The circular unified the cross-regional real-time settlement policy of hospitalization expenses, general outpatient expenses and inpatient outpatient expenses, and established the current policy of medical insurance fund payment under normal circumstances when cross-regional real-time settlement is implemented. Service specifications of medical insurance management methods in different places, such as "filing first, selecting points, holding code cards for medical treatment"; "Advance first, then settle" and other requirements for allocation of medical insurance funds in different places.
The circular further standardized the current policy of keeping medical records in different places, including expanding the scope of medical records in different places to cross-regional emergency department staff and non-emergency department staff who did not seek medical treatment; The validity period of unified filing, during which the insured can go to the hospital many times and enjoy real-time settlement service; Applicable to the insured person's dual enjoyment of treatment in the place of filing and social security participation.
In addition, the circular clarified the real-time settlement business scope of the designated medical insurance hospitals, and included the emergency rescue expenses, the medical examination and treatment expenses inside and outside the hospital during hospitalization, and the trauma expenses that met the management standards for real-time settlement of medical treatment in different places into the real-time settlement scope of medical treatment in different places. Allow the insured to get medical treatment in different places before discharge settlement and enjoy cross-regional real-time settlement service. With the large-scale migration of population, retired workers settle and retire in different places, and medical insurance in different places is an urgent need. Even if there is no real-time settlement, medical insurance in different places will have some actions.
Further improve the current policy of medical records in different places. The scope of medical record-keeping personnel in different places has been expanded to cross-regional emergency rescue personnel and non-emergency personnel who have not seen a doctor. Unified filing period, during which you can see a doctor many times from the place where you see a doctor and enjoy real-time settlement service. The applicant enjoys the dual treatment of filing place and social security participation. Specifically guide the region to reasonably determine the current cross-regional temporary outpatient reimbursement policy.
Further clarify the real-time settlement business scope of medical insurance designated hospitals. Emergency rescue expenses, in-hospital and out-of-hospital examination and treatment expenses during hospitalization, and trauma expenses without third-party obligations that meet the management norms of medical treatment places are included in the immediate settlement of medical treatment in different provinces. Allow the insured to get medical treatment in different places before discharge settlement and enjoy cross-regional real-time settlement service.
After the implementation of real-time settlement of medical insurance in different places, the average medical insurance settlement fee in big cities is not higher than that in the outflow place. The first reason is that the diagnosis and treatment in big cities is more standardized; Second, after real-time settlement, it avoids some disadvantages of the original manual reimbursement. For example, medical insurance in different places is a frequent area of fraudulent insurance, and this loan is directly avoided after real-time settlement. These points prompted us not to see the situation that the outflow of medical insurance funds could not be supported. At the level of collaborative business, the Notice strengthens the norms of cross-regional collaborative steps of social security agencies, creates a mechanism for medical places and social security insured places to solve problems collaboratively, and improves the efficiency of inter-regional collaborative problem solving.