Just now! The National Healthcare Security Administration announced that the Healthcare Security intelligent monitoring system will be launched before the end of the year
On September 13, 2023, the National Healthcare Security Administration issued the Notice on Further Deepening the Intelligent Review and Monitoring work of the Medical Security Fun (Medicare (2023) 25). This notice marks the further upgrading of the intelligent audit and monitoring of the medical care fund, aiming to better protect the rights and interests of insured personnel, ensure the safety of the medical care fund fund, and promote the intelligent management of the medical security fund.
#01 What does the Notice contain?
– The Notice consists of six parts.
1．Clarification of objectives and tasks: By the end of 2023, the intelligent supervision subsystem will be fully promoted online, and the national intelligent monitoring “one net” will be initially realized. By the end of 2025, a standardized, scientific and normal intelligent audit and monitoring system will be established to ensure the safe, efficient and rational use of medical care funds.
- Strengthening the construction and application of the “two libraries ” : Local medical care departments should independently set rule parameters, indicators, thresholds, etc. under the national “two libraries” framework system according to local realities, and reasonably determine the number of online rules to meet regulatory needs.
- Optimizing the intelligent audit and monitoring process: The supervision process is divided into prior reminder, in-process audit, and post-supervision, and hospitals are encouraged to connect with intelligent supervision systems and carry out prior reminder.
- Promoting comprehensive intelligent audit by handling agencies: Promoting comprehensive intelligent audit of handling agencies: Handling agencies at all levels should use the intelligent supervision subsystem to comprehensively review the costs of designated medical institutions and establish a management mechanism to improve the audit process.
- Expanding the application scenarios of intelligent monitoring：Adapt to the changes of the new situation, including the reform of the outpatient mutual support mechanism and the intelligent audit and supervision under the DRG/DIP payment method.
#02 Why should we issue the Notice to further promote the intelligent review and monitoring of medical care funds?
– The medical care department needs to innovate the way of supervision, realize the whole process of intelligent monitoring, anti-fraud intelligent monitoring, etc.
#03 What positive impact will the comprehensive promotion of intelligent audit and monitoring of medical care funds have on the internal management of designated medical institutions?
– Encouraging pharmaceutical institutions to take the initiative to connect with the intelligent supervision system, link to the annual assessment.
– It can reduce the frequency of on-site inspection and other policy incentives.
– It is Helpful to regulate medical behaviour and improve the internal management system.
– Stopping illegal expenditures by the medical care fund and support hospitals to develop valuable medical technologies.
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Source：Medical Device Market
Translated & edited ： Bradyknow
