44 artificial crystal categories Of Medicare payment standards and health insurance codes set!

Pharmaceutical Network September 27 - Tianjin Pharmaceutical Purchasing Center issued "on the city's medical insurance payment scope of artificial crystal medical supplies information maintenance notice", announced in the Beijing-Tianjin-Hebei nine provinces in the procurement of the volume of the 44 artificial crystal products selected the highest medical insurance payment standards and codes (see the table at the end of the article).
, the maximum published medical insurance payment price is the selected price for the volume purchase of these products.
payment criteria for medical supplies are the basis for payment by the Health Insurance Fund, not a reimbursement ratio but a clear numerical amount.
July 31 last year, the State Council issued a major document, "The Reform Program for the Treatment of High-Value Medical Supplies", which made the development of medical insurance payment standards an important hand in reducing the price of consumables.
contents include: "Scientific development of high-value medical supplies medical insurance payment standards, and the establishment of dynamic adjustment mechanism."
have already passed the health care access negotiations, the standard of payment for health care is determined at the negotiated price.
to develop a unified standard of medical insurance payment for high-value medical supplies with the same categories and similar functions.
medical insurance fund and patients pay high-value medical supplies according to the standard of medical insurance payment, and guide medical institutions to take the initiative to reduce the purchase price.
" In June of this year, the State Health Insurance Administration publicly solicited opinions on the Interim Measures for the Administration of Medical Supplies for Basic Medical Insurance (Draft for Comments), and the document once again provided clear information on the determination of the standard of payment for medical insurance: for exclusive products, the first standard of payment for medical insurance was negotiated in principle.
negotiations are successful, the health-care sector pays according to the payment criteria set out in the negotiated agreement.
negotiations have been unsuccessful, are not covered by Medicare payments, and have been included in the list to be transferred out.
rules for negotiating medical supplies are formulated separately.
for non-exclusive products, payment criteria are determined and adjusted in principle through centralized procurement.
The provincial medical security administrative departments shall determine the medical insurance payment standards of the province (autonomous regions and municipalities directly under the Central Government) according to the results of the procurement of the national, federal and provincial (autonomous regions and municipalities directly under the Central Government) with the lowest selected price for medical supplies of the same type and similar functions.
for medical supplies that are not included in the scope of volume procurement, the provinces (autonomous regions and municipalities directly under the Central Government) shall determine the payment standards according to the calculation method of the payment standards in the catalogue.
rules for determining the payment standards for medical supplies for medical supplies are formulated separately.
it is clear that the coordination of purchase prices with the standard of payment for health care has become a trend.
At present, in most of the belt procurement project programs, we can see the description of "with the volume purchase selected price as the standard of medical insurance payment", rather than the purchase price of the selected product in principle shall not be higher than the price of the product selected in the same functional attribute, encourage non-selected enterprises to take the initiative to reduce prices, to pay the standard convergence.
, hospitals do not pay for health insurance using non-selected products, such as Minnan.
"using centralized procurement prices as the standard of payment for health insurance" is to clarify a feasible way of setting payment standards, and to express the state's support for centralized procurement.
as the health insurance bureau takes over the collection and the widespread roll-out of procurement, the standard of payment for health insurance has become an important weapon in promoting price reductions.
For the same category, similar functions of the variety, the State encourages the exploration of the development of a unified standard of payment for health insurance, and generally the lowest selected price as the standard of payment for health insurance, and higher than the payment standard part of the patient's own payment, then for the vast majority of patients, in the case of similar functions of treatment products, certainly tend to choose the one with more medical insurance reimbursement.
pressure on companies to reduce prices has increased significantly.
today, the Tianjin Municipal Health Insurance Bureau also issued "on the implementation of Beijing-Tianjin-Hebei and Heji Liaomun Jinlu medical supplies (artificial crystal class) joint belt procurement and use of the notice", effective from tomorrow.
reiterated the main task of implementing health care payments, requiring "to do a good job of selecting artificial crystal code assignments in accordance with national requirements, and to be included in the scope of health insurance payments."
For medical institutions that reasonably use selected artificial crystals, fulfilled procurement contracts, completed joint strip procurement and used artificial crystals, the total medical insurance control index shall not be reduced due to the decrease in the cost of centralized procurement and use of artificial crystals.
to medical institutions to realize the balance according to the standard of payment according to the disease, according to the head, according to the relevant grouping of disease diagnosis, etc.;
is just the beginning, and more and more places will follow to put the standard health care payment policy on the ground.
: Tianjin Medical Insurance Payment Range Medical Supplies (Artificial Crystals) Information Maintenance Schedule (First Issue 2020)