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贵州省将于10月1号开始实施《贵州省基本医疗保险定点协议医疗机构医师医疗服务管理办法》)

2017-09-01 23:36:02   央广网

央广网贵阳9月1日消息(记者王珩 贵阳台齐凤麟)记者从贵州省人力资源和社会保障厅获悉,贵州省将于10月1号开始实施《贵州省基本医疗保险定点协议医疗机构医师医疗服务管理办法》。此举旨在进一步加强医疗保险服务管理,规范定点协议医疗机构医师医疗服务行为,切实维护参保人员合法权益。

《办法》适用于具有执业医师或执业助理医师资格、在定点协议医疗机构注册执业的医务人员为参保人员提供医疗服务的监督管理。

《办法》明确,将建立医师医疗服务行为动态管理机制。各统筹地区社会(医疗)保险经办机构对医师医疗服务行为实施检查,其方式包括网络监控、实地检查、专项检查、受理举报、聘请第三方监督检查和其他适当方式。

根据《办法》,实行医师医疗服务违规行为积分管理,每个自然年度初始分值为12分。根据医师发生的违规行为进行相应的扣分,扣分在自然年度内累加计算,不跨年累计。在一个自然年度内,扣分满12分的,予以相关处理后扣分重新累计;扣分不满12分的,次年扣分重新累计。多点执业的医师,扣分累加计算。

《办法》要求,定点协议医疗机构应及时将医师责罚期相关信息对外公布,便于参保人员就医时选择,并以一定方式提醒告知参保人员。各统筹地区社会(医疗)保险经办机构对监管中发现的医师违规行为,要严格按照协议约定进行处理,在进行相应扣分后,应及时将扣分情况录入全省定点协议医疗机构医师信息系统。

医师的扣分情况,由所在统筹地区社会(医疗)保险经办机构书面通知其执业的定点协议医疗机构,由定点协议医疗机构在3个工作日内告知其本人。医师对本人扣分情况有异议的,可在定点协议医疗机构接到书面通知之日起7个工作日以内,由医师本人向统筹地区社会(医疗)保险经办机构申请复核。统筹地区社会(医疗)保险经办机构可自行或通过第三方机构邀请有关专家、定点协议医疗机构有关人员等对相关情况进一步核实,并在15个工作日内将复核情况书面通知医师本人。

《办法》指出,将建立医师为参保人员服务奖惩机制,可将医师扣分情况作为专业技术职称评聘、个人年度考核、工资待遇等重要参考内容或依据。对执行医疗保险政策到位、医疗服务好、群众满意度高的医师给予通报表扬,依规对其奖励。

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