Steps (taking drug control as an example):
1. Click on the drug comparison in transaction management (for example, the latest version of Xinjiang Medical Insurance app v 1.5.5 Android version).
2. Select the medical insurance type, and then click Query.
3. Select the drug you want to control.
Comparison of medical insurance catalogue is the basis of hospital medical insurance interface reform. Must be accurate. Only by comparing the catalogue can the hospitalization expenses of medical insurance patients be correctly settled. Because the three medical insurance catalogues in Chongqing are detailed, it is suggested that in the process of comparison, we should start with the coding rules of each item, find a good comparison method, filter the conditions and improve the comparison efficiency.
List of drugs for basic medical insurance: refers to the policy basis and standards for the basic medical insurance, industrial injury insurance and maternity insurance funds to pay the drug expenses of the insured and strengthen the management of medical services in medical insurance.
Catalogue of diagnosis and treatment items: When medical institutions designated by medical insurance provide medical services for the insured, the price department shall formulate the charging standards for diagnosis and treatment items and clinical diagnosis and treatment, and standardize the diagnosis and treatment items for patients.
Standard of medical service facilities: In the process of providing hospitalization and other medical services, select the necessary number of medical service facilities and environments as the scope of medical insurance payment. In practice, it is determined by formulating the standard of basic medical insurance service facilities. In order to standardize the scope of medical service facilities and payment standards, various provinces and cities have also formulated corresponding measures to ensure the basic medical needs of the insured.
The three catalogues are the scope of drugs, diagnosis and treatment projects and medical service facilities that can be paid by the comprehensive medical insurance fund. The reimbursement standards for specific items and drugs shall be formulated by the municipal labor and social security administrative department in accordance with the relevant provisions of the national and provincial basic medical insurance.
① Drug reimbursement: Drugs are mainly divided into Class A, Class B and out-of-range. Class A drugs are included in the comprehensive payment and can be reimbursed according to regulations; Class B drugs must bear a certain proportion by individuals before they can be included in the comprehensive payment. For example, the antibiotic "must cure bacteria", 20% of the cost is paid by the individual, and the rest is included in the comprehensive payment; Out-of-range drug costs are entirely borne by individuals.
② Reimbursement of diagnosis and treatment items: diagnosis and treatment items are divided into overall planning items, partial overall planning items and out-of-scope items. All items are included in the total payment; Some overall planning projects must be undertaken by individuals before they can be included in the overall planning scope. For example, individuals must bear 20% of the cost of CT examination, and the rest can be included in the scope of overall fund payment. Beyond the scope of the project costs should be borne by individuals.
③ Reimbursement of medical service facilities: items not included in the comprehensive reimbursement scope shall be borne by individuals; Items included in the scope of reimbursement are reimbursed according to the standard. If the bed fee of tertiary hospital is 23 yuan/bed day, the bed fee exceeding this standard shall be borne by the individual. If the actual bed fee is lower than the reimbursement standard, it will be included in the overall plan according to the actual cost.