How to report the reimbursement of NCMS outpatient clinics, and how to reimburse NCMS outpatient cli

1.Outpatient reimbursement: Be sure to visit a designated hospital. However, the insurance ratio of hospitals at all levels is different, and there is an upper limit for reimbursement every year, and the reimbursement ratio will be different due to the slight differences in medical insurance policies in various places;

2.Hospitalization reimbursement: According to the level of the hospital, the reimbursement ratio varies greatly.

Generally, the reimbursement ratio of township-level hospitals is 80%-90%; 70%-80% in county and municipal hospitals; The proportion of provincial or inter-provincial reimbursement will be lower. Similarly, the deductible will increase with the level of the hospital, from the township, county, city, and provincial level, the deductible will vary in different regions;

3.Reimbursement for serious illnesses: Reimbursement for critical illnesses generally has a deductible, and the deductible is also different according to the local standard of living, and the reimbursement ratio will also be adjusted according to the grade of the first expense.

NCMS reimbursement process 1, outpatient reimbursement process (1) Insured patients go to designated hospitals for medical treatment with cooperative medical certificates; (2) Charge at the outpatient billing office with examination and prescription; (3) Pay for outpatient medical expenses by yourself; (4) Conduct inspections in relevant departments. Pick up medication at an outpatient pharmacy; (5) Hold the cooperative medical certificate, ID card, household registration book, and invoice on the first floor of the outpatient clinic; (6) Finally, go to the NCMS window for review, reimbursement and receive the reimbursement. 2. Hospitalization reimbursement process: (1) The insured patient should go to the designated hospital for medical treatment with the cooperative medical certificate (2) The doctor will issue the hospitalization certificate, and the attending doctor will check the patient's cooperative medical certificate, ID card, original and photocopy of household registration book and sign it; (3) Go to the NCMS window for hospitalization registration; (4) Pay for inpatient medical expenses by yourself; (5) Go to the first floor of the hospital with the discharge certificate, hospitalization invoice, cooperative medical certificate, patient ID card, household registration book, and recipient's ID card; (6) Go to the NCMS window for review, reimbursement and receive reimbursement.

Legal basis

Article 23 of the Social Insurance Law of the People's Republic of China stipulates that employees shall participate in the basic medical insurance for employees, and the employer and the employee shall jointly pay the basic medical insurance premiums in accordance with the provisions of the state. Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

NCMS outpatient reimbursement process: 1. Insured patients go to designated hospitals for medical treatment with cooperative medical certificates 2. (3) Pay for outpatient medical expenses by yourself; (4) Conduct inspections in relevant departments. Pick up medication at an outpatient pharmacy; 5. Hold the cooperative medical certificate, ID card, household registration book, invoice, etc. to the NCMS window for review, reimbursement and receive the reimbursement.

Social Insurance Law of the People's Republic of China

Article 26 The standards for the treatment of basic medical insurance for workers, new rural cooperative medical care, and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 27 Individuals who participate in the basic medical insurance for workers and workers who have paid contributions for the number of years specified by the state when they reach the statutory retirement age shall no longer pay the basic medical insurance premiums after retirement, and those who enjoy the basic medical insurance benefits in accordance with the provisions of the state for the number of years specified by the state may pay the premiums for the number of years specified by the state.

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, in accordance with the provisions of the state from the basic medical insurance ** payment.

1. The working principle of outpatient co-ordination.

Outpatient reimbursement is carried out in accordance with the working principle of pilot and steady promotion, and is only limited to outpatient reimbursement in township health centers and village clinics in our county.

2. The first batch of township hospitals and village health chambers to carry out outpatient reimbursement work.

There are 6 health centers in Chengguan, Linping, Liangcun, Yangyu, Xuelu, and Yanghong, and 79 village health centers under their jurisdiction.

3. Reimbursement standards for outpatient services.

1. The reimbursement of outpatient clinics in the village clinic is 1 yuan for every 3 yuan (compensation at the rate of 30%); 1 yuan for every 4 yuan of outpatient clinic in township health centers (compensation at the rate of 25%); Regardless of the level of the hospital, the annual one-time reimbursement of 20 yuan at the rate of 30% is carried out, and the accounting is rounded, the single person is calibrated, and the whole household is capped, with a maximum reimbursement of 20 yuan per person per year, and a maximum reimbursement of 10 yuan each time, and the cap standard for each household is 20 yuan per household.

2. Newborns can enjoy outpatient reimbursement with their mothers in the current year, and the cap of the household will be increased by one person accordingly.

3. Outpatient reimbursement compensation, special chronic disease reimbursement compensation, and inpatient reimbursement compensation are included in the cap line of 10,000 yuan per household per year.

Four. Outpatient reimbursement coverage.

** Fees, injection fees, infusion fees, debridement and suture fees, acupuncture cupping, B-ultrasound, electrocardiogram, X-ray, laboratory tests, disposable infusion sets, syringes and other fees, drugs are implemented in the "Shaanxi Province New Rural Cooperative Medical System Basic Drug Catalogue 2008 Edition" specified drugs.

5. Outpatient reimbursement method.

Participating patients can be treated in pilot township health centers and village clinics with their joint treatment certificates and household registration books, and the designated medical institutions will directly reduce or reduce reimbursement compensation when paying the premium.