I. When a patient with medical insurance or NAC needs to be hospitalized, the outpatient physician shouldFirst, medical insurance, the new rural cooperative patients need to be hospitalized, outpatient physicians should timely write medical insurance, agricultural hospitalization certificate, inform the first diagnosis and treatment, after the settlement of the scope of application, such as special circumstances, can not be handled at that time, health care personnel should prompt to urge the patient to make up for the procedures within three days, more than three days did not go through the formalities, the department should be to the medical insurance office to explain the reasons.

Second, the medical and nursing staff must verify the identity of the insured patients and inform the hospital medical insurance office in time if they find any fraudulent name or person who hangs up his/her bed. If they intentionally do not report or participate in forgery, the hospital will implement one-vote veto for medical and nursing according to the requirement of 1,000-point assessment system, and severely penalize the relevant departments.

Third, medical and nursing staff should inform the enrolled patients that they are not allowed to leave the ward without authorization during hospitalization, and in special cases, they need to be signed by the physician in charge and informed of the direction of the nurse on duty.

Fourth, medical and nursing staff should adhere to the principles of reasonable examination, reasonable medication, reasonable treatment and reasonable charges in the process of diagnosis and treatment. Strictly in accordance with the medical insurance, the new rural cooperative “inpatient disease catalog”, “drug catalog”, “diagnosis and treatment and service facilities directory” provisions of the implementation, can not change the type of disease or light disease into hospitalization; large-scale instrumentation examination rate of not less than 80% positive, generally do not use the provisions of the scope of the drugs, diagnostic and therapeutic facilities outside of the project, the user really because of the condition of users, should be the consent of the patient or his family members and sign an agreement on the treatment of off the directory before use (). The proportion of out-of-pocket expenses shall not be more than 5% for medical insurance and 20% for agricultural insurance; otherwise, all the consequences shall be borne by the responsible person or department.

Fifth, the average cost of medical insurance patients to implement the fixed amount of management, each department should strictly control the average cost of medical insurance patients. Otherwise, it will be handled in accordance with the thousand-point assessment requirements.

Sixth, the use of special materials for patients with medical insurance, large-scale instrumentation, blood products and retirees with more than 80 yuan of medication items, in line with the principle of approval before application, such as first aid or surgical emergency application of the next day to be approved in a timely manner.

Seventh, the discharge of chronic diseases with medication shall not exceed 7 days, acute diseases shall not exceed 3 days, chronic special patients need to be signed by the Office of the Medical Insurance can take 14 days of oral medication, can not take injections.

VIII. Scope of application of first diagnosis and treatment and then settlement

This approach is temporarily applicable to Liaocheng city urban workers' medical insurance patients, surgical department of Liaocheng city new rural cooperative patients and urban residents. Liaocheng City new rural cooperative trauma patients are excluded.

Nine, medical insurance and urban residents need to use 500 yuan and above the large-scale instrument examination, placed in the body of the disposable materials and blood products, should first fill out the appropriate approval form, by the hospital medical insurance office, the city medical insurance office approved the use of; really is an emergency need to rescue patients, can be used first and then the next day to make up for the relevant formalities, the application with the relevant materials.

The reimbursement rate of Liaocheng New Rural Cooperative Medical Insurance is 53% for 80,000 yuan (including 80,000 yuan), and 70% for more than 80,000 yuan. The starting line is 500 yuan, and the maximum annual reimbursement is 100,000 yuan. Linqing NAC patients who need to be transferred to other hospitals should go to Linqing Health Bureau's Cooperation Management Office to complete the formalities (with NAC certificate, ID card, and two photos). The starting line for Xiajin Nongjia patients is 500 yuan, and the reimbursement rate is 44%, while the starting line for Linxi Nongjia is 1,500 yuan, and the reimbursement rate is 55% - 60%.

Eleven, the outpatient compensation for chronic diseases of enrolled patients, no starting line, reimbursement rate of 50%, the ceiling line of 10,000 yuan per person per year.

Twelve, urban workers in a medical year, the first hospitalization starting line is 500 yuan, the second is 250 yuan, the third and later no starting line, above the starting line included in the co-ordination fund 0-20000 yuan in-service reimbursement of 80%, retirement reimbursement of 83%; 20000-50000 yuan in-service reimbursement of 82%, retirement reimbursement of 85%; 50000-50000 yuan in-service reimbursement of 85%; the retirement reimbursement of 85%. Retirement reimbursement 85%; RMB 50,000-70,000 in-service reimbursement 84%, retirement reimbursement 87%, RMB 70,000-250,000 reimbursement 90%.

In a medical year, the starting line for the first hospitalization of urban residents is RMB 300 yuan, the second is RMB 150 yuan, and there is no starting line for the third and subsequent hospitalizations; the reimbursement rate for adult urban residents is 55% for the starting line - RMB 30,000 yuan to be included in the unification fund; the reimbursement rate for underage urban residents to be included in the unification fund is 65%; RMB 30,000 yuan - RMB 80,000 yuan The reimbursement rate is 60% for adult residents and 70% for minor residents.

XIII. If the mother of a newborn child born between the last payment period and the next payment period in accordance with the National Family Planning Policy participates in the New Farmers' Cooperative Program, the medical expenses incurred in the current year can enjoy the New Farmers' Cooperative Program in the capacity of his/her mother.

XIV. Questions and Answers

1、The implementation program of the hospital's first diagnosis and treatment and then billing

Patients in the medical insurance office signed a “first diagnosis and treatment, after the settlement” agreement, where the “first diagnosis and treatment, after the settlement” conditions of patients admitted to the hospital temporarily do not pay a deposit, by the hospital first prepaid 2,000 yuan as the patient's start-up funds, this prepaid funds referred to as the “advance payment”. This advance fund is referred to as “prepayment”, and the prepayment for all patients is 2,000 yuan. The prepayment note is stored in the hospitalization office without being given to the patient.

Treatment process patients spend close to 2,000 yuan, automatically lock the billing window nurse workstations can not be credited, ward workstations according to the window prompts, (the process and the same model in the past, the account to stay 100 yuan can not be credited) nurses to call the amount of the self-contained portion of the amount of the patient each time to pay a deposit in proportion to the patient's automatically set up a prepayment.

2, the new rural cooperative document stipulates how to reimburse patients with traumatic injuries?

Accidental injuries (including trauma, poisoning and other non-normal diseases) hospitalized participating farmers, to strengthen the investigation of trauma and poisoning patients, verification, records, to a high degree of responsibility to treat the cause of trauma and poisoning investigations, there is a third-party responsible for all non-compensatory; no third-party responsibility for accidental injuries to the patient, the hospitalization of the cost of medical expenses can be reimbursable costs of the part of the starting line or above, the proportion of 40% compensation The hospitalized patients without third-party responsibility will be compensated at a rate of 40% of the compensable medical expenses above the starting line, capped at 50,000 yuan; patients who are injured and hospitalized due to their courageous actions or the execution of public welfare tasks such as disaster relief and rescue, and who are required to provide evidence of the circumstances issued by the relevant governmental departments at the county level or above, can be hospitalized according to the hospitalization compensation policy for normal illnesses; all patients who are included in the traumatic injuries and poisonings compensated by the New Rural Medical Cooperative, the originals of the discharge statement will be retained for inspection.

3、What corresponding information should our hospital provide to patients who are not reimbursed in our hospital?

A: Discharge settlement certificate, discharge summary, total cost list, hospital inpatient charge settlement (original), cooperative medical certificate, copy of ID card and the filing form issued by the New rural cooperative management agency of the place of participation and other materials back to the local reimbursement.