AG真人国际厅官网

索  引  号 MB1846817/2019-00014 分        类 基金监督  
发布机构 江苏省医疗保障局 发文日期 2018-04-04
标        题 江苏省医疗保障局关于印发全省医疗保障基金监管年实施方案的通知
文        号 苏医保发[2019]25号
时        效

jiangsushengyiliaobaozhangjuguanyuyinfaquanshengyiliaobaozhangjijinjianguannianshishifangandetongzhi

AG真人国际厅官网geshequshiyiliaobaozhangju,kunshanshi、taixingshi、shuyangxianyiliaobaozhangju:

weiguancheluoshidangzhongyang、guowuyuanjuecebushu,jiaqiangyiliaobaozhangjijinjianguan,jianjuedajiqizhapianbaoxingwei,qieshibaozhangjijinanquan,genjuguojiayiliaobaozhangjuheshengweishengzhengfuyouguanjiaqiangjijinjianguandegongzuoyaoqiu,juedingzaiquanshengkaizhan“yiliaobaozhangjijinjianguannian”huodong,xianjiang《quanshengyiliaobaozhangjijinjianguannianshishifangan》yinfanimen,qingjieheshiji,renzhenguanchezhixing。



                           jiangsushengyiliaobaozhangju

                            2019nian4yue4ri




全省医疗保障基金监管年实施方案


AG真人国际厅官网weiguancheluoshidangzhongyang、guowuyuanjuecebushu,jiaqiangyiliaobaozhangjijinjianguan,jianjuedajiqizhapianbaoxingwei,qieshibaozhangjijinanquan,genju《guojiayiliaobaozhangjuguanyuzuohao2019nianyiliaobaozhangjijinjianguangongzuodetongzhi》(yibaofa〔2019〕14hao)yaoqiuhenianduyiliaobaozhangjijinjianguangongzuohuiyijingshen,juedingzaiquanshengkaizhan“yiliaobaozhangjijinjianguannian”huodong,zhidingfanganruxia:

一、总体要求

(yi)zhidaosixiang。renzhenguanchexijinpingzongshujiguanyudajiqizhapianbaodezhongyaopishijingshen,luoshilikeqiangzongli、hanzhengfuzongliguanyujiaqiangjijinjianguandezhishiyaoqiu,jianchiyirenminweizhongxindefazhanlinian,guancheluoshiguojiayiliaobaozhangju“2019niankaizhandajiqizhapianbaozhuanxiangzhili”he“dajiqizhapianbaojizhongxuanchuanyuehuodong”deanpai,lvxingfadingzhize,kangqijianguandaqi,zuzhishishi“yiliaobaozhangjijinjianguannian”huodong,zhelijiejueyiliaobaozhangjijinzhifuguanliguochengzhongcunzaidetuchuwenti,fangfanhezhizhigezhongqinzhanyiliaobaozhangjijindeweifaweiguixingwei,baozhangjijinanquan,tigaojijinshiyongxiaolv,qieshibaozhangyiliaobaozhangshiyejiankangkechixufazhan。

(er)gongzuoyaoqiu。yiyaojiangzhengzhi,jianjueguancheluoshidangzhongyangguowuyuanyouguanjuecebushu,laojiquebaoyibaojijinanquanshiyibaobumendeshouyaozhizeshiming。eryaogandandang,zhenduiqizhapianbaoxingweijishuxingheyinbixingqiangdetedian,yongyuyingzhan、ganyutiaozhan、shanyuzuozhan,yongshijixingdongzhanxianyibaoduiwudezhizhengdinglihenengli。sanyaoxingchengheli,gaoduguanzhujijinliuxiang,zhuzhongxitongjicheng,jiaqiangshangxialiandong、zuoyoulianhe,jizhongliliangdajiqizhapianbaoxingwei。siyaoyingzaofenwei,yaoyingzaoquanmincanyudedajiqizhapianbaofengqi,fahuishehuizuzhihegongzhongjianduzuoyong,xingchengshehuigongtongcanyudelianghaofenwei。

