Schlagwort: ‘Reimbursement’
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。
Hospitals and pharmacies should pay the drug cost within 30 working days
On May 12th, the NMPA issued the “Notification on Issuing the List of National Medical Security Management Services.” The “Notification” stipulates that medical institutions including hospitals and pharmacy chains should pay the drug cost for distributors and manufacturers within 30 working days.
国家医保局：定点医院、药店费用结算时限不超过30个工作日
来源：医药网 2020.05.13
5月12日，国家医保局发布《关于印发全国医疗保障经办政务服务事项清单的通知》。《通知》明确，定点医疗机构（含医疗机构、零售药店）费用结算办理时间应不超过30个工作日。
The “One Invoice Policy” will be implemented
On March 5th, the State Council issued a document on reforming the medical and health care system. The document indicates that a regional and a national allied procurement system should be implemented to realize an orderly drug supply system with reasonable prices and competition; medical insurance agencies should deal with the settlement payment directly with manufacturers or pharmaceutical companies. Besides, provincial centralized procurement platforms that are based on medical insurance payment should be established, which combines bidding, procurement, trading, settlement, and supervision.
国务院：推行一票制 经销商结款方式要变了
来源：医药网 2020.03.09
3月5日，国务院官网发布医疗保障制度改革文件。文件提出，将推进构建区域型、全国性联盟采购机制，形成竞争充分、价格合理、规范有序的供应保障体系；推进由医保经办机构直接与药品生产或流通企业结算货款；应以医保支付为基础，建立招标、采购、交易、结算、监督一体化的省级招标采购平台。
Deepening the reform of the medical and health care system
On February 25th, the State Council issued the “Opinions on Deepening the Reform of the Medical and Health Care System.” The “Opinion” stipulates that medical institutions should improve the management of drug reimbursement lists, medical service protocols, and medicare settlement or increase the efficiency of medicare payment. Besides, the use of medical insurance funds should be strictly supervised, and insurance fraud will be dealt with according to legislation. In addition, the reform of centralized drug procurement should be deepened, and a pricing system that depends on the market should be established. Moreover, medical institutions should improve their service capacity and standardize new medical services, such as consulting over the internet.
关于深化医疗保障制度改革的意见
来源：医药网 2020.03.06
2月25日，国务院发布《关于深化医疗保障制度改革的意见》。《意见》要求，应完善医保目录、协议、结算管理，提升医保支付效率；完善医保基金监管，依法追究欺诈骗保行为；深化药品集中带量采购制度改革，并建立以市场为主导的药品价格形成机制；增强医疗服务能力，规范“互联网+医疗”等新服务模式发展。
97 negotiations targeted drugs will be published on the internet (National Negotiation)
On December 16th, the NHSA and the National Health Commission jointly issued the “Notification on Ensuring the Usage and Supply of Drugs that are Targeted in the National Negotiation.” The “Notification” stipulated that provincial healthcare security administrations should publish the 97 negotiations targeted drugs on their centralized procurement platform and their new reimbursement drug lists. Besides, healthcare departments should regulate the usage and supply of these drugs and instruct medical institutions to reserve and use them properly according to functions, clinical requirements, and healing effects.
两部门发文：97个国家谈判药品按时直接挂网
来源：医药网 2019.12.18
12月16日，国家医保局、国家卫健委联合发布《关于做好2019年国家医保谈判药品落地工作的通知》。《通知》要求，各省级医保部门应在规定时限内将97个谈判药品在省级药品集中采购平台上直接挂网，并保证新版目录及时落地。此外，各地医保和卫生部门应对谈判药品的配备及使用等方面提出具体要求，并指导各定点医疗机构根据功能定位、临床需求、和诊疗能力等即时配备、合理使用。
The National Medical Insurance Bureau issued new regulations
On August 30th, the National Medical Insurance Bureau issued the “Guidelines of Improving the price management of the ‘Internet+’ Medical Services and the Policies of Medical Insurance Payment.” The “Guidelines” proposed that the price management of the “Internet+” medical services should be included in the policy system of general medical services to realise a unified regulation. The eligible “Internet+” medial services will be regulated under proper medical insurance payment policies in accordance with the principle of online and offline consistency, and its management of medical insurance agreement(Every citizen contracts with a specific hospital) and the settlement process should be improved.
国家医保局公布新规，影响所有医药人
来源：医药网 2019.09.02
8月30日，国家医保局发布《关于完善“互联网+”医疗服务价格和医保支付政策的指导意见》（以下简称《指导意见》）。《指导意见》提出，应将“互联网+”医疗服务价格纳入先行医疗服务价格的政策体系统一管理；符合条件的“互联网+”医疗服务，按照线上线下公平的原则配套医保支付政策，并根据服务特点完善协议管理、结算流程。
The Xi’an Municipal Government launches the submission of increased purchase of selected drugs(“4+7”)
On August 6th, the Xi’an Municipal Government issued the “Notification on Launching the Submission of Increased Purchase of Selected Drugs in Xi’an from the ‘Office of the Leading Group for the Implementation of Centralized Drug Procurement and Pilot Work’”. It is decided to increase the purchase of selected drugs in Xi’an because its procurement exceeds expectations. Besides, the deferred payment of the increased procurement should be paid in time.
“4+7″采购量完成超预期，启动中选药品增加采购量报送
来源：医药网 2019.08.07
8月6日，西安市发布《落实国家组织药品集中采购和试点工作领导小组办公室关于启动西安地区中选药品增加采购量报送工作的通知》。因西安地区”4+7″准备采购量完成情况已经超过预期，经研究，决定启动西安地区中选药品增加采购量报送工作。同时，对于增加的采购量，应确保及时回款。