Medicare designated hospital management system is as follows:
1, the health insurance agency for designated medical institutions to implement the agreement management. The content of the agreement includes the scope of services, services, service quality, cost settlement, audit and control of the approach, as well as the rights, obligations and responsibilities of both parties, the agreement is valid for one year. Either party violates the agreement, the other party has the right to terminate the agreement, but must notify the other party and the relevant participants three months in advance, and reported to the Municipal Labor Security Bureau for the record.
2. The designated medical institutions shall hang the signboard of "Designated Medical Institution" in the prominent position of their units, and keep it properly, and shall not transfer or damage it. The medical insurance agency shall recover the fixed-point label in time after the agreement with the fixed-point medical institution is canceled or terminated.
3. When an insured person visits a designated medical institution, the designated medical institution shall record in detail the examination, treatment and medication in the medical record issued by the medical insurance administration organization, and if a request is made for dispensing of prescription, the designated medical institution shall provide the dispensing of the prescription and stamp it with the valid seal of the designated medical institution.
What does it mean to be a designated medical institution?
A designated medical institution is a medical institution that has been examined by the labor security administrative department of the coordinating area, and has signed an agreement with the medical insurance agency, and has been determined by the social insurance agency, to provide medical services for the urban workers' basic medical insurance participants, and to bear the corresponding responsibility. This includes public medical institutions and private medical institutions with certain qualifications.
The designated medical institutions will hang the label of designated medical institutions issued by the Human Resources and Social Security Bureau from the date of approval by the Human Resources and Social Security Bureau.
2. What are the categories of designated medical institutions?
1, general hospitals, hospitals of traditional Chinese medicine, Chinese and Western medicine hospitals, specialized hospitals;
2, central health centers, township (township) health centers, street health centers, maternity and child health care hospitals (institutes);
3, general outpatient clinics, specialized outpatient clinics, outpatient Chinese medicine clinics, outpatient Chinese and Western medicine clinics;
4, clinics, clinics, clinics of traditional Chinese medicine, health clinics, Medical clinic;
5, specialized disease control hospitals (institutes, stations);
6, approved by the health administrative department to set up community health service centers, stations;
7, social services to the military medical institutions.
Three, apply for basic medical insurance designated medical institutions must have the conditions are?
1, in line with the regional medical institutions set up planning.
2, in line with the standards for the evaluation of medical institutions
3, to comply with national and municipal laws, regulations and standards relating to the management of medical services, there are sound and perfect medical services management system.
(1) the development and implementation of the Health Bureau of medical quality management standards for common diseases clinic;
(2) drugs, medical equipment, medical materials, medical statistics, case management, financial and other management systems;
(3) accurately provide outpatient emergency room, hospitalization, single-patient costs and other relevant information.
4. Strictly implementing the prices and charges of medical services and medicines set by the national and municipal price departments, and passing the inspection of the price departments.
5. Strictly enforcing the relevant policies and regulations of the basic medical insurance system, establishing an internal management system compatible with the management of basic medical insurance, and equipping it with full-time (part-time) management personnel and specialized equipment.
Through the reading of the above medical insurance need to be designated, designated medical institutions refers to the coordinated area of labor security administrative department review, and signed an agreement with the medical insurance agency, and the social insurance agency to determine, for the urban workers of the basic medical insurance participants to provide medical services, and bear the corresponding responsibility of the medical institutions. If you still have its
Legal basis
"Chinese People's Republic of China Social Insurance Law"
Article 29 The part of the medical expenses of the insured persons which should be paid by the basic medical insurance fund shall be settled directly by the social insurance agency with the medical institutions and the 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. Article 30 The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:
(1) those that should be paid from the workers' compensation insurance fund;
(2) those that should be borne by a third person;
(3) those that should be borne by the public ****health;
(4) those that seek medical treatment outside China.
Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.