AG真人国际厅官网(san)gongzuomubiao。zaiquanshengkaizhan“yiliaobaozhangjijinjianguannian”huodong,chixubaochidajiqizhapianbaogaoyataishi。yishizhidingdajiqizhapianbaojubaochulibanfa,jianlijianquanyiliaobaozhangjijinjianguanchengxintixi,buduanwanshanyiliaobaozhangjijinjianguantixi。ershiduidingdianyiyaojigouxianchanghechaquanfugai,moqingdingdianyiyaojigouweiguiweijiweifaxingwei。sanshishixiantongchoudiquzhinengjiankongquanfugai,buduanwanshan,tigaodajiqizhapianbaodezhenduixing。sishiyunyongduozhongshouduan,shixianyiliaofeiyong100%chushen,zhuyuanfeiyongchouchafushenbilibudiyu5%。wushijianquanzonghejianguan,jiaqiangduiwuagzhenrenguojitingguanwang,jijiyinrudisanfangjianguan,chixutigaojianguannengli。

二、重点工作安排

2019nian,shiyiliaobaozhanggongzuomaijinxinshidai、benxiangxinzhengchengdekaijuzhinian。gediyaojiaqiangxuexi,renzhenlinghuidangzhongyangguowuyuanheshengweishengzhengfuduijijinjianguangongzuodezongyaoqiu;yaotongyisixiang,tigaoduizuohaojijinjianguangongzuozhongyaoxingderenshi;yaojianlijianquanjijinjianguantixi,xiangguanliyaoxiaoyi,cujinyiliaobaozhangkechixufazhan。zhongdianzhuahaoyixiaqigefangmiandegongzuo。

(yi)shengshiliandong,chixukaizhandajiqizhapianbao

1、kaizhanxianchangjiancha。gediyaozhenghegefangziyuan,jizhongshijian、jizhongliliang,zhuyipaichaxiaquneidingdianyiyaojigouweifaweiguixingwei,shixiandingdianyiyaojigouxianchangjianchaquanfugai。zongheyunyongzhinengjiankong、tujijiancha、zhuanjiashencha、disanfangcanyudengfangshi,jiangyiliaobaozhangjijinzhifuquanbunarushenchafanwei。shengjuhegediyaozaiquanmianpaichadejichushang,jianlijianquandingdianyiyaojigoujibenxinxiku,duiweifaweiguiyiyaojigoushixingzhongdianbiaozhu。

2、kaizhanzhuanxiangzhili。anzhaoguojiatongyibushu,zaiquanshengtongyikaizhandajiqizhapianbaozhuanxiangzhilihuodong,jiangpianbaoduofadedingdianyiliaojigoujidingdianlingshouyaodianzuoweizhuanxiangzhilidezhongdian。gediyaojiangdingdianyiliaojigoutongguoxujiaguanggao、yitijiandengmingmuyoudao、pianqucanbaorenyuanzhuyuan,xugouyiliaoagzhenrenguojitingguanwang、weizaoyiliaowenshuhuopiaoju、guachuangzhuyuan、daoshuayibaokadengxingwei;dingdianlingshouyaodianliucun、daoshua、maoyongcanbaorenyuanyibaoka、youdaocanbaorenyuangoumaihuazhuangpinheshenghuoyongpindengxingwei;canbaorenyuanweizaoxujiapiaojubaoxiao、maomingjiuyi、shiyongyibaokataoxianhuotaoquyaopindengxingwei,zuoweijizhongliliangdajidezhongdian。

yaojiaqiangduiyibaojingbanjigoudejiandujiancha,zhongdianchachuneikongzhidubujianquan、jijinjihebuquanmian、lvyuejianchabudaowei、weiguibanliyibaodaiyu、weiguizhifuyibaofeiyongyijineiburenyuan“jianshouzidao”、“neiwaigoujie”dengxingwei。shengjuzai9-10yuezuzhililiang,duigedishixingjiaochachouchahefucha。

AG真人国际厅官网3、shishitujijiancha。shengjujianlijianquanyiliaobaozhangjijinjianguanzhuanjiaku,congzhongchouquyiliao、yibao、caiwudengzhuanjia,duigedizhongdianjigou、wentijigoubudingqikaizhanshengneikuashequshitujijiancha,bingducuzhidaodifanggongzuo。gediyaoyansugongzuojilv,jijizhudongpeihejiancha,binganyaoqiuwanchengtujijianchahouxuchachugongzuo。

