First, carefully check the identity of the patient. The insured should check the certificate, card and person when seeing a doctor. Strictly investigate and curb fraudulent use or borrowing of medical insurance identity to prescribe drugs, diagnosis and treatment and other violations; Implement the first diagnosis responsibility system. If the attending doctor really stipulates the medical record, records the medical history and the treatment process, it is strictly forbidden to resort to deceit. Second, fulfill the obligation to inform. Inform the inpatients that they should provide medical insurance cards when they are hospitalized, and keep them in the charge room during hospitalization.
Third, strictly implement the "Ningbo Basic Medical Insurance Drug Catalogue and Medical Service Item Catalogue". For drugs and medical treatment items that cannot exceed the scope of medical insurance payment, providing self-funded drugs, medical treatment items and medical service facilities must obtain the consent of the insured in advance and sign the medical records for confirmation. Otherwise, the resulting patient complaints, etc. , by the relevant responsible person responsible for handling.
Four, in strict accordance with the relevant provisions of the "prescription management measures". Each prescription shall not exceed 5 kinds of drugs (western medicine and Chinese patent medicine can be prescribed separately), and the dosage of each prescription for outpatient service shall generally not exceed 3 days for acute diseases, 7 days for general diseases and half a month for chronic diseases. Inpatients must prescribe a second bottle of medicine after taking oral medicine, otherwise the medical insurance will overtreatment. Strictly grasp the indications of drug use, and consolidate drug treatment when hospitalized patients leave the hospital, with reference to the above implementation. Five, in strict accordance with the provisions of the examination and approval. Medicare restricted drugs can be used for medical insurance only after they meet the requirements of medical insurance restricted drugs and are approved by the hospital. Otherwise, it should be used at its own expense and inform the patient.
Six, medical record writing must be standardized, objective, true, accurate, timely and complete records of outpatient and inpatient medical records of insured patients, all kinds of accidental injuries, in outpatient and emergency medical records and hospitalization course records must truthfully record the time, place and reason of accidental injuries.
Seven, rational drug use, reasonable inspection, safeguard the interests of insured patients. If hospitalized patients need repeated examination, there must be a record of cause analysis. Control the use of antibacterial drugs and self-funded drugs
Eight, strictly grasp the admission and discharge standards of medical insurance patients. It is forbidden to decompose outpatient prescriptions and artificially decompose the number of inpatients; It is forbidden to hang up the bed and be hospitalized or hospitalized for outpatient treatment or examination. The contents of hospitalization medical records must be standardized and complete.
Nine, in strict accordance with the provisions of fees, fees, put an end to arbitrary charges, overcharging and other phenomena. The inpatient department implements a daily list system, and the daily list should be handed over to the patient for signature and confirmation. It is necessary to keep accounts in time, eliminate repeated charges, and the accounting of various expenses should be consistent with medical records and doctor's advice. If medical insurance refuses to pay due to arbitrary charges, overcharges and repeated charges, the relevant responsible doctors and nurses shall bear the full amount.
Ten, all doctors fully understand the relevant policies of medical insurance through various channels, the hospital regularly check and publicize the medical insurance work, and timely organize the hospital to learn the latest medical insurance policies and documents.
Eleven, medical insurance management center to provide terminal software, should be properly maintained; The new medical insurance policy was introduced, and the revised procedures were downloaded in time as required to ensure the safety and integrity of medical insurance data and provide all-weather card-holding medical services for insured patients.
Those who violate the provisions of the above system shall be dealt with according to the Regulations on Employees' Rewards and Punishment, and bear the full amount of medical insurance refusal.
Legal basis: Article 30 of the Social Insurance Law of People's Republic of China (PRC), the following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.