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重大利好!跨省异地就医住院费用结算进入倒计时

2016-12-21 人力资源和社会保障部微信 人力资源和社会保障部微信

日前,人社部、财政部印发《关于做好基本医疗保险跨省异地就医住院医疗费用直接结算工作的通知》,这项被广泛关注的民生热点问题有说法了,赶紧来看看有什么要点。

日前,人社部、财政部印发《关于做好基本医疗保险跨省异地就医住院医疗费用直接结算工作的通知》,这项被广泛关注的民生热点问题有说法了,赶紧来看看有什么要点。




一、时间表

2016年底,基本实现全国联网,启动跨省异地安置退休人员住院医疗费用直接结算工作;

2017年开始逐步解决跨省异地安置退休人员住院医疗费用直接结算,年底扩大到符合转诊规定人员的异地就医住院医疗费用直接结算。

结合本地户籍和居住证制度改革,逐步将异地长期居住人员和常驻异地工作人员纳入异地就医住院医疗费用直接结算覆盖范围。

二、这些人可以申请

参加基本医疗保险的下列人员,可以申请办理跨省异地就医住院医疗费用直接结算。
异地安置退休人员:指退休后在异地定居并且户籍迁入定居地的人员。
异地长期居住人员:指在异地居住生活且符合参保地规定的人员。
常驻异地工作人员:指用人单位派驻异地工作且符合参保地规定的人员。
异地转诊人员:指符合参保地转诊规定的人员。



三、异地就医结算流程

规范转出流程

参保人员跨省异地就医前,应到参保地经办机构进行登记。

参保地经办机构应根据本地规定为参保人员办理异地就医备案手续,建立异地就医备案人员库并实现动态管理。

参保地经办机构将异地就医人员信息上报至人力资源社会保障部社会保险经办机构(以下简称部级经办机构),形成全国异地就医备案人员库,供就医地经办机构和定点医疗机构获取异地就医参保人员信息。

规范结算流程

参保人员异地就医出院结算时,就医地经办机构根据全国统一的大类费用清单,将异地就医人员住院医疗费用等信息经国家异地就医结算系统实时传送至参保地经办机构,参保地经办机构根据大类费用按照当地规定进行计算,区分参保人员个人与各项医保基金应支付的金额,并将计算结果经国家异地就医结算系统回传至就医地定点医疗机构,用于定点医疗机构与参保人员直接结算。

强化跨省综合协调

部级经办机构按照《基本医疗保险跨省异地就医住院医疗费用直接结算经办规程(试行)》(以下简称经办规程)负责协调和督促各省(区、市)按规定及时拨付资金。

对无故拖延拨付资金的省份,部级经办机构可暂停该省份跨省异地就医直接结算服务。

各省级经办机构负责协调和督促统筹地区及时上缴跨省异地就医预付及清算资金。



四、加强异地就医管理服务

实行就医地统一管理

就医地经办机构应将异地就医人员纳入本地统一管理,在定点医疗机构确定、医疗信息记录、医疗行为监控、医疗费用审核和稽核等方面提供与本地参保人相同的服务和管理,并在与定点医疗机构协议管理中予以明确。

探索实行与就医地付费方式改革相一致的异地就医费用结算办法。

规范待遇政策

跨省异地就医原则上执行就医地支付范围及有关规定(基本医疗保险药品目录、诊疗项目和医疗服务设施标准)。

基本医疗保险统筹基金的起付标准、支付比例和最高支付限额原则上执行参保地政策。

明确传输信息内容

参保人员直接结算时,就医地经办机构通过国家异地就医结算系统按照统一格式向参保地经办机构传输大类费用信息,医疗费用明细信息延后传输。

高起点、全兼容

根据需要为其他部门管理的新农合参合人员提供服务。

新农合由其他部门管理的统筹地区,其参合人员需要到北京、上海、广东等已实现城乡居民基本医疗保险管理体制和制度整合的省份就医,统筹地区应预留社保信息系统接口,确定信息系统对接及相应业务流程,通过参保地系统对接为确有需要的参合人员一视同仁提供跨省异地就医直接结算服务。

