National Health Insurance Bureau: Fixed-point hospital, pharmacy fee settlement time limit of no more than 30 working days

Medical Network May 13th, May 12th, the National Health Insurance Administration issued the "Notice on the issuance of the National Medical Security Administration Service List" (hereinafter referred to as the "National List"), a total of 10 main items, 28 sub-itemsAmong them, the clear fixed-point medical institutions (including medical institutions, retail pharmacies) fee settlement processing time limit of no more than 30 working daysIt is hoped that the problem of the settlement of medical insurance expenses of fixed-point medical institutions will be solved and the pressure of capital flow should be reducedIt is understood that the "National List" focus on the field of medical security and people's livelihood "difficult, blocking points, pain points" problem, for the current medical security management of government services in the field of the existence of the process is not simplified norms, insurance transfer and manual reimbursement procedures cumbersome and cumbersome time cycle, off-site medical records are not convenient enough, the experience of operating services is not ideal and other issues put forward new requirementsthe National List covers the ten general service items currently handled by medical security, namely: basic medical insurance coverage and change registration, basic medical insurance insurance information inquiry and personal account one-time withdrawal, basic medical insurance relationship transfer succession, basic medical insurance insurance participants off-site medical records, basic medical insurance insured persons enjoy outpatient chronic disease treatment recognition, basic medical insurance insurance personnel medical expenses manual (sporadic) reimbursement, maternity insurance treatment, medical aid approval payment, medical institutions to apply for fixed-point managementThe main sub-item is broken down into 28 sub-items, each sub-item of the matter name, the matter code, processing materials, processing time limit, processing link, set the basis are standardized and unifiedaccording to the relevant person in charge of the National Health Insurance Administration, the processing time limit has been reducedIn the 26 sub-items that have been clearly processed (excluding medical institutions applying for fixed-point agreement management, retailapplication fixed-point agreement management two government service matters), the processing time limit than before the actual processing time limit has been significantly reduced, the overall compression ratio of more than 50%; There were 12 immediate closings, accounting for 46%, 9 items for 5-20 working days, accounting for 35%, and 5 items within 30 working days, accounting for 19%according to the deployment of the, by the end of August 2020, the provincial medical security departments should earnestly abide by the contents and format requirements of the national list and follow the "six unified" (unified matter name, unified matter code, unified handling materials, unified processing time limit, unified processing link, unified service standard) And the "four most" (the best quality of service, the least required materials, the shortest processing time, the most simple process) requirements, complete the province's list and the publication of the work guide, synchronous unified standard line (including mobile terminals) handling matters, to ensure the full implementation of the inventory system by the end of August 2020in this regard, the State Health Insurance Administration will strengthen the supervision and evaluation of various places, the implementation of the inventory system as a special evaluation of the medical security system and standardize the conduct of the supervision and inspection of the important content, increase the intensity of covert visits and exposure, timely system-wide notification of the results, establish and improve accountability and accountability mechanism, and urge the implementation of the problem rectificationThe industry is concerned that the National List focuses on solving the problem that past fixed-point pharmaceutical institutions face the problem of lagging settlement of health insurance costsSome local health care department heads and retail pharmacies point out that a large part of the revenue of fixed-point medical institutions comes from health insurance fundsShortening the time limit for the settlement of costs will greatly improve the efficiency of the use of health insurance funds, so that pharmaceutical institutions have sufficient funds to purchase the required drugs and medical equipment in a timely manner, and reduce the burden on pharmaceutical institutionsthis year, especially with the outbreak of new coronapneumonia, some medical insurance fixed-point medical institutions capital turnover pressure increasedA survey of hospital operations in Guangzhou, a third-party hospital management consultancy in Guangzhou (survey covering 26 provinces and 316 hospitals, of which 65% were public hospitals and 64% of hospitals at level 3 and above) showed that since February this year, almost all of the hospitals surveyed had seen a sharp decline in business volume and revenue from the same period last year 76.6 per cent of hospitals surveyed saw a drop in cash flow of more than 20 per cent; 50 per cent of hospitals had less than two months' support; and 24.4 per cent had only one month' of existing funds in the industry, through innovative medical insurance settlement service model, will reduce the financial pressure of fixed-point pharmaceutical institutions, to help pharmaceutical institutions, pharmaceutical enterprises to resume production With the payment of health insurance funds, business processes "slim", health insurance settlement service model will also accelerate reform At present, in addition to the health insurance department to shorten the fixed-point medical institutions medical insurance fee settlement time limit, some regions are also accelerating the exploration of "health insurance funds for medical institutions advance" model for example, Zhejiang Ryan City to the medical insurance fund pre-allocation way to the city of the financial fixed-point unit funds operation, from January to April this year, has accumulated the pre-allocated health insurance fund 350 million yuan It is understood that the city of Ryan implemented the "medical community" medical institutions fund monthly advance allocation, according to the monthly average amount at the beginning of each month pre-allocation of this month's health insurance fund, the fund will be allocated "audit, culling, settlement" process from the "front" to "back", greatly reducing the financial pressure of the medical fixed-point units in addition, , in March 2020, the State Council issued the Opinions on Deepening the Reform of the Medical Security System, which made it clear that the direct settlement of medical insurance funds and pharmaceutical enterprises should be promoted, and that various places were also being implemented March, fujian Province, Zhangzhou City Health Insurance Bureau issued "on further speeding up the outbreak period of payment settlement notice", strictly implement the payment price settlement time requirements, to ensure that before the 15th of each month in accordance with the provisions of the contract to the previous month's drug payment settlement in place, to help drug supply enterprises resume production On April 21, the Hunan Provincial Medical Insurance Bureau issued the Regulations on online payment settlement of medical loans for procurement platform in Hunan Province (trial), which requires the first and second batch of national quantity procurement of selected drugs and the special centralized procurement of antimicrobial drugs in Hunan Province to make online payment settlement for centralized purchase of pharmaceutical purchases industry believes that by reducing the time limit for medical insurance settlement, the implementation of the advance payment of health insurance funds, supervision of medical institutions in a timely manner, the problem of arrears will be improved, to reduce the pressure on the operation of the funds flow By the medical insurance department and pharmaceutical companies to settle the money directly, will solve the triangular debt between , pharmaceutical enterprises, medical insurance.