Medicare reimbursement scope and standard:
1, the drugs are divided into class A, B and C drugs, of which class A drugs are necessary for clinical treatment, widely used, the drug cost of this kind of drugs are all reimbursed in accordance with the proportion of the medical insurance regulations. Class B drugs are first paid a certain percentage, and then reimbursed by the health insurance, the specific reimbursement rate is different in different places of the health insurance bureau regulations are different;
2, diagnosis and treatment items refers to the hospital for treatment, the use of medical instruments, equipment and medical materials, mainly two ways to reimbursement of the full co-ordination of all the items are all included in the health insurance reimbursement, according to the prescribed proportion of payment. The first part of the integrated project, is to pay a part of the first, and then reimbursement according to the prescribed proportion;
3, medical service facilities standard, refers to the hospital bed fee, outpatient hospital bed fee and so on, the reimbursement scope and standard is different from place to place. If the social security of the medical insurance reimbursement scope is for the medical insurance catalog within the project reimbursement, including drugs, diagnostic and treatment items and medical services facilities.
Medical insurance reimbursement process:
1, in the medical insurance designated hospitals: each city will have medical insurance designated hospitals, only in the medical insurance designated hospitals inside the diagnosis and treatment, only to be able to use the medical insurance to reimbursement. So if you want to use the medical insurance, you must go to the medical insurance designated hospitals, and to handle the relevant registration procedures;
2, ready for the discharge data: in the discharge of the hospital in advance to the discharge of the data to be ready, such as the diagnosis of the disease, the discharge record and the medical record, and so on. Generally in the treatment with the doctor said, need these information, the doctor will help us to prepare, it is best to get these information and then make a copy. One copy is submitted to the medical insurance reimbursement office, and the other copy is kept as a backup;
3, discharge settlement: take the hospitalization list as well as invoices, and go through the settlement procedures in the hospital. After that, you can bring the relevant information to the medical insurance reimbursement department to reimbursement and audit;
4, waiting for the reimbursement of expenses to the account: when the information has been handed over, you will receive a receipt, the reimbursement of the amount of money will be within 15 days to the account, you just need to wait patiently.
In summary, lactulose oral solution has always been a variety of national health insurance, basic drug catalog. Patients can use the social health insurance card to pay for it, lactulose oral solution health insurance can be reimbursed, belongs to the health insurance category B.
Legal basis:
Article 25 of the Social Insurance Law of the People's Republic of China
The state establishes and improves the basic medical insurance system for urban residents.
Basic medical insurance for urban residents is a combination of individual contributions and government subsidies.
The government shall subsidize the portion of individual contributions required by those who are entitled to the minimum subsistence guarantee, persons with disabilities who have lost the ability to work, and elderly persons and minors over the age of sixty from low-income families.
Article 28
Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facility standards, as well as those for emergencies and resuscitations, shall be paid out of the basic medical insurance fund in accordance with state regulations.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.