Bac Ninh: Rectifying medical examination and treatment, payment of health insurance costs

Accordingly, to strengthen the work of preventing and combating abuse and profiteering of health insurance, ensuring the rights of health insurance participants, using health insurance funds reasonably and effectively, promptly detecting, preventing and strictly handling violations of the law on health insurance examination and treatment, the Provincial Social Insurance requests health insurance examination and treatment facilities in the province to enhance their sense of responsibility, develop plans to inspect, supervise and rectify health insurance examination and treatment; strengthen self-inspection to prevent and combat abuse, fraud and profiteering of health insurance funds at the unit.

Illustration photo.

Ensure that the human resources performing health insurance examination and treatment at the unit have full diplomas, training certificates, and practice licenses according to regulations, are assigned to perform medical examination and treatment, and perform technical services in accordance with the scope of professional activities on the practice license and training certificate, and the time of performing medical examination and treatment of practitioners at the unit must be in accordance with the time of registration to practice at the unit according to the unit's practice registration list posted on the Electronic Information Portal or the Electronic Information Page of the competent authority that issues operating licenses according to regulations. Regularly check and review the operating status of machinery and medical equipment serving medical examination and treatment.

Make a list of medical examination and treatment costs of patients to ensure accuracy, publicity, transparency and must have the signature of the patient or the patient's family to save the medical record and provide the patient with a copy in accordance with the provisions of Decision No. 6556/QD-BYT dated October 30, 2018 of the Minister of Health . Publish the price list of medical services approved by the competent authority at the place of patient admission and payment. The price list of medical services must be clear, easy to read, easy to see, and the medical examination and treatment facility must promptly answer the patient's questions related to the price of medical services. The medical examination and treatment facility covered by health insurance is fully responsible before the law if there is fraud or profiteering from the health insurance fund at the unit.

The grassroots social insurance has a plan to control the cost of medical examination and treatment under health insurance. Regularly analyze and evaluate the situation of medical examination and treatment under health insurance of the medical examination and treatment facilities under the authority of signing contracts, focusing on reviewing, analyzing and evaluating the causes (objective and subjective) leading to the increase in medical examination and treatment indicators under health insurance of each medical examination and treatment facility, developing detailed assessment outlines, proposing solutions to strengthen management and control of the use of medical examination and treatment funds under health insurance for medical examination and treatment facilities.

The Director of the Social Insurance at the grassroots level directly directs and organizes the effective implementation of the health insurance policy in general and the health insurance appraisal work in particular. Strictly and fully implement the appraisal process issued with Decision No. 3618/QD-BHXH of the Vietnam Social Insurance. Implement and be responsible for the results of the review, thematic appraisal, and data appraisal announced by the Provincial Social Insurance. Arrange human resources to perform health insurance appraisal flexibly, in accordance with the actual appraisal requirements at each medical examination and treatment facility and the workload of health insurance appraisal.

Resolutely refuse to pay for medical examination and treatment costs covered by health insurance that are not in accordance with regulations. Seriously monitor and evaluate the adjustment of the average increase indicators according to the warning of the Provincial Social Insurance of the medical examination and treatment facility covered by health insurance. In case the medical examination and treatment facility covered by health insurance does not adjust or the adjustment efficiency is low, the organization will work with the medical examination and treatment facility to request the medical examination and treatment facility to clarify the reasons for the increase in the average cost indicator and implement appropriate adjustment solutions and report the implementation results to the Provincial Social Insurance according to regulations.

Source: https://baobacninhtv.vn/bao-hiem-xa-hoi-tinh-bac-ninh-chan-chinh-cong-tac-kham-chua-benh-thanh-toan-chi-phi-kham-chua-benh-bao-hiem-y-te-postid428924.bbg