(er)gongkenandian,jianliquanshengtongyidezhinengjiankongpingtai

4、dajianquanshengtongyidezhinengjiankongpingtai。shengjuanzhaoguojiatongyibushu,yijuquanguotongyidejishubiaozhun、yewubiaozhun、yewuguifanheguojiayiliaobaozhangxinxipingtaiagzhenrenguojitingguanwangxuqiu,lizhengzai2019niandijianchengquanshengjizhongtongyidezhinengjiankongpingtai。gediyaochongfenfahuiyibaozhinengjiankongzaifeiyongchushenzhongdezuoyong,shixianyiliaofeiyong100%chushen;jiangzhinengjiankongcongdengjiyiliaojigouxiangjicengyiliaojigouyanshen,lizhengshixianzhinengjiankongdingdianyiyaojigouquanfugai。

AG真人国际厅官网5、tishengzhinengjiankongzhilianghexiaolv。yaobuduanzongjiejingyanjiaoxun,genjuqizhapianbaoxingweitedianhebianhuaqushi,jinyibuwanshanjiankongguize、xihuajiankongzhibiaohezhinengjiankongzhishiku,cujinzhinengjiankongtizhizengxiao。zaidingdianyiyaojigoushoufeijiesuanchuangkoudengguanjianchuanzhuangshipintantou,shixianzhenliaoshujuheagzhenrenguojitingguanwangyingxiangdeshishibidui、tongbuzaixianjiankong;tansuotuijinrenlianshibiedengxinjishushouduan,shixianzhinengjiankongguankouqianyi,tishengjianguanxiaoneng。yaoshiyingzhifufangshigaigedexuyao,yingyongdashujufenxi,kaizhananbingzhongfufeiheanjibingzhenduanxiangguanfufeidengzhinengjiankong,tigaozhinengjiankongdezhenduixing。yaojianquanzhinengjiankonggongneng,jiakuaixiangshizhonglanjieheshiqiantixingyanshen,tansuojiangzhinengjiankongyuchengxintixiagzhenrenguojitingguanwangyuyibaolingyu“heimingdan”zhiduderonghe,tigaojianguannengli。

6、jijikaizhanguojiazhinengjiankongshifandianagzhenrenguojitingguanwang。tuijianbufenjijixinggao、xinxihuaagzhenrenguojitingguanwangjichuhaodediqucanjiaguojiazhinengjiankongshifandianagzhenrenguojitingguanwang,jiakuaiyingyongdashuju、yunjisuandengxiandaixinxijishu,congguochengjiankongxiangguochengjiankong+jieguojiankongzhuanbian,guifanyindaohelideyiliaoagzhenrenguojitingguanwangxingwei,bingyiciweizhuashoufahuishifandaidongzuoyong,jianliquanshengtongyidejiyudashujufenxidezhinengjiankongpingtai。yaojiaqiangduiyiliaoshujuguifantianbaozhidao,tigaoyiliaoxinxishujutianbaozhiliang。yaozhuzhongshujushiyonganquanguanli,qianghuabaomizerenheshujushiyongquanxianguanli。

AG真人国际厅官网(san)lizudangqian,jianlijianquandajiqizhapianbaogongzuozhidu

7、guifanjubaochuliliucheng。yaowanshanjubaodianhua,changtongjubaotousuqudao;zhidingjubaochulibanfa,guifanjubaoxiansuofanwei、shouli、jiaoban、chachu、fankuidenggongzuoliuchenghegongzuojizhi,mingqueshoulihechachubiaozhun,jishixiangjubaorenfankuixiansuoshoulijichachuqingkuang。yaojianlijubaotaizhangzhidu,renzhenhecha,zhenbiezhenwei,xianshibanjie,yangezhixinganqingbaogaozhidu。

8、luoshijubaojianglicuoshi。yaoluoshi《zhuanfaguojiayiliaobaozhangjubangongshi caizhengbubangongtingguanyuyinfaqizhapianquyiliaobaozhangjijinxingweijubaojianglizanxingbanfadetongzhi》(suyibaofa〔2019〕5hao)yaoqiu,huitongxiangguanbumen,zhidingchutaijubaojianglijutishishixize,mingqueshishijianglidejutibiaozhun,shenling、shenpi、fafangliuchengdengneirong。gediyaoguangfanxuanchuanjubaojianglibanfa,jishiduixianjianglizijin,yifabaohujubaorendehefaquanyi,xingchengshehuigongtongjiandudelianghaofenwei。

