Guangdong will inspect the case by random samples Renovate the hospital " Deceive and protect "

Guangdong will inspect the case by random samples Renovate the hospital " Deceive and protect "
There are new rules in the medical insurance from July 1 in Guangzhou
Handle the organization and inspect the prescription by random samples at random, the expenses in violation of rules and regulations of the hospital will be deducted
Information Times reports ' Reporter Huang Yan) Guangzhou municipal Labour Insurance Bureau, Municipal Health Bureau, municipal Bureau of Finance jointly gave notice yesterday, require every unit concerned enter into force on July 1 new " Guangzhou social the intersection of medical insurance and hospitalization cost close method " ' Hereafter referred to as " The method " ). The new method is clear, the city works and ensures the department to organize the medical expert regularly and spot check the cases and hospitalization costs which joins the sponsor at random, if find the expenses in violation of rules and regulations, in the fixed medical organization declare all pool expenses settled in the same term, account for the proportion of spotting check the total hospitalization cost of the case to deduct according to the expenses in violation of rules and regulations.
One pair of standards that the patient transfers from one hospital to another to get up " It is high "
Method suitable for medical insurance handle organization, fixed medical organization and the whole city effect an insurance the hospitalization cost among personnel is closed. Join sponsor, seek medical advice expenses that take place in fixed medical organization, handle the organization to settle by part that fund pay with fixed unit by the medical insurance of the city. Ordinary the door ' Urgent) Examine, press medical service item or " The limit once of moon " Or " year per person's limit " Wait for the way to settle account, " the door is slow " , door close according to medical service item and cycle ceiling way specially, the hospital bed set up at a patient's home is calculated according to ways such as medical service item and total value control or quota of daily average expenses of bed,etc.. To the single number of the policies and regulations, person's average fee limit way according to year or cycle of the fund is calculated. And ordinary the basic hospitalization cost in hospital of disease, calculate according to ways such as the medical service item or annual person's quota of average expenses or quota of daily average expenses of bed,etc..
The method stipulates, joined sponsors during in hospitalling because the condition needed to transfer from one hospital to another to treated, it gets up to pay the standard expenses to calculate in hospital according to once. Change over to hospital get up pairs of standard higher than produce hospital, join sponsor, must change hospital over to, hand in retroactively, blow, pay standard the intersection of expense and difference; Ones that are lower than producing the hospital, do not need to afford and pay the standard expenses separately.
The ones that have not been confirmed have exceeded standard the expenses hospital bears
Method stipulate, close on the checking and ratifying standard by norm in ordinary the intersection of disease and average expenses, do not exceed 120% of the expense average level of ordinary disease by norm, is most less than 70% of the expense average level of ordinary disease, newly-increased average expense of fixed hospital make ' Limit) Volume close standard, must check and ratify in the light of at the same level of the same type fixed standard of medical organization.
According to do the intersection of law and regulation, expenses close 85% of standard by norm on average through examine degrees of the intersection of person and average expenses to less than the year after next, clear and pay the corresponding pool expenses according to the basic hospitalization cost happening actually; If the average expenses of the annual person are higher than the average standard, is ordered to rectify and improve other punishment within a definite time period in according with condition and annual internal cause violation, refuse to pay the corresponding pool expenses; Go beyond on average the expenses are settled above 115% of standard by norm, refuse to clear the corresponding pool expenses; Exceed and settle account standard more than 4 times by norm, does not charge to the ordinary disease of the hospital and settle the standard expenses range by norm.
In single number settlement, but not through joining the superstandard expenses that sponsor or its relative confirmed, by the fixed commitments in full of medical organization. Through joining the superstandard expenses that sponsor or its relative confirmed, is joined sponsor's commitments in full.
Handle the organization to inspect by random samples at random
It is reported, the hospital " deceives and protects " Risk once again strengthen. The method stipulates, declare the hospitalization cost settled to the fixed medical organization per month, handle organization and collect no less than 5% at random ' The lowest quantity is no less than 10 )Case and their hospitalization cost carry on verify, to unreasonable expenses of checking, treating and using medicine etc. and decomposing in hospital, unreasonable in hospital and expenses that the behavior of transferring from one hospital to another etc. takes place, in the fixed medical organization declares all pool expenses settled in the same term, account for the proportion of spotting check the total hospitalization cost of the case to deduct according to the expenses in violation of rules and regulations.
The medical insurance will verify the situation feedback set point unit in violation of rules and regulations found if the medical insurance handles the organization, if the hospital has objections, should handle the organization and propose appealing and proving to the city medical insurance in writing in 15 workdays after receiving and feedbacking information. After the city medical insurance handles the organization and organizes experts to evaluate, and then pay the pool expenses according to the regulation.
Must at one time cure impatients
Join sponsor, reach, leave hospital standard arrange, leave hospital, the intersection of internal cause and the same disease get until will certainly some medical organization in hospital repeatedly 15 day, refuse to calculate and is in hospital the settlement person, expenses were incorporated into last time the expenses were calculated together in hospital in hospital this time.
Join sponsor internal cause get other fixed medical organization in hospital by the same disease in 15, handle medical insurance organization, check, confirm not true, deduct, join fixed the intersection of medical organization and 1 that sponsor in hospital last time, in hospital settlement person.

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