The medical insurance fund is the "medical money" and "life-saving money" of the people. On the 13th, the National Medical Insurance Administration issued a notice on further deepening the intelligent review and monitoring of medical security funds, clarifying the implementation of real-time dynamic intelligent monitoring of big data, achieving full coverage of intelligent review of medical insurance fund payments, and constructing a fund security prevention and control mechanism for pre, during, and post supervision. The notice clearly states that by the end of 2023, all coordinated regions will have launched intelligent supervision subsystems, and intelligent audit and monitoring data will be accurately uploaded to the national medical insurance information platform. We will comprehensively carry out intelligent audit handling, and preliminarily achieve the "one network" of national intelligent monitoring; By the end of 2025, a standardized, scientific, and normalized intelligent audit and monitoring system will be basically established, forming a normalized regulatory system that handles various methods such as daily audit and on-site verification, big data analysis, and full scene intelligent monitoring. The notice requires that the intelligent review and monitoring of medical insurance funds be combined with protocol management work, and effective measures should be taken to encourage designated medical institutions to actively connect with the intelligent supervision subsystem. The system connection situation should be linked to the annual assessment of designated medical institutions. At the same time, explore policies such as reducing the frequency of on-site inspections for pharmaceutical institutions that actively strengthen the application of intelligent regulatory systems and carry out self inspection and self correction. According to the relevant person in charge of the National Medical Insurance Bureau, overall, medical institutions can automatically remind and intercept medical personnel of obvious violations through intelligent monitoring, and provide real-time reminders for suspicious violations. Currently, more and more designated hospitals are actively utilizing intelligent monitoring to achieve self inspection and self correction, reducing the occurrence of violations. The person in charge introduced that strengthening the supervision of medical insurance funds through intelligent regulatory measures will not have an impact on the normal medical treatment behavior of insured individuals. For clear violations, it is necessary to strengthen supervision and intervention, and gradually achieve automatic interception of violations that can be rigidly constrained; For issues related to medical rationality, after the system detects suspicious issues, they should be promptly reported to designated medical institutions for appeal. They should fully listen to the appeal opinions of medical institutions and determine whether to pay after necessary review, deliberation, final review, and other procedures. (New News Agency)
Edit：GuoGuo Responsible editor：FangZhiYou
Source：gmw.cn
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