time:
Participants: All medical staff
Speaker: Zhang Jun
Training content: Detailed explanation of medical insurance policy
1. Carefully verify the ID card and "Medical Insurance Manual" of the insured person, implement the relevant regulations of the provincial and municipal medical insurance centers, and promptly mark the hospitalization information of the insured person on the nursing list (such as the province, city, county, and other places where medical insurance is located) ). If problems are discovered, the medical insurance center should be notified promptly and access to the medical insurance system should be refused. When going through hospitalization procedures, submit the "Medical Insurance Manual" to the hospital nursing department for safekeeping for verification by the medical insurance center. The hospital shall not violate the rules of "hospitalization by hanging bed".
2. The interval between two hospitalizations of insured persons shall not be less than 28 days (except for emergency admission, normal transfer, and tumor radiotherapy and chemotherapy). The hospital cannot require insured persons to go to outpatient clinics or set up separate self-pay accounts to pay fees during hospitalization. Patients who do not meet the discharge standards shall not be expelled from the hospital or hospitalized at their own expense on the grounds of the medical insurance center's indicator control, nor shall it lower the quality of medical services.
3. The hospital must strictly manage the hospitalization treatment of insured patients, and shall not engage in illegal activities such as "hospitalization under false pretences", fabricating medical documents or other fraud.
4. When the patient needs to be transferred to a higher-level hospital for treatment due to limitations in medical technology and equipment, the hospital will handle the patient's discharge and checkout procedures in a timely manner, and handle the transfer procedures in accordance with relevant medical insurance regulations.
5. The hospital should adhere to the principle of reducing the personal burden of insured persons. When it is necessary to use partially or fully self-paid drugs, diagnosis and treatment items, and medical service facilities due to illness, the hospital must fill in the "Medical Insurance Patient Self-paid Items Consent Form" item by item, and Explain clearly to the patient and family members and sign for confirmation before use. Insured patients who require medical services to be provided beyond the standard must sign a commitment that the cost of exceeding the standard service will be borne entirely by the individual, and the medical insurance department may not include it in the total medical expense control.
6. Strictly grasp the indications of various tests and examinations, and do not list unnecessary examinations and special items as routine examinations.
7. Reasonable examination, rational use of medication, and rational treatment. Laboratory examinations, medications, and treatments should be described in the course record, with results analyzed. Achieve "four consistent hospitalization expenses".
8. Medical expenses incurred by insured persons for medical treatment caused by the following circumstances are not included in the compensation scope of the basic medical insurance fund: (1) suicide, self-mutilation, fighting, alcoholism and drug abuse; (2) traffic and medical accidents; (2) traffic and medical accidents; 3) Plastic surgery; (4) Medical expenses incurred when going abroad or to Hong Kong, Macao and Taiwan;
(5) Seeking medical treatment at non-designated basic medical insurance designated medical institutions without approval; (6) Exceeding the prescribed disease catalog, drug catalog, diagnosis and treatment items, medical service scope and payment standards; (7) Other illegal acts resulting in injury, illness or disability.