The procedure for informing insured persons about the cost of medical care provided to them under the program of compulsory medical insurance of the Belgorod region in the OGAUZ "Sanatorium" Krasivo "
1. Accepted abbreviations.
| № | Abbreviation | Definition |
|---|---|---|
| 1. | ZL | An insured person under compulsory medical insurance. |
| 2. | MIS | Medical Information System |
| 3. | MO | Medical organization |
| 4. | MP | Medical care |
| 5. | VMP | High-tech medical care |
| 6. | CSG | Clinical and statistical groups of diseases |
| 7. | OMS | Mandatory medical insurance |
| 8. | Policy | Compulsory medical insurance policy |
| 9. | CFR | Medical insurance organization (operating in the region) |
| 10. | TFOMS | Territorial Fund of compulsory Medical insurance of the Belgorod region |
| 11. | FOMS | Federal Compulsory Medical Insurance Fund |
| 12. | TP MMI | Territorial program of compulsory medical insurance of the Belgorod region |
| 13. | VEHICLE | Tariff agreement in the MHI system of the Belgorod region |
2. General provisions.
2.1. The subject of regulation of this Procedure (hereinafter referred to as the Procedure) is the organization of informing insured persons about the cost of medical care provided to them under the territorial program of compulsory medical insurance of the Belgorod region. The procedure was developed for the implementation of measures to fulfill the order of the President of the Russian Federation No. Pr-1788 dated July 25, 2014 on the introduction of a form of individual information of insured persons into the mandatory medical insurance system, containing a list of medical services provided and their cost, and also in compliance with the order of the Federal Medical Insurance Fund No. 108 dated July 28, 2014 "On the introduction of a system for informing insured persons about the cost of medical care" in order to form an objective idea of the costs of medical care provided to the insured person within the framework of the mandatory medical insurance program of the Belgorod region.
2.2. Information is provided on cases of providing MP within the framework of the Program.
2.3. The result of the notification is the provision of information to the insured person or his legal representative about the cost of the MP provided to the insured person under the TP MHI in any of the following formats:
- a certificate of the cost of medical care provided (hereinafter referred to as the Certificate);
- a cliche in the discharge epicrisis when discharged from the inpatient department;
- oral information with the reflection of the fact of informing in the medical history with the signature of the ZL.
2.4. Patients are informed about cases of medical care in the specialized department of medical rehabilitation of the sanatorium.
2.5. The certificate is issued upon request to all insured persons or their legal representatives in accordance with the current legislation on the protection of information and medical secrecy.
2.6. The certificate can be filled out by hand on the appropriate form.
2.7. To inform the insured person, the cost of medical care is used, established on the basis of the CU MP, which is available on the TFOMS website, effective on the date of provision.
2.8. Director of the sanatorium:
- appoints a person from among the medical staff of the sanatorium, who is responsible for providing information to patients in the sanatorium;
- defines the circle of medical workers whose duties include the registration and issuance of certificates;
- defines the workplace (discharge center) for issuing Certificates;
- provides the above-mentioned employees with information about the current tariffs for medical services and informs about their changes on the basis of the CU.
2.9. Responsible person:
- provides the workplaces of employees who extract and issue a Certificate to the insured person with a list of current tariffs for medical services provided under the CHI program;
- updates the vehicle data in the software used for maintaining personalized medical care records, for generating a Certificate in an automated mode;
- controls the availability of forms for handwritten filling or the functioning of the software and hardware complex for automated statement of the Certificate;
- informing the manager about problems when issuing Certificates.
2.10. The certificate is issued immediately after the provision of medical care (discharge from the inpatient department) to the insured person.
2.11. The insured person who has not received a Certificate, immediately after the service provided, has the right to apply to the sanatorium to the responsible employee with a request to issue a Certificate of cost, within the limitation period not exceeding one year from the moment of medical care.
2.12. The Insured person has the right to refuse to receive a Certificate on the cost of medical care.
2.13 The fact of issuing a Certificate or refusing to receive it under the signature of the insured person or his legal representative is registered in the register of certificates.
2.14. The certificate is of a notifying nature about the cost of medical care from the funds of the compulsory medical insurance and is provided free of charge.
2.15. If the services actually rendered to the insured person do not correspond to the services specified in the certificate, the insured person may contact the responsible person of the sanatorium, the service for the protection of the rights of insured persons of the CFR, or the TFOMS.
3. Features of informing insured persons when providing various types of medical care.
3.1. The procedure for informing insured persons when providing medical care in a round-the-clock hospital (a specialized department of medical rehabilitation of a sanatorium).
3.1.1. The insured persons are informed about the cost of medical care provided in the specialized department of medical rehabilitation of the sanatorium when the insured person is discharged.
3.1.2. To inform the insured person, the cost of medical care is used, determined on the basis of current tariffs for the payment of units of the volume of medical care provided in hospital conditions for the completed case of treatment of the disease included in the corresponding CSG.
4. Requirements for the material and technical and information-technical support of the information process.
4.1. In order to inform the insured person, the director of the sanatorium must take measures to equip the workplaces of employees responsible for issuing and issuing a Certificate to the insured person with computing and copying and multiplying equipment, application software for maintaining personalized records of medical care provided to the insured person in the MHI system.
4.2. When issuing Certificates filled in manually, it should be provided that responsible persons are provided with forms of Certificates.
5. Final provisions.
5.1. The cost of medical care provided, indicated in the certificate, is given without taking into account the results of monitoring the volume, timing, quality and conditions of providing medical care in a sanatorium under the CHI program. These certificates cannot serve as a basis for determining the amount of compensation for damage, presenting it to the judicial and tax authorities.
