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    Home > Medical News > Latest Medical News > Chs-drgs and its technical specifications and grouping scheme

    Chs-drgs and its technical specifications and grouping scheme

    • Last Update: 2019-10-24
    • Source: Internet
    • Author: User
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    In order to implement the reform of medical insurance payment mode and do a good job in the national pilot project of DRG payment, our bureau has organized and formulated the technical specifications for DRG grouping and payment of national medical insurance (hereinafter referred to as the technical specifications) and the grouping scheme of national medical insurance DRG (chs-drg) (hereinafter referred to as the grouping scheme) 1、 Adhere to the combination of integration and separation, and gradually form a DRG payment system with Chinese characteristics Each pilot city shall follow the basic principles, scope of application, definition of terms, data requirements, data quality control, standardized upload specifications, grouping strategies and principles, weight and rate determination and other requirements of DRG grouping determined in the technical specifications to carry out relevant work The grouping scheme shall be strictly implemented to ensure that 26 major diagnostic classifications (MDCs) and 376 core DRG groupings (adrgs) are consistent across the country, and local subdivision DRG groupings (DRGs) shall be formulated in accordance with the unified grouping operation guidelines and the actual situation of each region Each pilot city shall not change the MDC and ADRG groups at will 2、 Carry out the standards and control the quality of basic data Each pilot city shall use the medical insurance disease diagnosis, operation and treatment uniformly in accordance with the requirements of the notice of the State Medical Insurance Bureau on printing and distributing the guiding opinions on medical insurance Standardization (medical insurance Fa [2019] No 39) and the notice of the State Medical Insurance Bureau on printing and distributing the coding rules and methods of information business such as medical insurance designated medical institutions (medical insurance Fa [2019] No 55) 5 information business coding standards, such as medical service items, drugs, medical consumables, medical insurance settlement list, etc The medical insurance agencies in pilot cities shall establish an information business coding standard maintenance team, carry out dynamic maintenance of medical insurance information system database, coding mapping and relevant interface transformation, promote the application of information business coding standards, and use "common language" in the whole country Collect relevant data of medical institutions through medical insurance settlement list All pilot cities should accelerate the transformation of information system related to DRG paid country pilot, improve the implementation and supervision of key links such as scheme design, bidding, procurement and deployment, and improve data management capabilities 3、 Establish a team of experts to provide technical support to the National Medical Security Bureau to establish a technical guidance group (hereinafter referred to as the "technical guidance group") of DRG payment national pilot working group, which is located in Beijing Medical Security Bureau The pilot cities and provinces (regions) should also set up local expert teams, including experts in medical insurance management, information technology, statistical analysis, medical record management, clinical medicine and other aspects, to build a professional management team, improve the management level, and ensure the smooth implementation and promotion of the pilot work The technical guidance group will organize DRG payment national pilot expert group to train key personnel and core experts of provincial and pilot city medical insurance departments Relevant provinces (districts, cities) and pilot cities shall be responsible for the training of other personnel of relevant departments, medical institutions and local experts, so as to ensure that all personnel participating in DRG paid national pilot work are trained in place The relevant provincial (District, city) medical insurance departments are requested to earnestly implement the requirements of this circular, and actively promote the national pilot work in accordance with the pilot work plan, together with the member units of the local DRG payment national pilot working group Our bureau will simultaneously carry out the monitoring and evaluation of DRG payment pilot countries, focusing on monitoring the progress of each pilot city, assessing the effectiveness of DRG payment reform, and adopting appropriate ways to publish the relevant results Appendix: Technical Specification for DRG grouping and payment of national medical security.pdf scheme for DRG (chs-drg) grouping of national medical security.pdf
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