'Having an X-ray for a full 6 minutes' is not the only basis for health insurance reimbursement.

The Ministry of Health affirms that the time taken in the radiology procedure is for professional reference only and should not be used as a basis for health insurance to refuse payment.

X-ray imaging. (illustrative image)

The Ministry of Health has issued a directive to address obstacles in health insurance payments related to the processing time of diagnostic imaging and interventional radiology services, following complaints from numerous medical facilities about being denied reimbursement for "procedures performed too quickly."

Previously, on August 29, 2025, the Ministry of Health issued Decisions 2775 and 2776, respectively publishing two sets of documents: "Guidelines for Technical Procedures in Diagnostic Imaging" and "Guidelines for Technical Procedures in Interventional Radiology - Volume 1," totaling over 550 technical procedures. These are specialized documents aimed at standardizing practices, improving service quality, and ensuring patient safety.

During implementation, some localities and hospitals reported that social insurance agencies used the time parameters recorded in the technical procedures as a basis for assessment and refusal of health insurance payments. In some cases, X-rays lasting less than 6 minutes and echocardiograms lasting less than 30 minutes were deemed "not up to standard," even though the results still had diagnostic value.

According to the Ministry of Health, such an interpretation and application is incorrect in its understanding of the nature of professional guidelines. The time parameters in technical procedures are only average reference times, developed based on common practice, to support professional expertise and ensure safety, and are not legally mandatory criteria.

The time recorded on technical systems such as PACS, DICOM files, or equipment logs primarily reflects the operating time of the machine, such as radiation, scanning, or direct ultrasound. This data does not cover the entire procedure, which includes many other crucial steps such as patient confirmation, history taking, positioning instructions, comparison with previous results, image interpretation and analysis, consultation, and result delivery.

"Using machine time alone to compare with the time in the guidelines and then using it as a basis for refusing payment is inconsistent with technical procedures," the Ministry of Health stated. In reality, the time to perform a service can vary depending on the clinical condition, professional requirements, personnel qualifications, and the level of modernity and automation of the equipment at each facility.

Regarding the principles of health insurance reimbursement, the Ministry of Health affirms that the assessment of radiology services is not based on the time parameters in the technical guidelines. Instead, the insurance agency needs to evaluate the overall medical records and the actual service provided, including the appropriateness of the indication, adherence to the main professional steps, the clinical value of the results, and the human resources and equipment conditions at the medical facility.

The Ministry of Health also cited current regulations in Circular 35/2016 and subsequent amendments and supplements, which clearly stipulate the conditions and principles for payment for services such as X-ray, CT scanner, ultrasound, and MRI.

In cases where unusually high numbers or abuse of services are detected, the social insurance agency is responsible for coordinating with hospitals and local health management agencies to inspect and verify the information in accordance with legal procedures, instead of mechanically applying a single time criterion.

To ensure consistency in implementation, the Ministry of Health requests the Ministry of Finance to direct the Vietnam Social Security to conduct audits and make payments in accordance with regulations, and not to use the time parameter in the radiology procedure guidelines as a basis for rejecting payments. According to the Ministry of Health, this not only protects the legitimate rights of medical facilities but also directly affects the rights of health insurance participants.

HA (synthetic)

Source: https://baohaiphong.vn/chup-x-quang-du-6-phut-khong-phai-can-cu-duy-nhat-de-tra-bao-hiem-y-te-535569.html