2022年医院新农合工作制度 .pdf
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1、医院?新农?合工?作制?度?篇?一:?医?院医?保新?农合?管理?制度?(完?稿)?医?院?医?执?行人?:?监管?第一?责任?人:?监?管第?二责?任人?:?保?、?新?农?合?管?理?制?度?年?月年?月?年?月?日?日?日?一、?20?1X?年职?工医?保定?点医?院管?理协?议要?求-?-?-?-?-?-?-?-?-?-?-?-?-?3?二?、新?农合?患者?外转?检查?操作?流程?-?-?-?-?-?-?-?-?-?-?-?-?6?三?、医?保、?城镇?居民?患者?外转?检查?操作?流程?-?-?-?-?-?-?-?-?7?四?、医?保、?新农?合扣?款问?题管?理方?案-?-?-?
2、-?-?-?-?-?-?-?-?-?-?-?-?-?-?-8?五、?20?1X?年各?县市?区新?农合?患者?住院?手续?办理?须知?-?-?-?-?-?-?-?12?六、?医疗?保险?科工?作职?责-?-?-?-?-?-?-?-?-?-?-?-?-?-?-?-?-?-?-?-?-?-?-?-?-1?3?20?1X?年度?职工?医保?定点?医院?管理?协议?要求?1.?患?者在?办理?入院?后,?经治?医生?、护?士有?义务?主动?询问?患者?的参?保类?别(?城镇?职工?医保?、城?镇居?民医?保)?,认?真核?对?医疗?保险?证?和医?疗卡?,按?规定?填写?医?保病?人住?院认?定卡?。
3、?凡发?现就?诊者?所持?医疗?保险?证、?医疗?卡与?其身?份资?料不?相符?时,?应及?时通?知院?医保?办。?参保?病人?住院?当天?登记?,实?行医?保网?络系?统实?时在?线,?特殊?情况?不得?超过?三天?(节?假日?顺延?),?否则?社保?中心?将按?挂牌?住院?对待?。参?保人?员欠?缴保?费,?须全?额收?费,?但应?按医?保人?员管?理。?2.?住?院医?师应?按洛?阳市?城镇?职工?基本?医疗?保险?统筹?基金?支付?范围?的要?求,?收治?参保?人员?住院?。同?时遵?照所?患主?要疾?病与?科室?业务?相对?应的?原则?;否?则统?筹基?金不?予支?付。?确因?病情?
4、需要?必须?提供?医疗?保险?支付?范围?以外?的服?务时?,需?向患?者本?人或?其家?属解?释清?楚,?征得?同意?并签?字后?方可?提供?,费?用较?高的?自费?项目?须在?病历?中记?录理?由。?参保?人员?住超?标准?床位?,其?超标?准部?分属?自费?项目?,应?征得?病人?或其?家属?同意?并签?字,?否则?,患?者有?权拒?付相?关费?用。?费用?较高?的自?费服?务项?目须?在病?历中?记录?理由?。不?得将?可以?在门?诊治?疗的?病人?收治?住院?。?3?.?严格?执行?卫生?部颁?发的?处?方管?理办?法?、?抗菌?药物?临床?应用?指导?原则?以?及其?它临?床诊?疗
5、规?范。?根据?豫人?社医?疗?20?1X?7?号文?件规?定,?医生?开具?西药?处方?须符?合西?医基?本诊?治原?则,?开具?中成?药处?方须?遵循?中医?辩证?施治?原则?和理?法方?药,?对于?每一?最小?分类?下的?同类?药品?原则?上不?宜叠?加使?用。?按西?医诊?断不?得开?具中?成药?,按?中医?诊断?不?得开?具西?药。?对住?院参?保病?人的?主要?用药?,应?在病?程记?录中?明确?记载?使用?理由?。住?院参?保人?员使?用自?费药?品和?自费?诊疗?项目?,均?应控?制在?住院?总费?用的?6%?以内?。?4?.?按规?定完?善有?关医?疗文?书,?各种?检验?(
6、检?查)?报告?单应?由检?验(?检查?)者?亲笔?签名?,否?则视?为无?效报?告,?复印?件无?效。?住院?病历?中应?如实?填写?包括?患者?参保?单位?、通?讯地?址、?联系?电话?等基?本情?况。?费用?较高?的检?查、?主要?治疗?及手?术等?应及?时在?病历?中记?录并?分析?,单?价在?10?00?元以?上的?体内?植入?材料?应在?手术?记录?单上?粘贴?该材?料的?条形?码。?5.?严?格控?制大?型检?查适?应症?,单?项费?用在?10?0 元?以上?的检?查,?实行?严格?的院?内审?批手?续,?由科?室主?要负?责人?、医?保负?责人?审批?。病?程文档编码:CM5D
7、3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F1
8、0E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3
9、I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM
10、5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7
11、F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9
12、C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:
13、CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8记?录中?应明?确记?载使?用理?由、?检查?目的?和结?果分?析,?否则?视为?不合?理检?查。?6.?出?院患?者应?在其?离开?医院?的当?日办?理网?上出?院结?算手?续。?不得?以节?假日?、双?休日?等理?由延?长达?到出?院标?准的?患者?住院?时间?,不?得诱?导参
14、?保人?员延?长住?院时?间,?不得?强行?让未?达到?临床?治愈?标准?的参?保人?员出?院,?不得?以费?用限?额等?理由?让未?达到?临床?治愈?标准?的患?者出?院。?未及?时办?理出?院的?视同?挂床?。因?病情?需要?须转?往上?级医?院的?参保?患者?,应?开具?市内?转院?单,?并在?病人?离开?本院?的同?时为?其办?理网?上转?诊手?续。?未按?规定?及时?办理?病人?网上?转院?登记?手续?所造?成的?病人?个人?负担?增加?部分?由相?关人?员负?担。?出院?带药?应与?住院?疾病?直接?相关?,一?般不?超过?7 天?量,?药物?不超?过 5?种,?同类?药物?不超?
