The instant settlement system successfully landed the pilot medical institution fund allocation process efficiently through

In order to promote the coordinated development and governance of medical care, medical insurance and medicine, improve the medical insurance scientific settlement system that is compatible with the "1+3+N" multi-level medical security system, and further improve the efficiency of the use of medical insurance funds, Qinghai, as a pilot province, actively promotes the implementation of the instant settlement system, and has selected seven medical institutions to pilot and successfully complete the whole process of the instant settlement business.

一、pilot first, explore experience

Under the background of deepening the reform in the field of medical insurance, with the characteristic services in the field of ethnic medicine and the perfect medical insurance management system, Qinghai Provincial Tibetan Hospital was approved as the pilot unit of the province's instant settlement reform. As the only top three ethnic medical hospital in the province, the hospital serves more than 110,000 outpatients and 16,000 inpatients annually. It has a solid information foundation and a professional management team, which provides a solid guarantee for the pilot work.

Donglei, president of Qinghai Provincial Tibetan Hospital, said: "We are deeply honored to become a pilot unit of the province's medical insurance fund instant settlement reform, and we know that our responsibility is great. For a long time, the hospital has been exploring and moving forward in the field of ethnic medicine, accumulating rich experience, and our medical insurance management system is also constantly improving. This pilot reform is a rare opportunity for us to contribute to the national health care reform, but also to improve the management level and service quality of the hospital itself. We are confident that we can make good use of our advantages and explore a set of experience that can be generalized and replicated."

二、the whole process verification pilot effectiveness

In this instant settlement business, pilot medical institutions have realized real-time reconciliation of medical insurance expense data, rapid response to intelligent review of violation complaints, accurate registration of settlement information, and successfully completed the allocation of medical insurance funds. The seamless connection of the whole process not only validates the stability of the operation of the medical insurance information platform, but also reflects the efficient ability of the pilot institutions in medical insurance management coordination. Compared with the traditional model, this mechanism has significantly shortened the patient reimbursement cycle, alleviated the pressure on hospital capital turnover, and promoted the use of medical insurance funds to be more transparent and efficient.

Zheng Youzhong, financial director of Huzhu County Maternal and Child Health Hospital in Haidong City, said: "From a financial point of view, the country's vigorous implementation of instant settlement reform is significant. In the past, the patient reimbursement cycle was long, and the hospital fund was slow to return, which brought great pressure to the hospital fund management. Now, the system realizes real-time settlement, greatly shortens the time of capital return, and effectively alleviates the pressure of capital turnover of the hospital. Moreover, the real-time reconciliation of medical insurance expense data makes the use of medical insurance funds more transparent, and also facilitates our financial management and risk control. At the same time, the quick response of intelligent review of complaints of violations has also improved our efficiency in handling medical insurance related matters, reducing unnecessary disputes and risks."

三、Step leap from monthly settlement to daily settlement

As the first pilot unit of the provincial medical insurance settlement reform, General Technology Heavy Medicine holding Qinghai Medicine Nanguan Street New health Pharmacy has broken through the traditional settlement model, and strives to achieve the national instant settlement reform goal, achieve daily settlement, and gradually optimize the fund review and allocation mechanism.

Zhang Yechi, general manager of General Technology Heavy Medicine Holding Qinghai Company, said: "In the reform process, we fully considered the actual situation of pharmacies and the pace of reform, strictly according to the requirements of the Qinghai Provincial Medical Insurance Bureau, to ensure that the pace of reform and the national deployment of the same frequency resonance." We hope that through this step leap, we can not only ensure the smooth progress of reform, but also continuously improve the efficiency and quality of medical insurance settlement."

Du Chenxi, financial director of the New Health Pharmacy in Nanguan Street, Qinghai Province, said happily: "The medical insurance instant settlement model has brought three benefits to our company: first, the fund payment cycle has been compressed from monthly settlement to daily settlement, effectively alleviating the pressure on working capital; Second, through the digital process of real-time upload and online audit, the efficiency of financial reconciliation is improved and the labor cost is reduced; Third, the settlement data can be traced throughout the process, greatly reducing the risk of manual audit errors. This mechanism of 'data running instead of manual running' not only ensures the safe and efficient operation of the medical insurance fund, but also allows us to focus more on improving the quality of health services for the people."

四、use successful experience to radiate the reform of the whole region

The president of the health center of Chabchia Town in the Republic County expressed confidence: "The success of the pilot operation is only a beginning, and we will use this as a driving force to continue to improve the instant settlement system module." By summarizing experience, we hope to build a more scientific and efficient medical insurance management system, so that medical insurance policies can better serve the people. We believe that with the deepening of the reform, the medical insurance policy will be truly implemented to benefit more patients."