Fees for “Internet +” medical follow-up drugs can be paid in accordance with health insurance regulations. The National Health Insurance Administration issued a document to actively promote the health insurance payment work of the “Internet +” medical service _ 东方 财 网

Original title: “Internet +” medical follow-up drug fees can be paid in accordance with health insurance regulations. The National Health Insurance Administration issued a document to actively promote the health insurance payment work of the “Internet +” medical service

On November 2, the National Health Security Administration published “About Active Promotion”Internet ++ “medical serviceMedicare paymentjobsguideopinion“(Hereafter referred to as opinions). Suggestions, do a good job”The Internet+ “DoctorServiceHealth insurance payment work should follow the principle of “highlighting key points and constant expansion.” Priority should be given to ensuring the demand for follow-up visits and prescription renewals such as chronic and special diseases in outpatient clinics, which increased significantlylongConvenience for patients to go to the doctor to buy medicine.In the standard development of “Internet +” medical services and doctorsStorageLiheAbility to payOn the basis of improvement, constantly expand the scope of health insurance payment.

The opinion holds that medical expenses and drug fees incurred by the insured person in the medical institution designated by the medical service “Internet +” in the general planning area can be paid in accordance with the planning area medical insurance regulations general.

Medical treatmentstrategyadvisorythe companyZhao Heng, founder of Latitude Health, told the “Daily Economic News” reporter that outpatient coordination is the focus of health insurance promotion, and outpatient chronic disease is the focus of outpatient coordination, so health insurance from InternetRefundIt will also lean towards chronic outpatient diseases. In the future, it will be possible to promote the reimbursement of medical insurance for common illnesses in the “Internet +” medical service.

　　Adhere to the principle of consistency between online and offline

By prioritizing the need for follow-up visits and prescriptions for outpatients with chronic and special conditions, will you drive the need for follow-up visits to switch from offline to online?

In Zhao Heng’s opinion, this mainly depends on theto acceptGrade and usability.As chronic diseases are mainly elderlygroupTheir use of the Internet is not widespread, so it is possible that services for young people with chronic diseases will be developed first.

Regarding the scope of payment for medical services, the opinion proposed that the scope of payment should be determined in accordance with local health insurance policies and the service content of designated medical institutions that provide “Internet +” medical services. The insured person’s medical examination fees and drug fees incurred in medical institutions designated by the “Internet +” medical service in the general planning area can be paid in accordance with the medical insurance regulations of the general planning area . Among them, the expenses borne by the individual can be paid by the employee’s personal health insurance account in accordance with the regulations.

In the future, the scope of health insurance payment will continue to expand. The ruling proposes that all localities can start from outpatient clinics for chronic diseases and gradually expand the scope of health insurance for “Internet +” medical services for common and chronic diseases.

New “Internet +” medical services declared by medical institutionspriceProjects, opinions submitted that all localities must adhere to the principle of results orientation, reflecting the law of resource consumption and reasonable connection between online and offline, speed up acceptance and review, scientifically determine the name of the project, content of the service, the price unit, the charging method, etc., for inter-agency cooperation. Services and income distribution provide the basis for the policy. Designated medical institutions provide “Internet +” qualified medical follow-up services and charge and pay according to the prices of general outpatient clinics in public hospitals.

In general, the “Internet +” medical service health insurance payment work should adhere to the principle of “consistency online and offline”. The rulings emphasized that a fair health insurance payment policy should be implemented for online and offline medical services, maintaining a balanced level of treatment and fostering fair competition between online and offline medical institutions.

　　drugdeliveryRates are not included in medical insurance.

Reviews support “Internet +” follow-up prescription drug circulation Browse designated medical institutions to purchase prescription information and designated pointsRetailPharmacies are interconnected and areas where conditions permit can rely on the unified national health insurance information platform to accelerate the implementation of functional modules related to the circulation of subcontracting prescriptions, facilitating the circulation of re-examination prescriptions of “Internet +” medical services. Explore and coordinate the mutual recognition of functional modules related to the circulation of outsourcing prescriptions between regions to achieve “more information and prescriptions, patients fewer errands.”

The ruling also made it clear that the drug costs incurred will be paid in accordance with the rules and payment policies stipulated by offline health insurance. The cost of providing drug delivery services is not included in the scope of the health insurance payment.

Zhao Heng believes that the use of the unified national health insurance information platform as a prescription circulation platform will strengthen prescription oversight and also facilitate the payment of prescription outflows by health insurance.

Regarding the health insurance settlement, the opinion proposes that the medical expenses incurred in the circulation of follow-up “Internet +” prescriptions to the designated retail pharmacies in the general planning area will be covered by the medical insurance in accordance with the regulations.backgroundPayment will be settled by the regional health insurance agency and designated retail pharmacies.

In terms of oversight, the opinion clearly reinforces the health insurance department’s cost reviewresponsibility.Completely understand the information about the medical treatment of the insured person and the inspection and monitoring of the medical institution.behaviorRelated records Non-compliant drug fees and exam fees are providedRefusal to payAnd treat it according to the agreement.

In addition, it will crack down on fraud and insurance fraud in “Internet +” medical services. In the event of fraudulent insurance, the insured will suspend their eligibility to use the “Internet +” medical service, payment of medical insurance or direct settlement of medical insurance according to regulations.

(Source: Daily Economic News)

(Responsible editor: DF522)