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重大疾病转诊省级医院统一省级结算

2017-08-23 09:48:55   中国青年网

兰州晚报讯(首席记者田小东)近日,甘肃省医改办、省卫生计生委、省人社厅、省财政厅下发有关通知,要求全面做好基本医保重大疾病患者住院费用即时结报工作。对患50种重大疾病转诊到14家省级医疗机构就医的城乡居民、城镇职工统一进行省级结算。随着基层医疗机构服务能力的提升,重大疾病病种可适当调整,实行动态管理。

A

参保患者出院时仅负担个人自付部分医疗费用

通知明确,结报对象为参保城乡居民(含尚未完成整合地区原城镇居民和新农合)和城镇职工中重大疾病住院患者。省级结算以14家省级医疗机构作为城乡居民、城镇职工医保重大疾病省级定点医疗机构;各市州可根据当地具体实际,协议确定当地城乡居民、城镇职工医保重大疾病定点医疗机构。省医保经办机构和信息管理部门要加快完成包括14家医疗机构在内的全省定点医疗机构与全国异地就医直接结算平台的联通。

通知明确了就医流程。包括明确诊断、办理入院、规范治疗、费用结算和有序转诊5个方面。各城乡居民、城镇职工医保定点医疗机构要主动为参保患者宣传城乡居民、城镇职工医保政策,正确引导患者就近及时到定点医疗机构就医,明确疾病诊断,规范接受治疗。已确诊的重大疾病参保患者,应按医保规定办理入院手续,其中,转往省级定点医疗机构就医的重大疾病参保患者入院时须持有“参保证明、本人身份证、转诊转院审批表原件、医保卡(新农合一卡通、社会保障卡)等相关资料”,定点医疗机构通过甘肃省城乡居民医保管理信息系统查验患者身份并核对患者参保信息正确无误后,即可为患者办理入院手续,并向甘肃省城乡居民医保管理信息系统等实时上传大病患者诊疗信息。参保患者入院免收押金,出院时仅负担个人自付部分医疗费用。

对于城乡居民、城镇职工参保重大疾病患者在住院期间,各定点医疗机构必须严格按照我省重大疾病临床路径实施规范化诊疗,在病种规定限额内完成规范化治疗要求的疗程和各项治疗内容,同时将已在本院完成主要治疗、病情稳定允许转至下级定点医疗机构治疗的患者,及时转至下级定点医疗机构接受后续康复治疗。

在费用结算方面,城乡居民重大疾病参保患者在定点医疗机构住院费用结算补偿,不设起付线,严格执行病种临床路径规范和医保目录(2017年版)规定,在城乡居民医保重大疾病支付限额内按其合规费用的70%由医疗机构负责结算,并为城乡居民患者提供包括基本医保补偿在内的大病保险和民政救助补助等“一站式”即时结报服务。城镇职工重大疾病患者住院费用报销比例各地可根据实际情况确定。

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