According to the Circular, in case a patient comes to the examination department for examination and is then assigned to inpatient treatment according to professional requirements, payment for the examination will be made according to regulations.
According to the Ministry of Health , the conditions for health insurance payment, if a patient visits the same medical facility at the same time (maybe on the same day after visiting a specialist, they need to see more specialists), then from the second visit, only 30% of the price of one medical examination will be charged...
This is one of the new points of Circular No. 39/2024/TT-BYT amending and supplementing a number of articles of Circular No. 35/2016/TT-BYT dated September 28, 2016 of the Minister of Health promulgating the List and rates, payment conditions for medical technical services within the scope of benefits of health insurance participants.
Determine the number of visits, prices and payment for medical examinations
Accordingly, Circular 39 has added regulations on determining the number of times, prices and payment for medical examinations in some specific cases.
According to the Circular, in case a patient comes to the examination department for examination and is then assigned to inpatient treatment according to professional requirements, payment for the examination will be made according to regulations.
In case you do not register for medical examination at the examination department but come for medical examination and inpatient treatment at clinical departments according to professional requirements, you will not have to pay for the medical examination.
Medical examination and treatment facilities that organize specialized examinations at the clinical department, people who register for medical examinations at the examination department and specialized examinations at the clinical department are counted as having medical examinations at the examination department. The calculation of the number of medical examinations and the price is implemented according to regulations.
According to Master Vu Nu Anh, Deputy Director of the Department of Health Insurance, Circular 39 has added the concept of "A medical examination and treatment session is defined as an outpatient visit or a treatment session (outpatient treatment or day treatment or inpatient treatment). The number of days of a medical examination and treatment session is decided by the practitioner based on the patient's medical condition."
How is the second or subsequent visits in one day calculated?
Circular 39 clearly states that, during the same visit to the same medical examination and treatment facility (possibly on the same day or due to objective conditions or professional requirements, the examination process cannot be completed during the day and must continue the examination on the following day), if a patient, after examining a specialist, needs to examine additional specialists, from the second examination, only 30% of the price of one medical examination will be charged and the maximum payment for that person's medical examination cost will not exceed 2 times the price of one medical examination.
For example, patient A is examined by an internal specialist, then the doctor prescribes a surgical specialist examination, the price of the surgical specialist examination (second examination) is calculated at 30% of the price of the first examination (internal specialist).
Patient A was examined by a neurologist, then was prescribed a neurosurgery examination by the doctor. The price of the neurosurgery examination (second examination) is calculated at 30% of the price of the first examination (neurology).
Patient A has a cardiology examination, then is prescribed a gastroenterology examination by the doctor. The gastroenterology examination fee (second examination) is calculated at 30% of the price of the first examination (cardiology).
Patient A was examined by an ENT specialist, then was assigned an in-depth audiology examination (vestibular/inner ear examination). The price of the in-depth audiology examination (second examination) was calculated at 30% of the price of the first examination (ENT specialist).
According to the Circular, if a patient comes to a medical examination and treatment facility, has been examined and given medicine for treatment, but then shows abnormal symptoms, goes to that medical examination and treatment facility for a re-examination on the same day and is continued to be examined, this visit is considered the second visit or more in one day, except in emergency cases, which are considered a new visit. Payment is made according to the provisions of the Circular.
How does the health insurance fund pay for examination tables with more than 65 examinations/8 hours/day?
Circular 39 clearly states that medical examination and treatment facilities must coordinate and arrange human resources and the number of examination tables as required to ensure the quality of medical examination. At the same time, regulations stipulate the maximum number of medical examinations paid by the social insurance agency for examination tables with more than 65 examinations within 8 hours/day, while the previous regulation was 65 examinations/day.
Accordingly, for examination tables that examine more than 65 times within 8 hours/day: the social insurance agency will only pay 50% of the examination fee from the 66th examination onwards of that examination table.
For a maximum of 3 consecutive months, if a medical examination and treatment facility still has an examination table with more than 65 examinations per day, the social insurance agency will not pay for the examination fees from the 66th examination or more of that examination table.
For example, if the medical examination time is 10 hours (due to 2 hours of overtime), the number of examinations per examination table for 10 working hours is 65:8x10 = 81 visits.
Circular 39 of the Ministry of Health takes effect from January 1, 2025./.
Source: https://www.vietnamplus.vn/bo-y-te-ban-hanh-huong-dan-moi-ve-thanh-toan-tien-kham-benh-bao-hiem-y-te-post995444.vnp
Comment (0)