Health care regulation has a legal eye! Every medical action will be monitored

Medicine Network December 4th, November 27th, the Office of the State Health Insurance Administration issued a notice on the implementation of 15 medical security information business coding standards (medical insurance office issued (2020) No. 51, called "Notice"), "Notice" gave 15 medical security information business coding standards to implement the deadline is the end of March 2021.
the standardization of medical insurance: 15 information business coding standards landed in June 2019, the National Health Insurance Administration issued guidance on the standardization of medical security (Medical Insurance No. 39 of 2019).
objectives set out in the guidance are: to establish a standardized working mechanism led by the State Health Insurance Administration, recognized by relevant departments and promoted in concert in various places, and to form a standardized system that is suitable for the reform and development of medical security.
2020, on the basis of the construction of a unified medical security information system in the country, gradually realize the use of 15 information service coding standards, such as disease diagnosis and surgical operation.
in accordance with the first pilot to improve, and then promote the way of popularization, and steadily promote the implementation of various types of medical security standards.
In the early stage, we will focus on the testing and use of the four information business coding standards for medical insurance disease diagnosis and operation, medical service projects, pharmaceuticals and medical supplies, sum up the experience and practice in a timely manner, and provide feasible experience and demonstration guidance for the full implementation of the remaining 11 information service coding standards.
In October 2019, the State Administration of Medical Security issued the rules and methods for the coding of information services such as medical security fixed-point medical institutions (Medical Insurance Issue (2019) No. 55), which "unified" the 10 information business coding rules and methods for medical insurance fixed-point medical institutions and the settlement list of medical security funds.
March 5, 2020, the State Council of the CPC Central Committee issued an opinion on deepening the reform of the medical security system, which points out the direction for the reform of China's medical security system in the next 10 years.
: a high starting point to promote standardization and information construction.
calls for the unification of medical security business standards and technical standards, the establishment of a unified, efficient, compatible, convenient and safe medical security information system, the realization of national medical security information interconnection, strengthen the orderly sharing of data.
the basic information and data security of the insured personnel in accordance with the law by regulating data management and application rights.
strengthen the development of big data, highlight application orientation, strengthen service support functions, and promote equal access to public services for health care.
Seth-step implementation, the realization of the modernization of medical insurance governance" notice pointed out that a high starting point to promote the standardization of medical security is an important part of the implementation of the national standardization strategy, is to promote the deepening of the reform of the medical security system, but also to achieve the modernization of medical insurance governance of the basic project.
to speed up the implementation of 15 medical security information business coding standards, to achieve the national medical security information business one yard pass, is an urgent task of the current medical insurance work.
The provincial medical security departments should improve their political standing, strengthen their mission, adhere to the goal orientation, promote the smooth implementation of the work, better play the supporting role of coding standards in the areas of off-site medical treatment, treatment guarantee, medical service management, pharmaceutical prices and tender procurement, fund supervision and public service, improve the quality of medical security governance and public services, and continuously enhance the people's sense of access.
implementation of information business coding standards is a systematic project, to adhere to the overall deployment, classification and policy, orderly development, steady progress.
First, to do a good job in the region's medical insurance drugs, medical supplies, medical services projects, outpatient chronic diseases, by disease settlement diseases and day surgery diseases and other 6 information business codes and national coding standard database mapping verification work, To ensure that the items have a code; to organize the cities under its jurisdiction to do a good job of coding correspondence and confirmation with the provincial mapping database; to do a good job in accordance with the responsibilities and authority of the provincial and local levels of the relevant medical insurance treatment policy identification, to organize and coordinate regional medical insurance agencies and fixed-point pharmaceutical institutions to complete the regional coding matching work.
Second, the medical insurance disease diagnosis and operation, medical insurance system units, medical insurance system staff, fixed-point medical institutions, medical insurance physicians, medical insurance nurses, fixed-point retail pharmacies, medical insurance pharmacists and other 8 information business code full maintenance, timely storage, dynamic adjustment, national code after synchronous update, to achieve the coding standard "vertical full, horizontal full coverage."
3 is to set up the application environment of the settlement list of medical security funds to ensure that DRG, DIP and other pilot areas of health insurance payment method reform take the lead in the application.
fourth is to do a good job in data governance and quality control, in order to speed up the establishment of a unified, efficient, compatible, convenient and safe medical security information system to provide basic support.
health care regulation is coming! As stated in the Notice, medical security departments at all levels, designated pharmaceutical institutions and related pharmaceutical enterprises are both participants and maintainers of standards, as well as implementers and users of standards.
Therefore, the Notice requires the provincial medical security departments to strengthen the training of coding standards, fully mobilize the enthusiasm and initiative of the medical security departments, fixed-point pharmaceutical institutions and related pharmaceutical enterprises in the overall areas under their jurisdiction, and make the personnel of the relevant units study the coding rules and methods in depth as soon as possible, and accurately grasp the standard content and application requirements.
At the same time, with the implementation of this work at the end of March next year, all medical security departments at all levels, fixed-point pharmaceutical institutions and related pharmaceutical enterprises engaged in this business staff, medical personnel, pharmaceutical practitioners medical representatives must be in accordance with the law norms, because, from then on, every drug, every device, every medical institution, every medical behavior will be marked with a personal "mark", can not escape the medical insurance supervision of the "law eye."
Perhaps by then, medical institutions, medical personnel, medical equipment, including drugs, supplies and other medical services in the health care system will become a "naked" person, which will be more bright and strict than the current health insurance flight inspection, as long as the eyes of health insurance eye you, you have no privacy.
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