Guidelines for the process of assessment of payment conditions for medical services in Vietnam

Guidelines for the process of assessment of payment conditions for medical services in Vietnam (Internet image)

On 12/12/2022, Vietnam Social Security issued Decision 3618/QD-BHXH promulgating the process of medical insurance assessment.

1. Guidelines for the process of assessment of payment conditions for medical services in Vietnam

The process of assessing the payment conditions for medical examination and treatment services is guided as follows:

- Gather documents:

The provincial social insurance agency guides medical examination and treatment establishments to send the documents mentioned in Article 15 of the promulgation process attached to Decision 3618/QD-BHXH (except for the contract appendix mentioned in Clause 4 and Article 15 of the promulgation process attached to Decision 3618/QD-BHXH);

At the same time, update the list of medical examination and treatment services on the receiving portal and send it to the assessment software when requesting to sign a contract for medical examination and treatment covered by insurance or when there is a change in the contract's performance.

In case of a request for payment for technical services mentioned in Clause 5, Article 15, Procedure issued together with Decision 3618/QD-BHXH: Medical examination and treatment establishments update the list of medical staff of other medical examination and treatment establishments assigned to follow the data format in Table 2 and Form No. 01/QTGD.

- Evaluation of the medical examination and treatment service list and prices:

+ The inspection software automatically returns to the portal the following medical examination and treatment services:

++ Medical examination and treatment services are not included in the list of equivalent technical services promulgated by the Ministry of Health and are not suitable for specialties and forms of medical examination and treatment;

++ Technical services have not been promulgated by the Ministry of Health or the head of medical examination and treatment establishments;

++ Prices of technical services, medical examinations, and hospital beds according to specialties are higher than those of medical examinations and treatment services prescribed by the Minister of Health;

++ Subclinical services performed at other medical examination and treatment establishments not included in the approved list of technical services of the medical examination and treatment facility covered by health insurance

++ The technical services that receive the transfer are mentioned in Clause 5 and Article 15. This procedure is not suitable for the scope of professional activities of the medical staff performing the transfer.

+ Provincial social security

Compare the data with the paper version in case the list data has not been digitally signed, and return the list to the medical examination and treatment establishment for adjustment if it is incorrect. Examine documents and return to the medical examination and treatment facility via the portal to receive the following technical services:

++ Technical services used by patients with health insurance are not included in the list of approved technical services;

++ Technical services for patients with health insurance are provided using medical equipment that is not on the list provided by medical examination and treatment establishments.

++ Technical services are not provided with sufficient documents by medical examination and treatment establishments in the cases mentioned in Clauses 4, 5, 6, and 7 of Article 15 of the Procedures attached to Decision 3618/QD-BHXH.

2. Applications and documents of assessment of payment conditions for medical services

- A list of technical services used for patients with health insurance and technical procedures or professional instructions issued by the head of the medical examination and treatment facility; data format according to Table 5 Form No. 01/QTGĐ.

- The list of medical equipment to perform technical services for patients with health insurance according to Table 6 and Form No. 01/QTGD.

- The list of medical examination specialties, the list of departments and treatment rooms according to the regulations of the Ministry of Health, made according to Table 1, Form No. 01/QTGD, and the list of practitioners made according to Table 2, Form No. 01/QTGD.

- In case the paraclinical services need to be transferred to another medical facility: a written notice enclosing the principle contract with the medical facility where the performance is performed, the list of paraclinical services to be transferred;

Appendix to the contract signed between the provincial social insurance agency and the medical examination and treatment facility on payment according to the health insurance regime for subclinical services that need to be transferred to another medical facility; a written approval from a competent authority for the provision of paraclinical services at the medical facility where the paraclinical services are performed without a contract for medical examination and treatment covered by health insurance.

- In the event of receiving technical transfer under the Ministry of Health's line-directing program, professional capacity improvement project, or technical transfer contract:

List of medical staff from other medical examination and treatment establishments assigned to perform the work; plans and decisions on sending practitioners to alternately support lower levels of the competent authority; the list of technical services to be transferred if they have not been approved by competent authorities for implementation.

- If technical services are performed using leased medical equipment or a joint venture or association, and the project is accompanied by an approval decision from the appropriate authority, the contract remains valid.

- In case of providing technical services with medical equipment that have not been accounted into the state budget and other forms of ownership transfer to the State of Vietnam: document establishing the entire people's ownership of property issued by a competent authority as prescribed in Decree 29/2018/ND-CP.

3. Contents of the assessment of payment conditions for medical services in Vietnam

Contents of assessment of payment conditions for medical examination and treatment services include:

- Determination of approved medical examination and treatment services within the scope of payment by the health insurance fund.

- Appointment and provision of technical services appropriate to the type of operation, professional and technical classification, medical equipment, practitioners in medical examination and treatment establishments.

- Prices of medical examination and treatment services covered by health insurance are in accordance with regulations of the Minister of Health.

More details can be found in Decision 3618/QD-BHXH effective from January 1, 2023, replacing Decision 1456/QD-BHXH dated December 1, 2015.

Quoc Dat

>> CLICK HERE TO READ THIS ARTICLE IN VIETNAMESE