical Insurance", clarifying that before the end of 2022, the implementation of medical insurance services "most runs "One-time" reform to realize the "cross-provincial administration" of high-frequency medical insurance services, and effectively improve the level of medical insurance services.

  The "Opinions" put forward 10 specific tasks such as promoting the standardized and standardized construction of medical insurance services, advancing "Internet + medical insurance services", optimizing the transfer and continuation of medical insurance relations and settlement of medical treatment in different places, and implementing medical insurance handling services nearby.

  In terms of promoting the standardization and standardization of medical insurance services, the "Opinions" clarified that by the end of 2021, the "six unifications" of national medical insurance service item names, item codes, handling materials, handling time limits, handling links, and service standards will be realized in a timely manner. Adjust and update.

At the same time, the implementation of the integrated package service of medical insurance reimbursement realizes one-time notification, one-form application, one-window processing, and explores the implementation of basic medical insurance, critical illness insurance, medical assistance and commercial insurance in one settlement, at most once.

  "We will promote the'Internet + medical insurance service', in accordance with the principle of online and offline fairness and medical insurance payment policies, to realize the integrated services of prescription circulation, online payment and settlement, and home delivery of medicines." The relevant person in charge of the National Medical Insurance Bureau said that the medical insurance departments of various regions It is necessary to unblock medical insurance consultation service channels, provide professional medical insurance hotline services to the masses, and actively explore the "video management" of medical insurance service matters.

  In order to meet the needs of population mobility and employment conversion, the "Notice" proposes to improve the medical insurance relationship transfer and continuation policy, actively promote the transfer and continuation of the basic medical insurance relationship across the coordination area, and realize the transfer and continuation of the basic medical insurance relationship "cross-province".

Speed ​​up the direct settlement of basic medical insurance across provinces for medical treatment in different places, realize national unified medical records for medical treatment in different places, and expand the scope of direct settlement for medical treatment in different places.

  According to the deployment, by the end of 2021, more than 60% of the counties in all provinces will have at least one inter-provincial networked medical institution for general outpatient expenses, and each coordinating area will basically achieve direct settlement of ordinary outpatient expenses across provinces; before the end of 2022, each county will have at least one A designated medical institution can provide cross-provincial direct settlement services for medical expenses, including outpatient expenses.

  In the process of optimizing convenient services in the medical insurance field, medical insurance handling services are expected to sink.

The "Notice" proposes to decentralize services such as insurance registration and payment, information inquiry and change, and off-site medical records to the township (street) level. It encourages the decentralization of outpatient chronic disease identification and newborn insurance to designated medical institutions for processing .

  In addition, the "Notice" emphasizes cracking down on fraud and insurance fraud in the medical insurance field, strengthening the supervision of the entire medical insurance fund, and severely cracking down on fraudulent insurance fraud such as induction of hospitalization, false expense receipts, and excessive diagnosis and treatment in accordance with the law, so as to protect the people's life-saving money.

Encourage places where conditions permit to promote the use of face recognition technology, so that insured persons can "swipe their face" for medical treatment and hospitalization, and eliminate "fake patients"; double authentication of doctors "face-swiping + positioning" and eliminate "fake doctors".

  Li Danqing