9、jianlianqingbaogaozhidu。duiyijingchachudesheanjinechaoguo5wanyuanyishang,huoyijiaogonganjiguan,huokenengyinqiyulunguanzhudezhongdaanjian,gediyaozaianjianbanjiehuoyijiaogonganjiguanhou2gegongzuorinei,jiangyouguanqingkuangjishibaoshengyiliaobaozhangju,baogaoxubaokuofaxianguocheng,weiyueweiguiweifashishi,chulijieguojichuliyijudeng。

AG真人国际厅官网(si)duocuobingju,jianlijianquanyiliaobaozhangjianguantixi

10、jianquanzonghejianguanjizhi。jianlijianquanweishengjiankang、shichangjianguan、caizheng、shenji、gongan、jijianjianchadengbumencanyudezonghejianguanlianxihuiyizhidu,tongchouyibaojijinjianguandexiediao、zhidaohezhongdaanjianchachudenggongzuo。bayijingchashideweiguiweifajigouhegerenxinxi,jishitongbaoxiaquneiweishengjiankang、shichangjianguanhejijianjianchabumen,anguidingdiaoxiaozhiyezigehuozhuijiudangjizhengjizeren。shexianweijiweifade,jishiyijiaosifabumen。

11、jijiyinrudisanfangliliang。canjiaguojiayiliaobaozhangjukaizhandejianguanfangshichuangxinshidian,yinruxinxijishuagzhenrenguojitingguanwangjigou、huijishiwusuo、shangyebaoxianjigoudengdisanfangliliang,fengfujianguanlilianghejianguanjineng。yaotongguozhengfuzhaobiaoxuandingcanyudisanfangdanwei,zhaobiaozhuyaobaokuojuticanyujianguanrenyuanzhuanyegouchengheshuliang、yewufanwei、gongzuolianghegongzuojixiaodeng,zhaobiaorenyingdangyuzhongbiaodedisanfangdanweiqiandinghetong,mingqueshuangfangzeren、quanliheyiwu,hetongqixianyijiweiyuezeren。yaojiaqiangduidisanfangdanweideguanlihezhidao,gongtongzuohaojijinjianguangongzuo。

(wu)jiaqiangzilv,tuijinyiliaobaozhangxinyongtixiagzhenrenguojitingguanwang

AG真人国际厅官网12、jianlijianquanjijinjianguanchengxintixi。jieheguojiachengxintixiagzhenrenguojitingguanwangshidian,tansuoyiliaobaozhangxitongchengxintixiagzhenrenguojitingguanwangxiangguanbiaozhun、guifanhezhibiaotixi,xiangguanxinxicaiji、pingfenheyunyongdengneirong。duijiechengxinagzhenrenguojitingguanwangzhinengguanlibumen,tansuojiangyiliaobaozhanglingyuqizhapianbaoxingweinaru“chengxinjiangsu”guanlitixi,jianlilianhechengjiezhidu。

AG真人国际厅官网13、tansuojianliyibaolingyu“heimingdan”zhidu。jiangyanzhongweiguidedingdianyiyaojigou、yibaoyishihecanbaogerenlieru“heimingdan”,bingyuyiliaobaoxianliangdingxieyiguanlixiangjiehe,duilieru“heimingdan”deliangdingyiyaojigouhezhiyeyishi、zhiyeyaoshishixingjufuyibaofeiyong、tuichuxieyiguanlifanwei,caiqushidangdetujingheshouduanxiangshehuigongbu。

AG真人国际厅官网(liu)yuantouzhili,tishengjingbanjigoufangfanfengxiannengli

AG真人国际厅官网14、yansuneibufengxianfangkong。yaoquanmianshuliyibaojijinzhifufengxiandian,jiaqiangjingbanjigouneikongzhiduagzhenrenguojitingguanwang,guifanjijinhuijizhiduhecaiwuzhidu,jianjuedusaifengxianloudong。jiaqiangduijingbanjigouneikongjiancha,zhongdianjianchajingbanjigouneibuguanlishifouguifan、gexiangzhidushifoujianquan、gangweizhizeshifoujiaocha,duiweiyuedingdianyiyaojigoushifouanxieyichulidaowei。

