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新农合异地结算加速度 破异地就医难“魔咒”

2017-09-08 11:07:23   新华网

新华网北京9月8日电(朱军平)9月4日,家在安徽的己女士怎么也没想到,“在老家办的新农合还能在北京享受异地就医联网结算服务”。

这位64岁的早期食管癌患者,8月24日入住国内最早实施消化道早期癌内镜治疗的单位之一——北京协和医院消化内科。该患者住院费用总计22000余元,按照就医地报销范围、参合地报销比例计算,报销后花费12000余元,实际补偿比例接近45%。

事实上,己女士只是享受异地就医联网结算服务的一个缩影,在国家出台异地就医联网结算服务的重要举措下,新农合异地就医联网结算速度以及服务人群的数量将逐步攀升,困扰人们多年的异地就医难“魔咒”将被打破。

 惠民新政

一直以来,异地就医人员医保报销周期长、垫资负担重、往返奔波劳累等成为社会难题。

为贯彻国家“加快推进基本医保全国联网和异地就医结算”的要求,2016年6月8日,国家卫生计生委等部委先后印发《全国新型农村合作医疗异地就医联网结报实施方案》(国卫基层发〔2016〕23号)、《关于新型农村合作医疗异地就医联网结报的补充通知》(国卫基层发〔2017〕26号)等文件,积极推进新农合异地结报工作,鼓励委托商业保险机构经办异地就医结算管理服务工作,由商业保险机构先行向就医地定点医疗机构结算垫付资金。

此后,为了贯彻上述要求,规范新农合跨省就医联网结报定点医疗机构业务流程,国家卫生计生委研究制定了《城乡居民基本医疗保险(新型农村合作医疗)跨省就医联网结报定点医疗机构操作规范(试行)》。

《操作规范》从入院登记服务管理、住院医疗服务管理、出院结报窗口服务、信息系统支持、垫付资金申请、联网结报协议管理等方面做出了具体的规定。

值得关注的是,在出院结报窗口服务方面,《操作规范》第十八条提到参合患者因参加商业保险或享受民政医疗救助,要求定点医疗机构提供出院结算发票复印件,定点医疗机构应当积极配合但不负责盖章。

此外,在垫付资金申请方面,《操作规范》提到与国家卫生计生委异地就医结算管理中心签约的医疗机构,每月5日前,向国家卫生计生委异地就医结算管理中心申请回款,由协议保险公司每月15日向医疗机构拨付上月垫付资金。

“异地就医联网结算服务的实施,实实在在的解决了人们异地工作、生活的现实问题,极大地改善了人们的生活质量,是个非常了不起的惠民工程。”有业内人士称。

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