Some notes on out-of-network medical care and inpatient treatment in Article 22 of Vietnam's Law on Health Insurance

According to the Official Dispatch, guidelines for the number of notes when implementing Article 22 of Vietnam's Law on Health Insurance are as follows:

- In case where any patient who receives an appointment note for a medical follow-up visit after an out-of-network medical care as prescribed in Clause 3 and 6, Article 22 of Vietnam's Law on Health Insurance (including the case of receiving further medical care after inpatient medical care), that medical examination or treatment visit with the medical follow-up appointment note will be considered as an out-of-network medical visit.

- In case where any participant in the health insurance plan making an out-of-network medical visit as prescribed in point c of clause 3 and clause 6 of Article 22 in Vietnam's Law on Health Insurance incurs expenses for an inpatient or outpatient medical visit (only in case of the outpatient medical visit to a district-level hospital) which are 15% less than the base pay and are fully covered by his/her health insurance benefit, the data field No. 17 (MUC HUONG (translated as COVERED BENEFIT)) in Table 2 and Table 3 annexed to the Decision No. 4210/QD-BYT dated September 20, 2017 of the Minister of Health of Vietnam, prescribing formats and standards of output data needed for management, assessment and payment of health insurance-covered costs and expenses, is filled with the value “100”.

- Regarding daylight inpatient beds:

+ The number of hospital beds in daylight should fall within the limit on the number of inpatient beds approved by competent authorities.

+ Payment and settlement of costs of per-day hospital beds on a quarterly basis must conform to regulations laid down in clause 16, Article 6 in the Vietnam's Circular No. 39/2018/TT-BYT.

Total days of inpatient care each quarter (year) of a medical establishment include days spent on inpatient beds or daylight inpatient beds.

More details can be found in Vietnam's Official Dispatch 296/BHXH-CSYT issued on February 02, 2021.

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