News from the Medical Insurance Bureau: The solution to the hospital's arrears is coming

Regulating the reporting, distribution, and settlement issues Recently, the Luliang Municipal Medical Insurance Bureau issued the "Notice on Prioritizing and Standardizing the Use of Centralized and Volume-Based Procurement of Medicines and Medical Consumables"
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It pointed out that in the use of the selected products in the purchase with quantity, there have been signs of problems such as inaccurate reporting, untimely delivery, untimely settlement of payments, and irregular implementation of agreements
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At present, in 2021, Lvliang City has completed the centralized procurement of 28 varieties and 188 specifications of medical consumables, saving 47.
7711 million yuan in procurement funds, and the two items in total save 73.
6247 million yuan in procurement funds
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However, with the continuous increase of the varieties of centralized procurement and the gradual expansion of the coverage, some secondary problems have also appeared, which need to be improved urgently
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The "Notice" pointed out that medical institutions are the first responsible person for the use of the selected products.
On the one hand, they must closely cooperate with the distribution company selected by the selected enterprises to ensure the supply of the selected products; product
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The rules and regulations should include: the system of preferential use of the selected products under the same curative effect or the same general name, the prepayment allocation system, the warehouse entry and exit system, the ledger system, the payment settlement system, the financial special account system, the balance retention incentive system,
etc.
For enterprises that cannot deliver as required, on the one hand, they are required to implement the contents of the agreement in accordance with the provisions of the agreement to ensure clinical use, and can use legal weapons to safeguard their rights; on the other hand, they can report to the local medical insurance department, and the medical insurance department will discuss the delivery The company may report it level by level.
For companies that seriously violate the agreement and cause serious consequences, they can apply to be included in the blacklist for the construction of the integrity system for procurement with volume
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In terms of settlement, it is necessary to fully consider the pressure of the company's capital advance, and settle the payment in a timely manner in accordance with the provisions of procurement with volume.

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The "Notice" pointed out that the whole process of closed-loop supervision and management from procurement, warehousing, warehousing, use, prepayment, settlement, assessment, and incentives should be completed.
It is necessary to strengthen warnings and punishments, and timely warn and interview medical institutions that do not purchase and use selected products in accordance with relevant regulations or purchase non-selected products with high use prices
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The establishment of the supervision platform, the withdrawal of the hospital from the settlement, and the purchase of consumables by medical institutions, the backlog of payment has always been a big problem
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The state and local governments have implemented prepayment of medical insurance funds and established early warning mechanisms.
In some areas, the problem of payment settlement has improved, but the pressure is still there
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On March 7, Jinan City, Shandong Province issued the "Notice on Comprehensively Carrying out the Direct Settlement of Medical Insurance Funds for Medical Consumables Payments and Pharmaceutical Enterprises", which clarified that the direct settlement between medical insurance funds and pharmaceutical enterprises for payment of medical consumables will be fully carried out from March
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The "Notice" pointed out that the delivery time is after March 1, 2022 (inclusive), and the national and provincial centralized procurement of medical consumables transaction data will be carried out through the Shandong Provincial Settlement Supervision Platform for direct settlement and online payment
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It is understood that in August last year, the Shandong Provincial Medical Insurance Bureau and other four departments jointly issued the "Notice on Printing and Distributing the Implementation Plan for the Direct Settlement of Medical Insurance Funds and Pharmaceutical Enterprises for the Payment of Medical Insurance Designated Public Medical Institutions for Drugs and Medical Consumables", proposing to establish a unified settlement for medical equipment in the province.
The supervision platform realizes the supervision platform and the provincial centralized procurement platform for medicines and equipment, and completes the direct settlement of the medical insurance fund for the purchase of medicines and consumables with quantity, and the development of online monitoring functions for self-settlement of medical institutions and pharmaceutical enterprises for the purchase of medicines and consumables without quantity
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Before the end of 2021, relying on the supervision platform, the state and Shandong Province will first carry out the direct settlement of the purchase of pharmaceutical consumables in a centralized manner
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Gradually promote the online monitoring of self-settlement settlement by medical institutions and pharmaceutical enterprises, and fully implement the direct settlement of medical insurance funds and pharmaceutical enterprises in 2025
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The scope of varieties participating in direct settlement includes: the selected varieties of drugs and medical consumables that are actually purchased by designated public medical institutions of medical insurance at all levels in the province at the national and provincial levels
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The medical insurance agency uses the bank's corporate online banking for direct settlement of the payment for drug consumables, and realizes the direct settlement process supervision.
The medical insurance fund shall not be transferred to the fund account in violation of regulations; the funds in the settlement account shall be transferred to the medical insurance fund expenditure account within 2 working days after receiving the payment from the medical institution
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It is required to establish a direct settlement supervision system for medical insurance funds
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The province uniformly determines the cooperative bank of the supervision platform, and the cooperative bank connects with the supervision platform to realize online payment
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Pharmaceutical companies use their settlement accounts opened in cooperative banks and payee merchants to receive settlement payments for pharmaceutical consumables (including direct settlement and self-settlement)
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At present, there have been some pilot projects to promote the settlement model of Shandong consumables
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On March 15, the Dezhou Municipal Medical Insurance Bureau issued a document saying that the Shandong Provincial Medical Insurance Bureau clarified that the city is specifically responsible for the implementation of the province's medical insurance fund and the direct settlement policy of pharmaceutical companies, and the monitoring and scheduling of the progress of direct settlement in various places
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Up to now, the direct settlement of the municipal medical insurance fund has fully covered 216 public medical institutions in the city, and a total of 177 million yuan has been allocated to 69 pharmaceutical companies for medicines and consumables
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Previously, the "14th Five-Year Plan" for National Medical Security has made it clear that a provincial-level centralized procurement platform integrating bidding, procurement, trading, settlement and supervision will be established based on medical insurance payment
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Promote and standardize the direct settlement between medical insurance funds and pharmaceutical companies, and improve the coordination mechanism for medical insurance payment standards and centralized procurement prices
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In the next few years, the promotion of direct medical insurance settlement and payment and the establishment of a unified recruitment and settlement platform are expected to be rolled out in more provinces
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Problems such as unreasonable use of consumables and payment arrears will also be gradually improved
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