按季度清算
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国家医保局:2026年全面推进医保基金即时结算,探索按季度清算
Mei Ri Jing Ji Xin Wen· 2025-12-13 04:29
Core Viewpoint - The National Medical Insurance Administration emphasizes the need to optimize the medical insurance payment settlement mechanism by 2026 to promote the healthy development of the medical sector [1] Group 1: Policy Initiatives - The meeting introduced the version 3.0 grouping scheme for payment by disease [1] - It will fully implement quarterly or monthly special case single negotiations and reviews to support the clinical use of new drugs and technologies, as well as the treatment of difficult and severe cases [1] - There is a focus on supporting the healthy development of grassroots medical and health institutions and promoting hierarchical diagnosis and treatment [1] Group 2: Financial Measures - The meeting calls for an increase in the prepayment of medical insurance funds and the full promotion of instant settlement of medical insurance funds [1] - Exploration of quarterly clearing is also part of the financial strategy [1] - The completion of 40 batches of project guideline compilations is aimed at achieving a basic national uniformity in medical service pricing items [1]