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In September 2022, 86.
9% of the coordinated areas (344) in the country have started the cross-provincial direct settlement of five outpatient chronic disease-related treatment costs, including hypertension, diabetes, outpatient radiotherapy and chemotherapy for malignant tumors, uremic dialysis, and anti-rejection therapy after organ transplantation, and the coverage of inter-provincial direct settlement of outpatient expenses has been further expanded
.
1.
The direct settlement of hospitalization expenses across provinces is stable
As of the end of September 2022, the number of designated medical institutions with inter-provincial direct settlement of hospitalization expenses nationwide was 61,000
.
From January to September, 4.
238 million hospitalization expenses were settled across provinces nationwide, involving 95.
228 billion yuan in medical expenses, and 56.
116 billion yuan was paid by the fund, with a fund payment ratio of 58.
9%.
In September, 576,000 hospitalization expenses were settled directly across provinces, involving medical expenses of 13.
043 billion yuan, and fund payments were 7.
899 billion yuan, down 7.
5%, 7.
6% and 5.
9% respectively from the previous month, and the fund payment ratio was 60.
6%; The average daily direct settlement is 19,200 people, the average medical expenses are 22,600 yuan, and the average fund pays 13,700 yuan
.
Second, the work of direct settlement of outpatient expenses across provinces has achieved remarkable results
As of the end of September 2022, there were 76,100 designated medical institutions and 210,200 designated retail pharmacies in the network of direct settlement of outpatient expenses across provinces
.
From January to September, 20.
6268 million outpatient expenses were settled directly across provinces, involving medical expenses of 4.
967 billion yuan, and the fund paid 2.
965 billion yuan, with the fund payment ratio of 59.
7%.
In September, 3,376,800 outpatient expenses were settled across provinces nationwide, involving medical expenses of 828 million yuan, and fund payments were 490 million yuan, an increase of 5.
3%, 7.
7% and 9.
1% respectively from the previous month, and the fund payment ratio was 59.
2%; The average daily direct settlement was 112,600 people, the average medical expenses were 245.
23 yuan, and the average fund paid 145.
12 yuan
.
Third, the inquiry function related to the settlement of medical treatment in different places on the APP of the national medical insurance service platform has been further expanded
In order to facilitate the insured to directly settle the treatment costs related to 5 outpatient chronic diseases across provinces and places, the national medical insurance service platform APP has added inquiry functions
such as inter-provincial outpatient chronic diseases notices.
The insured can download the APP of the national medical insurance service platform, click the "Off-site Filing" column, and use the query functions of "Door Slow Special Notice" and "Door Slow Special Qualification" in the sub-column of "More Inquiries for Medical Treatment in Other Places" to understand their own outpatient chronic disease recognition qualifications and cross-provincial direct settlement policies and procedures for outpatient chronic diseases related expenses in the insured place
.
At present, the direct settlement of the five outpatient chronic disease-related treatment costs across provinces and places is still in the pilot stage, and if there are problems in the settlement process, the insured can consult the service hotline
of the place where the insurance is insured.
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