15、xihuayibaoxieyineirong。yangeluoshi《guanyudangqianjiaqiangyibaoxieyiguanliquebaojijinanquanyouguangongzuodetongzhi》(yibaobanfa〔2018〕21hao)wenjianyaoqiu,yaogenjudangqiandingdianyiyaojigoupianbaoxingweidetedian,jianquanxieyidongtaiguanlijizhi,zaixieyiwenbengeshijibentongyidejichushang,genjudingdianyiyaojigoudeleixing、agzhenrenguojitingguanwangfanwei、agzhenrenguojitingguanwangtediandengfenjifenleizhidingxieyiwenben。yaoduiweiyuezerentiaokuanxihualianghua,zhongdianmingquexianqizhenggai、zantingjiesuan、zantingxieyi、jiechuxieyidengjuticuoshi,zengqiangxieyiguanlidezhenduixinghekezhixingxing。

AG真人国际厅官网16、yanbaxieyidingdianzhunru。duidingdianyiyaojigoushishixieyiguanli,jianlijianquandingdianyiyaojigoutuichujizhi,duishoudaoguoxiangguanbumenxingzhengchufaqieqingjieyanzhongde,jianjuebuyudingdian;duidingdianyiyaojigougenghuanfarende,yaojishiqidongxiangguanyibaozhangmudeqingcha;yibeijiechuxieyideyiliaojigou,3nianneibudezaishenqingyibaodingdian。

AG真人国际厅官网17、yangeyiliaofeiyongshenhe。gejiyibaojingbanjigouyaoyunyongzhinengjiankongduiyiliaofeiyongjinxingchushenquanfugai,caiqusuiji、zhongdianchouchadengfangshi,duizhuyuanyiliaofeiyongheshougongbaoxiao5wanyuanyishangdedaefeiyongjiadafushenlidu,fushenbilibudediyu5%。

AG真人国际厅官网(qi)jizhongxuanchuan,yingzaodajiqizhapianbaodelianghaofenwei

18、kaizhandajiqizhapianbaojizhongxuanchuanyuehuodong。4yuefen,anzhaoguojiayaoqiu,tongyikaizhanxuanchuanyuehuodong,gediyaozhidingyiliaobaozhangzhengcexuanchuanqingdan,caiquduozhongcuoshi,jizhongxuanchuanjieduyiliaobaozhangjijinjianguanfalvfaguiyuzhengceguiding、yibaodaiyuzhengceheagzhenrenguojitingguanwangguanliguiding。guangfanzhangtiedajiqizhapianbaoxuanchuanhaibao,fafangxuanchuanzheye,bofangtongyizhizuodongmanxuanchuanpiandeng,yunyongqunzhongxiwenlejiandexuanchuanxingshi,jiaqiangyulunyindaohezhengmianxuanchuan。

19、puguangdianxinganli。jiangxuanchuanyulunguanchuan“jianguannian”,yaojijizhudongpuguangyijingchashidedianxingqizhapianbaoanjian,xingchengzhenshezuoyong。tongguodingqibudingqizhaokaixinwenfabuhui、meititongqihuidengxingshi,fabudajiqizhapianbaochengguohedianxinganli。zhudongyaoqingxinwenmeiticanyutujijiancha、mingchaanfangdenghuodong,yindaomeitixingchengliangxinghudong。

三、工作步骤

yiliaobaozhangjijinjianguannianhuodong,cong2019nian3yuedao2019nian12yue,jutifenweiyixiasigejieduan:

AG真人国际厅官网(yi)bushuqidongjieduan(2019nian3yue—4yue)

shengchengliyiliaobaozhangjijinjianguannianlingdaoxiaozuzhidingbingyinfa《quanshengyiliaobaozhangjijinjianguannianshishifangan》,bushuqidongquanshengyiliaobaozhangjijinjianguannianhuodong。geshequshianzhaoshengtongyibushu,jiehebendiqushijizhidingyiliaobaozhangjijinjianguannianjutigongzuofangan,chenglishijiyiliaobaozhangjijinjianguannianlingdaoxiaozu,jiaqiangduijianguanniangongzuodezuzhilingdao。

AG真人国际厅官网(er)jianzhanglizhijieduan(2019nian4yue—5yue)

