Time:

Participants: All medical personnel.

Speaker: Zhang Jun.

Training content: Detailed description of medical insurance policy.

First, carefully verify the insured's ID card and medical insurance manual, implement the relevant provisions of provincial and municipal medical insurance centers, and timely identify the hospitalization information of the insured on the nursing list (such as the attribution of medical insurance in provinces, cities and counties and different places). Inform the medical insurance center in time when problems are found, and refuse to enter the medical insurance system. When going through the hospitalization formalities, the medical insurance manual shall be kept by the hospital nursing department for verification by the medical insurance center. Hospitals are not allowed to commit the illegal act of "hanging bed for hospitalization".

2. The interval between two hospitalizations of the insured shall not be less than 28 days (except for emergency admission, normal referral and tumor radiotherapy and chemotherapy). Hospitals can't require the insured to go to the outpatient clinic or set up a separate out-of-pocket account to pay for the expenses during hospitalization. Patients who do not meet the discharge standards shall not be rushed out of the hospital or hospitalized at their own expense on the grounds of the index control of the medical insurance center, and the quality of medical services shall not be reduced.

Third, hospitals must strictly manage the hospitalization of insured patients, and there must be no "false hospitalization" to fabricate medical documents or other fraud and other irregularities.

Four, because of medical technology and equipment conditions need to be transferred, the hospital in a timely manner for patients to go through the formalities of discharge and checkout, according to the relevant provisions of medical insurance for transfer procedures.

Five, the hospital should be based on the principle of reducing the personal burden of the insured. If it is really necessary to use some or all of the self-funded drugs, diagnosis and treatment projects and medical service facilities due to illness, it is necessary to fill in the "Consent for Self-funded Projects of Medical Insurance Patients" item by item, and explain it clearly to patients and their families before using it. Insured patients who require over-standard medical services shall sign and promise that the over-standard service fees shall be borne by individuals, and the medical insurance department shall not be included in the control scope of the total medical expenses.

Six, strictly grasp the indications of various tests and inspections, and do not list some unnecessary inspections and special items as routine inspections.

Seven, reasonable examination, rational drug use, reasonable treatment. Laboratory examination, medication and treatment should be explained in the course record, and the results should be analyzed. Realize the "four matching of hospitalization expenses".

8. The medical expenses incurred by the insured for medical treatment due to the following circumstances are not included in the compensation scope of the basic medical insurance fund: (1) Suicide, self-mutilation, fighting, alcoholism and drug abuse; (2) Traffic and medical accidents; (3), plastic surgery, plastic surgery; (4) medical expenses incurred in going abroad or going to Hong Kong, Macao and Taiwan;

(five) without approval, in the non basic medical insurance designated medical institutions for medical treatment; (six) beyond the prescribed disease list, drug list, diagnosis and treatment items, medical service items and payment standards; (seven), other illegal acts lead to injury, illness, disability.