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    2017-11-09 vividelife
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  5. [GetPortalCommentsPageByObjectIdResponse(id=2086107, encodeId=4e95208610ed6, content=<a href='/topic/show?id=a62d9311221' target=_blank style='color:#2F92EE;'>#跨省异地#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93112, encryptionId=a62d9311221, topicName=跨省异地)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Wed Mar 29 03:34:00 CST 2017, time=2017-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1670212, encodeId=089816e0212ac, content=<a href='/topic/show?id=c50be87281c' target=_blank style='color:#2F92EE;'>#结算#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78728, encryptionId=c50be87281c, topicName=结算)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=178c26602075, createdName=vividelife, createdTime=Thu Nov 09 09:34:00 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1972256, encodeId=b5d719e2256af, content=<a href='/topic/show?id=6c32264625a' target=_blank style='color:#2F92EE;'>#住院费用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26462, encryptionId=6c32264625a, topicName=住院费用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05a2499, createdName=dzx0922889, createdTime=Fri Oct 27 10:34:00 CST 2017, time=2017-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1814462, encodeId=019a181446209, content=<a href='/topic/show?id=f9d395e5868' target=_blank style='color:#2F92EE;'>#重大利好#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95758, encryptionId=f9d395e5868, topicName=重大利好)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b191324, createdName=marongnuan, createdTime=Sat Aug 19 00:34:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1769844, encodeId=59481e6984410, content=<a href='/topic/show?id=e46993109c3' target=_blank style='color:#2F92EE;'>#跨省#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93109, encryptionId=e46993109c3, topicName=跨省)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f7438117512, createdName=d830385, createdTime=Sun May 21 22:34:00 CST 2017, time=2017-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537137, encodeId=a583153e1375b, content=<a href='/topic/show?id=78a049e553a' target=_blank style='color:#2F92EE;'>#异地就医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49755, encryptionId=78a049e553a, topicName=异地就医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e6112820234, createdName=weihongyv, createdTime=Fri Dec 23 07:34:00 CST 2016, time=2016-12-23, status=1, ipAttribution=)]
    2017-05-21 d830385
  6. [GetPortalCommentsPageByObjectIdResponse(id=2086107, encodeId=4e95208610ed6, content=<a href='/topic/show?id=a62d9311221' target=_blank style='color:#2F92EE;'>#跨省异地#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93112, encryptionId=a62d9311221, topicName=跨省异地)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Wed Mar 29 03:34:00 CST 2017, time=2017-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1670212, encodeId=089816e0212ac, content=<a href='/topic/show?id=c50be87281c' target=_blank style='color:#2F92EE;'>#结算#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78728, encryptionId=c50be87281c, topicName=结算)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=178c26602075, createdName=vividelife, createdTime=Thu Nov 09 09:34:00 CST 2017, time=2017-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1972256, encodeId=b5d719e2256af, content=<a href='/topic/show?id=6c32264625a' target=_blank style='color:#2F92EE;'>#住院费用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26462, encryptionId=6c32264625a, topicName=住院费用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05a2499, createdName=dzx0922889, createdTime=Fri Oct 27 10:34:00 CST 2017, time=2017-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1814462, encodeId=019a181446209, content=<a href='/topic/show?id=f9d395e5868' target=_blank style='color:#2F92EE;'>#重大利好#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95758, encryptionId=f9d395e5868, topicName=重大利好)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b191324, createdName=marongnuan, createdTime=Sat Aug 19 00:34:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1769844, encodeId=59481e6984410, content=<a href='/topic/show?id=e46993109c3' target=_blank style='color:#2F92EE;'>#跨省#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93109, encryptionId=e46993109c3, topicName=跨省)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f7438117512, createdName=d830385, createdTime=Sun May 21 22:34:00 CST 2017, time=2017-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537137, encodeId=a583153e1375b, content=<a href='/topic/show?id=78a049e553a' target=_blank style='color:#2F92EE;'>#异地就医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49755, encryptionId=78a049e553a, topicName=异地就医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e6112820234, createdName=weihongyv, createdTime=Fri Dec 23 07:34:00 CST 2016, time=2016-12-23, status=1, ipAttribution=)]
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