Schlagwort: ‘Reimbursement’
Shandong: Online medical insurance payment + medication home delivery service
On 18th January, the Shandong Medical Insurance Bureau issued the interpretation of the “Notice on Insisting on the Innovation of Traditional and Intelligent Medical Services and Implementing the Twelve Measures of Convenient Medical Services for the Elderly. ” The “Notice” stipulates that the “online consultation”, “online prescription renewal”, “online medical insurance payment” and “medication home delivery service” should be realized with the help of the provincial online medical insurance service platform and internet hospitals.
医保局1号文力推“线上医保结算+线下送药上门”！ 年内全面落地！
来源：医药网 2021.01.20
1月18日，山东医保局官网挂出《关于坚持传统服务与智能化服务创新并行推行老年人医疗保障便捷服务十二条措施的通知》的政策解读。《通知》要求，应依托省互联网医保大健康服务平台、互联网医院等“互联网+医保”服务新模式，实现复诊“线上问诊““线上续方”“线上医保结算”“线下送药上门”服务。
The NMPA: Internet hospitals can get reimbursement
On January 11th, the NMPA issued the “Interim Measures for the Administration of Designated Pharmacy Chains regarding Basic Medical Insurance” and the “Interim Measures for the Administration of Designated Medical Institutions regarding Basic Medical Insurance”, which will be implemented from February 1st, 2021. These two measures stipulate that local medial insurance agencies can pay the service cost produced by internet hospitals by paying to the designated medical institutions they rely on. Moreover, the two measures indicate that designated pharmacy chains can sell prescription drugs to patients when they have electronic prescriptions issued by designed medical institutions.
国家医保局：互联网医院可报销 网售处方药仍待明确
来源：医药网 2021.01.13
1月11日，国家医保局正式对外发布《零售药店医疗保障定点管理暂行办法》和《医疗机构医疗保障定点管理暂行办法》并均将于2021年2月1日起施行。“两定办法”规定，互联网医院提供服务产生的相关费用可由其依托的定点医疗机构与当地医保经办机构结算。此外，“两定办法”提出，医保定点零售药店可凭医保定点医疗机构开具的电子处方销售药品。
Unified reimbursement rate of online and offline medical consultations
Recently, the NMPA issued the “Guidelines on Promoting the Medical Insurance Payment of Online Medial consultation services.” The “Guidelines” clarifies that medical entities can help eligible online medical institutions that rely on them to be included in medical insurance, and the reimbursement rate for online and offline medical institutions is the same. The “Guideline” indicates that the payment of consultations and drugs for patients that need further consultations is also included in the medical insurance, which should be paid according to the regulations in different cities.
国家医保局：“互联网+”医保支付采取线上线下一致
来源：医药网 2020.11.04
日前，国家医疗保障局印发《关于积极推进“互联网+”医疗服务医保支付工作的指导意见》。《意见》明确，符合条件的互联网医疗机构可以通过其依托的实体医疗机构，自愿“签约”纳入医保定点范围，“互联网+”医保支付将采取线上、线下一致的报销政策。《意见》提出，医保参保人在本统筹地区“互联网+”定点医疗机构复诊并开具处方发生的诊察费和药品费，可以按照当地医保规定支付。
The NMPA: implementation of Diagnosis-Intervention Packet
On October 19th, the NMPA issued the “Notice on the Pilot Work of the Regional Point-Based Medical Insurance Fund Allocation and the Diagnosis-Intervention Packet.” The “Notice” stipulates that medical institutions should change the costs of each medical services into points; the regional medical insurance bureaus should calculate the value of each point according to the amount of points provided by all medical institutions of each region and the budget of medical insurance funds to pay for those medical institutions (Diagnosis-Intervention Paket). The “Notice” indicates that a data center on the basis of the unified national medical insurance information coding list should be established, which can inspect the quality of medical insurance settlement checklists, medical insurance cost schedule etc.
国家医保局发布区域点数法总额预算和按病种分值付费试点工作方案
来源：HIT专家网 2020.10.20
10月19日，国家医保局下发《国家医疗保障局办公室关于印发区域点数法总额预算和按病种分值付费试点工作方案的通知》（以下简称《通知》）。《通知》要求，医疗机构应将治疗项目等付费单元转化为一定点数；医保部门年底根据各医疗机构所提供服务的总点数以及地区医保基金支出预算得出每个点的实际价值，按照各医疗机构实际点数付费。《通知》指出，应打造数据中心，在全国统一的相关医保信息业务编码的基础上，开展医保结算清单、医保费用明细表等质量控制工作。
Pharmacy chains can only rise the price of drug in the reimbursement list by 15%
On September 1st, the “Reform Project on Improving the Functions of the Centralised Drug Procurement Platform and Promoting a Full Coverage of Payment Requirement of Drugs on the Reimbursement List in Zhejiang Province” was implemented. The “Project” indicates that drugs included in the list of online transactions on the provincal procurement platform of drugs and medical equipments are included in the provincal drug reimbursement list. Designated public medical institutions and private medical institutions should fix the drug price that accords with the price on the drug reimbursement list while pharmacy chains can rise the price upto 15% based on the price on the list.
