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"driver's license-style scoring"! national medical insurance administration: serious violators will be terminated from medical insurance payment qualifications

2024-09-27

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today (27th), the national medical insurance administration held a press conference on the "guiding opinions on establishing a medical insurance payment qualification management system for relevant personnel in designated medical institutions". the objects of medical insurance supervision will extend from institutions to relevant personnel, implement "driver's license-style scoring" for relevant personnel of designated medical institutions.

relevant personnel within the calendar year

scored 12 pointseligibility for medical insurance payment will be terminated

according to the relevant person in charge of the national medical insurance administration, according to the service agreement signed between the designated medical institution and the medical insurance agency, relevant personnel involved in the use of medical insurance funds at this designated medical institution are eligible for medical insurance payment, and are also included in the scope of medical insurance supervision. mainly includes two categories -

  • the first category is hospital-related personnel, including relevant medical, nursing, and technical health professional technicians who provide services to insured persons, as well as relevant staff responsible for medical expenses and medical insurance settlement review.

  • the second category is the main person in charge of designated retail pharmacies, that is, the main person in charge of the drug business license.

the first category is hospital-related personnel, including relevant medical, nursing, and technical health professional technicians who provide services to insured persons, as well as relevant staff responsible for medical expenses and medical insurance settlement review.