Jinan City, Shandong Province issued a notice: Completely cancel the hospital payment authority

For businesses, getting money back is a matter of life and death
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For a long time, the absolute position of public hospitals in the market has caused consumables companies to be in a dilemma in chasing money
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With the promotion of direct settlement between medical insurance and equipment companies, public hospitals are out of the money collection link, and the crux of the difficulty in collecting money is dissolving
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Direct settlement of medical insurance, the reconciliation time is only 5 days.
On March 7, Jinan City, Shandong Province issued the "Notice on Comprehensively Carrying out the Direct Settlement of Medical Insurance Funds for Medical Consumables Payments and Pharmaceutical Enterprises" (hereinafter referred to as the "Notice"), requiring that starting from March , and comprehensively carry out the direct settlement of medical consumables payment medical insurance funds and pharmaceutical enterprises
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The delivery time is after March 1, 2022 (inclusive), and the national and provincial centralized procurement of medical consumables transaction data will be carried out through the Shandong Provincial Settlement Supervision Platform for direct settlement and online payment
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The procurement personnel of medical consumables in medical institutions should review the invoices submitted by pharmaceutical enterprises in a timely manner, and the financial personnel should follow the reconciliation schedule in the "2022 Jinan Medical Insurance Fund and Pharmaceutical Enterprises Direct Settlement Work Reconciliation Process Schedule" (see the figure below) Review settlement and reconciliation reports
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As shown on the form, the reconciliation time is 5 days
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What is the relationship between the reconciliation deadline and the payment collection date? The senior medical insurance research experts in the industry analyzed the Cyberblue equipment: reconciliation is a financial operation link before settlement, and the date of payment is the realization of receipt and payment, so reconciliation is to confirm the occurrence of accruals
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In this mode, the number of days between the reconciliation date and the payment collection period is also constant to a certain extent.
Although it sometimes fluctuates, the latest payment collection time and date should be stipulated to determine the binding force to prevent any delay in time
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It can be simply understood as "with the reconciliation date, the repayment date will enter the countdown", which is the implementation of the concept of decentralization and co-governance
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He believes that in this relationship, with the guarantee of the national medical insurance fund, the efficiency of visiting the hospital will be greatly accelerated, and the triangular relationship between the hospital, the enterprise and the medical insurance fund will be solved, so that the enterprise will no longer have to pull with the hospital.

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The "Notice" shows that after the reconciliation time expires, the handling agency will generate settlement details and payment orders through the supervision platform for the payment data of drug consumables that have been confirmed by medical institutions and approved by medical companies and reviewed and confirmed by pharmaceutical companies, and push the payment data to the local medical insurance.
core business system
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Unified platform, unified settlement process According to the observation of Cyberlane Equipment, in August last year, the Shandong Provincial Medical Insurance Bureau, the Shandong Provincial Department of Finance, the Shandong Provincial Health Commission, and the Jinan Branch of the People's Bank of China jointly issued the "Regarding the issuance of medical insurance for designated public medical care.
" Notice on the Implementation Plan for Direct Settlement between Institutional Drugs and Medical Consumables, Medical Insurance Funds and Pharmaceutical Enterprises (hereinafter referred to as the "Plan"), which is the predecessor of this Jinan policy
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After that, Dezhou City will gradually implement the pilot work of direct settlement of medical consumables from October 1, 2021
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Shandong Province's "Plan" proposes that it plans to fully implement the direct settlement of medical insurance funds and pharmaceutical companies in the province in 2025
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Before the end of September 2021, establish a unified supervision platform for the settlement of medicines and equipment in the province, realize the supervision platform and the centralized procurement platform for medicines and equipment in the province, and complete the direct settlement of the medical insurance fund for the purchase of medicines and consumables with quantity, and the self-settlement of medical institutions and pharmaceutical enterprises for the purchase of medicines and consumables without quantity.
Online monitoring function development
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According to the documents of Jinan City, the settlement and supervision platform of Shandong Province has been completed and is running smoothly.
Since March, medical insurance funds and enterprises will carry out direct settlement and online payment on the platform
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The varieties participating in the direct settlement include the selected varieties of drugs and medical consumables actually purchased by the designated public medical institutions of medical insurance at all levels in the province at the national and provincial levels
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In addition, the non-selected varieties purchased in a centralized manner with a price not higher than the selected price will be included in the direct settlement in due course, and the scope of varieties will be gradually expanded
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The "Plan" requires the establishment of a direct settlement supervision system for medical insurance funds
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The whole province uniformly determines the cooperative bank of the supervision platform, and the cooperative bank is connected with the supervision platform to realize online payment
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Pharmaceutical companies use their settlement accounts opened in cooperative banks and payee merchants to receive settlement payments for pharmaceutical consumables (including direct settlement and self-settlement)
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The medical insurance agency uses the bank's corporate online banking for direct settlement of the payment for drug consumables, and realizes the direct settlement process supervision.
The medical insurance fund shall not be transferred to the fund account in violation of regulations; the funds in the settlement account shall be transferred to the medical insurance fund expenditure account within 2 working days after receiving the payment from the medical institution
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In terms of the direct settlement process, the payment for pharmaceutical consumables payable directly by the medical insurance fund is deducted from the monthly medical insurance fund settlement receivable by the medical institution, and the remaining part is paid by the medical insurance fund to the pharmaceutical enterprise.
The payment for pharmaceutical consumables is not high in principle.
Regarding the amount of medical insurance funds receivable by the relevant medical institutions, if the medical insurance fund settlement amount payable to the medical institution is insufficient to offset the payment for drug consumables, the insufficient part shall be paid by the medical institution to the settlement account of the medical insurance agency.
Payment will be made within 5 working days of the receipt notice by the agency
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In terms of settlement of primary medical institutions, the Dezhou Municipal Medical Insurance Bureau has made it clear in the document that the direct settlement of medical supplies purchased by primary public medical institutions on the provincial platform was carried out in November last year
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Second-level and above public medical institutions shall authorize the medical insurance agency to pay the hospital's drug consumables payment on behalf of the hospital through the provincial pharmaceutical and equipment settlement supervision platform before October 9 and primary-level public medical institutions before October 25
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According to the observation of Cyberlane Equipment, the "Plan" should be the first provincial-level document on the establishment of a direct medical insurance settlement mechanism in the country.
As a result, the country's implementation of the direct medical insurance settlement policy for consumables has finally achieved provincial-level implementation
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As the provinces and cities in Shandong have been fully implemented, the long-term three-party entanglement involved in the collection of payments will end
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Not only in Shandong, the direct settlement between medical insurance and enterprises has been gradually promoted all over the country, and the settlement method and time have been gradually refined and implemented.

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Under the gradual improvement of supporting policies, the collection of consumables companies will no longer be constrained by the capital turnover or infrastructure problems of medical institutions, and transparency, timeliness and fairness will be the rhythm of settlement in the future
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