03 Principles of Payment for Technical Rehabilitation Service Fees

20:55, 10/07/2024

This content is stipulated in Circular 18/2016/TT-BYT, which regulates the list of techniques, the list of medical supplies used in rehabilitation, and the payment of day rehabilitation costs within the payment scope of the Health Insurance Fund.

According to the provisions of Circular 18/2016/TT-BYT, the cost payment for technical rehabilitation services (PHCN) is carried out based on the following principles:

- There is a rehabilitation technical list approved by the competent authority. When prescribing, the specific name of the technical service and the body part where the technique is performed must be recorded in the medical record.- Payment for any technical service that is performed. For medical examination and treatment establishments (KBCB), rehabilitation establishments applying the capitation or disease group payment method, Social Insurance will base on the Technical List to inspect and pay.- Health Insurance (BHYT) payment for cases identified as proper referral KBCB as follows:

- Referral according to the provisions of [Circular 14/2014/TT-BYT](https://lawnet.vn/vb/thong-tu-14-2014-tt-byt-viec-chuyen-tuyen-giua-co-so-kham-chua-benh-37bbd.html) regulating referral between medical examination and treatment establishments and [Circular 40/2015/TT-BYT](https://lawnet.vn/vb/thong-tu-40-2015-tt-byt-dang-ky-kham-chua-benh-bhyt-chuyen-tuyen-kham-chua-benh-bhyt-48923.html) regulating initial medical examination and treatment registration and referral for medical examination and treatment under health insurance.- If the district-level KBCB establishment does not have the appropriate technology for the patient's rehabilitation needs, the commune-level KBCB establishment can refer the patient to the provincial rehabilitation establishment.

More details can be found in Circular 18/2016/TT-BYT effective from August 19, 2016.

- Thanh Lam -

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