15、过 2?种,?出院?不允?许?带注?射剂?。超?出上?述约?定的?相关?费用?统筹?基金?不予?负担?。?7?.?自 2?01?X年?7 月?1 日?起,?意外?伤害?所发?生的?医疗?费用?,纳?入基?本医?疗保?险统?筹基?金支?付,?但下?列医?疗费?不纳?入支?付范?围:?(一?)?应当?从工?伤保?险基?金中?支付?的;?(二?)?应当?由第?三人?负担?的;?(三?)?应当?由公?共卫?生负?担的?。?8?.?城镇?职工?和城?镇居?民普?通住?院医?疗费?,按?年度?人均?25?00?元医?疗费?定额?标准?,单?病种?不计?入年?度定?额标?准计?算。?参保?人员?在门?诊就?
16、医,?应?允许?其持?本医?疗机?构医?务人?员所?开处?方到?定点?零售?药店?购药?。?篇二?:?医院?新型?农村?合作?医疗?工作?管理?制度?沂?南?仰?成?医?院?新?型农?村合?作医?疗工?作管?理制?度?为执?行省?、市?、?县关?于新?型农?村合?作医?疗工?作的?有关?规定?,确?保“?新农?合”?病人?在我?院就?医过?程中?做到?因病?施文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2
17、U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D
18、3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F1
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20、I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM
21、5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7
22、F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9
23、C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8治?、合?理用?药、?合理?治疗?、合?理检?查,?最大?限度?地维?护“?新农?合”?病人?的就?医利?益,?规范?就医?行为?,以?方便?农民?、服?务农?民、?实惠?农民?的原?则,?制定?以下?管理?制度?及实?施细?则。?一?、基?础管?理?(?一)?组织?机构?:?成立?沂南?仰成?医院?新型?农村?合作?医疗?管理?办公?室,?配置?专职?人员?,在?主管?院长?领导?下,?全权?负责?“新?农合?”病?人的?医疗?服务?管理?工作?。?(?二)?配置?专用?微机?,满?足“?新农?
24、合”?医疗?信息?统计?要求?的计?算机?系统?。?(?三)?设专?职财?务人?员,?负责?为“?新农?合”?病人?核算?。?(?四)?“新?农合?”病?人统?一使?用医?院规?定的?处方?、收?据和?补偿?费用?收据?。?(?五)?各项?制度?健全?,并?得以?落实?。?(?六)?医院?工作?人员?了解?“新?农合?”的?各项?规章?及工?作程?序。?(七?)“?新农?合”?病人?的医?疗文?书保?管、?医疗?专用?章及?收费?票据?等管?理按?医院?相关?规定?制度?化管?理。?二、?新农?合病?人就?医管?理?各相?关科?室工?作人?员应?热情?接待?参合?病人?就诊?,不?得以?任何?
25、理由?、借?口推?诿或?拒绝?参合?农民?就医?与咨?询。?(一?)入?院处?:?1、?热情?、和?蔼接?待参?合病?人办?理入?院手?续。?认真?审核?合疗?证、?身份?证(?户口?本)?所填?写内?容是?否一?致,?杜绝?冒名?顶替?。?2?、“?二证?”核?实无?误后?,在?住院?证上?加盖?院农?合章?,以?便各?相关?科室?对病?人就?医方?式的?确认?。?文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9C3I2U8R8文档编码:CM5D3T3I6T7 HR7F10E9J6I8 ZH9
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