The National Medical Insurance Administration solicits opinions on the management of medical insurance payment qualifications for personnel related to designated medical institutions

2023-10-13

In order to strengthen the supervision of medical service behavior and medical expenses included in the scope of medical insurance payment, the National Medical Insurance Bureau publicly solicited opinions on the 8th on the "Guiding Opinions on Strengthening the Management of Medical Insurance Payment Qualifications for Personnel in Designated Medical Institutions (Draft for Soliciting Opinions)". The deadline for feedback is October 17, 2023. The draft for soliciting opinions clarifies the management objects and requirements. The management object is the personnel involved in the use of medical security funds by designated medical institutions, mainly including two categories: medical, pharmaceutical, nursing, technical and other health professionals who provide medical services to insured individuals by designated medical institutions; Pharmacists (including licensed pharmacists and traditional Chinese medicine pharmacists) who provide medical services for insured individuals using fund settlement in designated retail pharmacies. According to the service agreement signed between the designated medical institution registered for practice and the medical security agency, relevant personnel are eligible for medical insurance payment, provide medical services to insured individuals, and include them in the scope of medical insurance supervision. The draft for soliciting opinions proposes that medical security agencies can refer to the scoring standards to score relevant responsible personnel for their violations of service agreements and commitments, and promptly report the scoring situation to the designated medical institutions where the relevant responsible personnel are located (including designated medical institutions that practice at multiple locations). After the accumulated score within the year reaches a certain value, the payment qualifications of relevant responsible personnel and the settlement of medical insurance fees shall be suspended or terminated according to the service agreement. The draft for soliciting opinions proposes that medical security agencies at all levels should open up channels for objection appeals, and accept statements and defenses from designated medical institutions regarding the dynamic maintenance of scoring results and registration status objections raised by relevant personnel of their own institutions. Reporter: Peng Yunjia (Xinhua News Agency)

Edit:GuoGuo    Responsible editor:FangZhiYou

Source:people.cn

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