AG真人国际厅官网zhidingxiafa《jiangsushengyiliaobaozhangjijinjubaochulibanfa》,kaizhanyiliaobaozhangjijinjianguanchengxintixiagzhenrenguojitingguanwangyanjiu,jianlidajiqizhapianbaoduobumenxiediaojizhi;zuzhituijianbufenchengshinaruguojiajianguanfangshichuangxinshidian、jijinjianguanchengxintixiagzhenrenguojitingguanwangshidianhezhinengjiankongshifandianagzhenrenguojitingguanwang。

(san)zuzhishishijieduan(2019nian4yue—12yue)

AG真人国际厅官网gejiyiliaobaozhangbumen、yibaojingbanjigouanzhaoquansheng“yiliaobaozhangjijinjianguannian”huodongyaoqiu,zhidinggongzuofanganbingjingxinzuzhishishi。zhongdianzuohaoxialiegongzuo:

AG真人国际厅官网(1)4yue,zaiquanshengzuzhikaizhandajiqizhapianbaojizhongxuanchuanyuehuodong。

(2)4yue—8yue,zuzhikaizhandajiqizhapianbaozhuanxiangzhilizichahuodong。

(3)5yue—7yue,zuzhikaizhanjianguanduiwurenyuanlunxun,jianliyiliaobaozhangjianguanzhuanjiaku,jianlijianquanquanshengdingdianyiyaoweishengjigouxinxiku。

AG真人国际厅官网(4)9yue—10yue,kaizhandajiqizhapianbaozhuanxiangzhilifucha。

(5)11yue—12yue,duichoucha、fuchagongzuozhongfaxiandewenti,jinxingdubanzhenggai。

AG真人国际厅官网(6) 4yue—12yue,xiangshehuifabushengjigeshequshitousujubaodianhua,zaijuwangzhan、weixingongzhonghaoheweibokehuduan,kaishequnzhongtousujubaochuangkou,quanmianjieshouqunzhongjubaohejiandu。

AG真人国际厅官网(si)zongjiebaogaojieduan(2019nian12yue)

AG真人国际厅官网shenglingdaoxiaozubangongshiduigedishangbaodeshishiqingkuangjinxingfenxihehuizong,tichujiaqiangyibaojijinjianguandejianyi,xingchengquanshengyiliaobaozhangjijinjianguanniangongzuozongjie。zongjie“liangshidianyishifan”gongzuobingshangbaoguojiayiliaobaozhangju。

四、加强组织领导

gediyaochongfenrenshijijinjianguangongzuodezhongyaoxing、jinpoxinghejianjuxing,jiangweihujijinanquanzuoweidangqianyiliaobaozhanggongzuoshouyaodezhengzhirenwu,yanmingzhengzhijilv,qianghuazerendandang,chuangzaoxingkaizhangongzuo,quebaozaikaijuzhinian,“yiliaobaozhangjijinjianguannian”huodongqudeshixiao。

AG真人国际厅官网(yi)qianghuazuzhilingdao。shengjuhegediyaochengliyoujuyibashourenzuzhang,jijinjiandubumenfuze,gebumenxietongde“yiliaobaozhangjijinjianguannian”gongzuolingdaoxiaozu,ba“yiliaobaozhangjijinjianguannian”huodonglierujuyishiricheng。gediyaozhunquebawohuodongneirong,jingxinzuzhishishi,zhashiyouxutuijin,quebaohuodongqudeshishizaizaidechengxiao。

(er)qianghuayaosubaozhang。gediyaojiaqiangjijinjianguanduiwuagzhenrenguojitingguanwang,tishengzhifalilianghezhifashuiping。jiadaduiyibaozhinengjiankongagzhenrenguojitingguanwangtouru,buduanwanshanyewuxitonggongneng,guifangaizaoyewujiekou,buduantishengjiankongshuiping。yaojijitansuoxiangdisanfanggoumaiagzhenrenguojitingguanwangjizhi,mingquegoumaiagzhenrenguojitingguanwangdefanwei、biaode、shulianghezhiliangyaoqiu,jiangjingfeibaozhangyuagzhenrenguojitingguanwangliang、agzhenrenguojitingguanwangjixiaodengguagou。

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AG真人国际厅官网1

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