The "first" outpatient treatment for new coronavirus infection in Shanxi Province was successfully settled

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At 1:30 a.m. on January 8, Ms. Feng came to the central hospital in the Apricot Blossom District of Taiyuan City with a new coronavirus infection, and the total medical cost was 85.79 yuan, of which 60.06 yuan was reimbursed directly by medical insurance and 25.73 yuan was paid from her personal account. This is also the province’s “first single” successful settlement of outpatient treatment costs for new coronavirus infection.

“Ms. Feng’s case belongs to the new coronavirus infection, according to the latest regulations can be paid by the medical insurance fund 70%.” Zhang Hongyan, director of the medical insurance department of the central hospital in Xinghualing District, Taiyuan City, introduced that in the early hours of January 8, the hospital did a good job of docking and debugging the system overnight, not long after the patient Ms. Feng came to the clinic, in the outpatient emergency treatment can be directly medical insurance settlement of treatment costs, effectively reducing the burden of treatment of patients with new coronavirus infection.

Zhang Hongyan said “the latest regulations”, refers to the Shanxi Provincial Medical Insurance Bureau, the Department of Finance, the Health and Health Commission recently jointly issued “on the implementation of the new coronavirus infection” after the health insurance policy optimization adjustment notice “B B management”, clearly from January 8, 2023 Starting from January 8, 2023, the province for the new coronavirus patients hospital medical expenses continue to implement the “Class B A” medical security policy, the basic medical insurance, major medical insurance, medical assistance, etc. in accordance with the provisions of the payment, the personal burden of the part of the financial subsidies. The medical expenses within the medical insurance catalog incurred by the participants in outpatient and emergency medical institutions at the second level or below due to the new coronavirus infection are not subject to a starting line and payment limit, and are paid 70% by the medical insurance fund, and are not included in the annual payment limit of the general outpatient medical insurance scheme for the participants. This policy is tentatively scheduled to be implemented until March 31, 2023.

In addition, the “Notice on Optimization and Adjustment of Medical Insurance Policies after the Implementation of “Class B B Management” for New Coronavirus Infection” also includes 56 drugs that are not included in the medical insurance drug list in the recent national and provincial programs for the prevention and treatment of new coronavirus infection in the scope of medical insurance reimbursement, and will be added in accordance with the adjustment of the program for the prevention and treatment of new coronavirus infection. For medical institutions that admit patients with neo-coronavirus infection and are not designated by medical insurance, all of them will be included in the scope of medical insurance designated by signing temporary agreements. At the same time, the designated medical institutions to carry out the “Internet + first consultation” related services, the implementation of online and offline consistent health insurance payment policy, to facilitate the public to purchase drugs.

In Taiyuan, for example, the Taiyuan Medical Insurance Center researched and formulated the implementation method for Taiyuan, and promptly drew up the “New Coronavirus Infection Outpatient and Emergency Medical Treatment Process” and precisely guided the docking system development unit to ensure that the reimbursement policy for New Coronavirus Infection Outpatient and Emergency Medical Treatment was implemented on time. At present, all 1,634 qualified medical institutions in the city have opened the “New Coronavirus Outpatient” medical insurance settlement function, which can provide real-time settlement of outpatient and emergency treatment costs for eligible participants. On the first day of the “New Crown Outpatient” medical insurance settlement function, Taiyuan City successfully settled 73 times, with a total cost of 15,847.14 yuan, and the overall payment of 11,093.05 yuan, with a total reimbursement ratio of 70%.