The latest news on the new medical insurance policy, is it really true that direct settlement of medical insurance outpatient visits in other places is coming?

The notice establishes the "14th Five-Year Plan" mission goal of real-time settlement of cross-provincial medical treatment in different places. By the end of 2025, the real-time settlement supervision system and handling personnel management method guarantee system will be more complete and unified across the country. The support function of the medical insurance information platform has been continuously strengthened, the settlement level of medical treatment in other places in my country has been significantly improved, the real-time settlement rate of hospitalization fees across regions has increased to more than 70%, and the number of designated medical institutions in the cross-regional connection network for general outpatient clinics has doubled.

The notice unifies the policies for cross-regional real-time settlement of chronic disease expenses for inpatient treatment, general outpatients and hospital outpatients, and establishes that when cross-regional real-time settlement is made, the "document directory of the place of treatment, social security participation" will be implemented under normal circumstances. "Regional policy" medical insurance fund payment policy; "Record first, select the point, and hold a code card for treatment" out-of-region medical insurance management method service standards; "First pay first, settle later" out-of-region medical insurance fund allocation requirements, etc.

The notice further standardizes the registration policy for medical treatment in other places, including the expansion of the scope of registration for medical treatment in other places to staff in cross-regional emergency departments and staff in non-emergency departments who do not seek medical treatment; the registration validity period will be unified, and the insured persons within the period will be unified You can enjoy real-time settlement services by seeking medical treatment multiple times from the place of treatment; it allows insured persons to enjoy dual benefits at the place of filing and social security participation, etc.

In addition, the notice clarifies the scope of real-time settlement business of designated medical insurance hospitals, including emergency rescue expenses, in-hospital and in-hospital inspection and treatment purchase drug expenses, and trauma expenses that comply with the management standards of the place of treatment without third-party obligations. Enter the field of real-time settlement for medical treatment in different places across provinces. Insured persons are allowed to apply for medical records in other places before discharge and settlement, and can enjoy cross-regional real-time settlement services. With the large-scale population mobility, retired employees settling in other places, and retiring in other places, medical insurance in other places is an urgent need. Even if there is no real-time settlement, there will be some measures to provide medical insurance in other places.

Further improve the current policy for registration of medical treatment in other places. The scope of staff who register for medical treatment in other places extends to cross-regional emergency rescue staff and staff in non-emergency departments who do not seek medical treatment. There is a unified registration validity period, within which you can enjoy real-time settlement services from multiple medical appointments at the place of treatment. Applicable insured persons enjoy dual benefits in the place of registration and the place of social security participation. Specifically guide regions to reasonably determine the policy for reimbursement of staff expenses for temporary outpatient medical treatment across regions.

Further clarify the scope of real-time settlement business of designated medical insurance hospitals. The expenses for emergency rescue, the expenses for purchasing medicines for in- and out-of-hospital examinations and treatments during hospitalization, and the expenses for trauma expenses that comply with the management standards of the place of treatment and have no third-party liability are included in the scope of real-time settlement of cross-provincial medical treatment in different places. Insured persons are allowed to make up for medical records in other places before discharge and settlement, and can enjoy cross-regional real-time settlement services.

After the implementation of real-time settlement of medical insurance in other places, the average medical insurance settlement cost in big cities is no higher than that in the place of origin. The first reason is that diagnosis and treatment in big cities are more standardized; the second reason is that after real-time settlement, some shortcomings that occurred in the original manual reimbursement are avoided. For example, medical insurance in other places is a frequent area for insurance fraud. After real-time settlement, this loan hole is directly avoided. These points have prompted us to see no situation in which the medical insurance fund in the place of outflow cannot support it. In terms of collaborative business, the notice strengthens the standardization of cross-regional collaboration procedures for social security agencies, establishes a collaborative problem-solving mechanism between medical treatment places and social security participating places, and improves the efficiency of collaborative problem-solving between regions.