NHSA Launches Intelligent Supervision Reform Pilot in Designated Medical Institutions

The National Healthcare Security Administration (NHSA) has released a notification to implement an intelligent supervision reform pilot in coordinated regions and designated medical institutions. The initiative aims to enhance oversight and compliance through advanced technological applications.

Objectives of the Reform Pilot
The primary goal of the intelligent supervision reform pilot is to empower designated medical institutions and medical insurance fund supervision through the implementation of advanced monitoring systems. Specifically, the pilot projects will focus on two key areas:

1. Promotion of “Two Databases”:
   • The NHSA will promote the implementation and application of the “two databases” (medical insurance financial intelligence audit and monitoring knowledge base, rule base) in the self-built early warning systems of designated medical institutions. Participating institutions will serve as “experimental fields” for the development, construction, and public disclosure of these databases, as well as “benchmarks” for self-examination and self-correction.
2. Enhancement of Intelligent Supervision Subsystem:
   • The pilot will also promote the effectiveness of the intelligent supervision subsystem within the national medical insurance system. This will involve moving the regulatory checkpoint forward to reduce the occurrence of illegal and irregular use of medical insurance funds at the source. The aim is to significantly decrease issues identified by designated medical institutions during in-process audits, flight inspections, and other forms of supervision, making the “two databases” and intelligent supervision effective tools for proactive compliance.

Implementation and Reporting Requirements
The provincial healthcare security administration bureaus are requested to submit three reform pilot areas and ten pilot units (including eight designated medical institutions and two designated retail pharmacies) to the NHSA for the implementation of the intelligent supervision reform pilot.-Fineline Info & Tech