National Health Insurance Administration: Medical Security Disease Diagnosis Related Sub-Group (CHS-DRG) Sub-group Program (Version 1.0)

Guide: Just now, the National Health Insurance Administration in order to implement the pilot work "three-step" goal, guide the local standard DRG groupwork, the development of "health care disease diagnosis-related group (CHS-DRG) sub-group program (1.0 version)" (hereinafter referred to as "CHS-DRG sub-group"), and releasedthe relevant provinces, autonomous regions, municipalities directly under the central government and Xinjiang Production and Construction Corps Medical Security Bureau:in accordance with the disease diagnosis-related sub-group (DRG) paid national pilot work arrangements, in order to implement the pilot work "three-step" goal, guide the local standard DRG group work, our bureau organized the "health care disease diagnosis related sub-group (CHS-DRG) sub-group program (1.0 version)" (hereinafter referred to as "CHS-DRG sub-group"), is issued and the relevant matters are issued, apply a unified CHS-DRG packet system
The CHS-DRG sub-group is a further refinement of the 376 core DRG (ADRG) group of the National Healthcare DRG (CHS-DRG) Subgroup Scheme, and is the basic unit of DRG payment, with a total of 618 groupsEach pilot city should make a local DRG sub-group by reference to the results of the grouping of CHS-DRG sub-groups, the list of complications of complications of comorbidities/severe complications of complications (CC-MCC table), grouping rules, named format, etcAccording to the actual situation, the pilot cities can also directly use the CHS-DRG sub-group to carry out local DRG paid country pilot work, standardize the use and collection of basic data
the medical insurance management departments of the pilot medical institutions should coordinate the departments of disease, information and finance, do a good job in quality control of the relevant data sources, and ensure that the items of the medical security fund settlement list are true, accurate and traceableIt is necessary to establish the unique identification variables of the medical security fund settlement list and the medical service detail information sheet (KC22 form), and do a good job of correlation to ensure the integrity of the same patient information, and submit it to the pilot city medical insurance department in accordance with the provisionsThe medical insurance departments in the pilot cities should strengthen the reform of information systems and improve the mechanisms for filling in, auditing and feedback the settlement list of medical security funds and the detailed information of medical services3Securely promote simulation operation
each pilot city should submit the assessment report to the DRG Paid National Pilot Technical Steering Group (hereinafter referred to as the "Technical Guidance Group") by August 31, and the work of the simulation operation phase can be carried out only after examination and approvalIn the simulation operation, the medical insurance department of the pilot city should strengthen the communication and feedback with the pilot medical institutions to form a unified and efficient working mechanismthe pilot cities using the local DRG subdivision group, the simulation run should continuously optimize and perfect the sub-group scheme under the premise of ensuring that the ADRG group ingressUsing the pilot cities of chS-DRG sub-group, we should form a collaborative mechanism with the technical guidance group, actively participate in the dynamic maintenance of the DRG sub-group, maintain the disease diagnosis and surgical operation code, submit the data related to the group, carry out clinical demonstration, etc., and support the improvement of the CHS-DRG sub-group version Fourth, improve the pilot supporting policies
all over the simulation operation to further clarify the corresponding policy measures First, formulate and improve the relevant weight adjustment, total budget management, settlement and clearing policies The second is to do a good job of controlling research Compare the changes of DRG simulation payment and existing payment methods in fund expenditure, patient burden, income and efficiency of medical institutions, medical behavior and so on Third, strengthen the study of the regulatory system to adapt to the characteristics of DRG payment, and formulate targeted measures for possible behaviors such as reducing services, high-set grouping, decomposing hospitalization, and pushing patients invitethe relevant provinces (regions, cities) and pilot city health insurance departments to attach great importance to the pilot work of THE DRG paying countries, conscientiously implement the requirements of this notice, will work with the local DRG paid national pilot working group member units, in accordance with the pilot work program to further promote the national pilot work In the work of any questions and suggestions please contact our Bureau Of Medicine Management Division and technical guidance team National Health Care Disease Diagnosis Group (CHS-DRG) Sub-group (version 1.0) pdf