The National Healthcare Security Administration (NHSA) has released a set of guiding opinions aimed at enhancing the management of medical insurance payment qualification for relevant personnel in designated medical institutions. The new policies are designed to implement supervision over medical service behavior and expenses covered by medical insurance, strengthen the self-management responsibility of these institutions, and establish improved credit management systems.
Targeting Key Personnel
The guiding opinions primarily target two categories of personnel involved in the use of healthcare security funds by designated medical institutions. The first category includes medical, pharmaceutical, nursing, technical, and other health professionals who provide services to insured individuals. The second category encompasses pharmacists, both licensed and those specializing in traditional Chinese medicine, who offer services through fund settlement in designated retail pharmacies.
Service Agreements and Commitments
According to the service agreements signed between the designated medical institutions and the NHSA, relevant personnel are eligible for medical insurance payment and are subject to medical insurance supervision. These personnel must make and fulfill service commitments in line with the medical security service agreement. This includes complying with laws, regulations, and service agreements regarding the use of medical insurance funds, providing reasonable and necessary medical services to insured individuals, and enhancing service quality. They must also ensure the safe, efficient, and reasonable use of medical insurance funds, adhere strictly to principles of integrity, avoid fraudulent insurance practices, and refrain from excessive diagnosis and treatment.
Implementation and Consequences
Healthcare security agencies at all levels are tasked with the specific implementation of medical insurance payment qualification management for designated medical institutions. They are responsible for strengthening the review and settlement management of medical insurance funds. In cases where designated medical institutions violate the service agreement, the relevant responsible personnel can be dealt with according to the service agreement. This may include the suspension or termination of medical insurance payment qualification and fee settlement.
Conclusion
The NHSA’s guiding opinions signify a stepped-up effort to regulate the use of medical insurance funds and ensure the provision of high-quality, cost-effective healthcare services to insured individuals. By strengthening the self management and credit management systems of designed medical institutions, the NHSA aims to curb fraudulent activities and enhance the overall efficiency of the medical insurance system.-Fineline Info & Tech