9月1日起执行：医保用药 药店只能加价15%
来源：医药网 2020.09.03
9月1日，《浙江省提升药品集中采购平台功能推进医保药品支付标准全覆盖改革方案》正式实施。《方案》明确，所有纳入该省药械采购平台在线交易的医保目录内药品均纳入医保支付范围。其中，定点公立医疗机构与民营医疗机构医保药品执行相同的支付标准，定点零售药店医保支付标准统一按医疗机构支付标准上浮15%。
Reimbursing online medical consulting services
On July 21st, the General Office of the State Council issued the “Opinions on Optimizing the Business Environment to Better Serve the Market Participants”. The “Opinions” indicates that under the premise of ensuring the medical safety and quality, the range of the online medical consulting services should be extended and qualified online medical consulting services should be included in the reimbursement list. In addition, a national unified approval requirement for online medical consulting services should be formulated and announced.
国务院：进一步放宽互联网诊疗范围， 将符合条件的医疗服务纳入医保报销
来源：搜狐网 2020.07.23
7月21日，国务院办公厅发布《关于进一步优化营商环境更好服务市场主体的实施意见》（以下简称《意见》）。《意见》指出，在保证医疗安全和质量的前提下，应进一步放宽互联网诊疗范围，将符合条件的互联网医疗服务纳入医保报销范围，并制定公布全国统一的互联网医疗审批标准。
Hospitals in Guizhou should pay for drugs within 30 days
Recently, the Healthcare Security Administration of Guizhou Province issued the “Measures on Managing the Settlement of the Centralised Procurement of Drugs in Guizhou Province.” The “Measures” indicates that medical institutions should transfer the drug payment to the settlement account on time, which means that the time range between the day after the delivery of the medicines is qualified and the storage is confirmed and the day of transfer should be less than 30 days. In addition, the settlement of medical insurance expenses by designated medical institutions organised by medical insurance agencies in different levels should not exceed 25 working day from the date of submitting the application of reimbursement.
1365家医院30天必须回款
来源：新浪医药新闻 2020.07.15
近日，贵州省医保局发布《贵州省药品集中采购货款统一结算管理实施暂行办法（征求意见稿）》。《征求意见稿》提出，医疗机构应按时将结算采购货款划拨到结算账户，从药品交货验收合格、确认入库的次日开始计算，不得超过30天。同时，各级医保经办机构对定点医疗机构医疗保险费用的结算从申请提交之日起不超过25个工作日。
Ningbo: medical insurance will not reimburse drugs that are not included in the “selected drugs”-list
On June 19th, the Ningbo Municipal Medical Insurance Bureau collects opinions from the whole society for the plan of centralized procurement of medicines and medical consumable materials in public medical institutions. The “Plan” stipulates that the medical insurance fund will not pay for medicines that are similar to the selected drugs but are not included in the list of selected drugs.
宁波集采新规：医保不报销非中选产品
来源：医药网 2020.06.17
6月19日，浙江省宁波市医保局向全社会征集公立医疗机构药品、医用耗材集中采购的工作方案。《方案》要求，公立医疗机构若采购中选产品目录以外的同类产品，医保基金不予支付。
Implementing online medical insurance settlement of prescriptions
On May 20th, the “Opinion on Settling the Price and Medical Insurance Payment of ‘Internet+’ Medical Services” issued by the Healthcare Security Administration of Chongqing province came into effect. The “Opinion” stipulates that for the pilot program of the “Internet+” medical insurance services for common and chronic diseases, doctors can issue electronic prescriptions after online consultations and settle up the medication costs online through medical insurance, and it is allowed to deliver medicines to patients in many ways.
线上处方医保支付落地！处方流转迎来新机遇！
来源：医药网 2020.05.21
5月20日，重庆市医疗保障局《关于“互联网+”医疗服务价格和医保支付政策的实施意见》开始实施。《意见》提出，对于正在试点的常见病、慢性病“互联网+”医保服务，患者通过网上问诊后，可由医生开出电子处方，医保在线结算，并且允许通过多种方式为患者进行配送。
Zhejiang: restricting the medication costs
On May 11th, the Medical Insurance Bureau of Zhejiang Province issued the “Regulations of DRGs Payment on Hospitalization Expenses of Basic Medical Insurance in Zhejiang Province and Hangzhou.” The “Regulation” clarifies that designated medical institutions can retain 85% of the settlement balance of medical insurance fund while they should pay 85% of the overspending. Moreover, the “Regulation” stipulates that designated medical institutions should restrict the cost of drugs, materials, and diagnosis and treatment services that are paid by inpatients on their own, which should be within 15% of their medical cost.
浙江医保新政策：医院要砍品种了 严控药费
来源：医药网 2020.05.14
5月11日，浙江省医保局印发《浙江省省级及杭州市基本医疗保险住院费用DRGs点数付费实施细则（试行）》。《细则》明确，2020年度医保基金年度结算结余部分的85%由定点医疗机构留用；超支部分的85%由定点医疗机构分担。《细则》要求，定点医疗机构应合理控制住院病人自费的药物、材料和诊疗项目费用，个人政策范围外费用比例原则上应控制在15%以内。