Preface

On June 28, the National Medical Insurance Administration issued the "Update of the Database of Classification and Codes of Medical Consumables for Medical Insurance" (June 2020). It is understood that this time a total of 32,554 codes for medical insurance medical consumables are included, covering the actual specifications of 9,404,543 medical consumables. The National Medical Insurance Bureau pointed out that in accordance with the overall requirements of "unified classification, unified coding, unified maintenance, unified release, and unified management", it will accelerate the promotion of a unified medical insurance information business coding standard and form a national "common language".

1. 32554 consumables have been coded

Medical consumables information will be included in the national medical insurance medical consumables classification and code database for use by medical security departments in various regions. The National Medical Security Administration pointed out in the "Notice of the National Medical Security Administration on Issuing Guidance Opinions on Medical Security Standardization": By 2020, based on the construction of a unified national medical insurance information system, 15 information services including disease diagnosis and surgical operations will be gradually realized Implementation of coding standards. Finally, a top-down, unified and standardized medical insurance information business coding system will be formed.

2. Interpretation of Consumables Code Announcement

You can find out what the codes that affect consumables across the country look like in the database released today. After clicking on the details, you can see more specific information.

So what does this series of numbers represent?

The National Medical Insurance Bureau displayed the coding rules and methods of medical insurance medical consumables in the "Four Information Business Coding Rules and Methods for Medical Insurance Disease Diagnosis and Operation, Medicines, Medical Service Items, and Medical Consumables":

(Image source: National Medical Insurance Administration)

Interpretation: The code of medical insurance and medical consumables is divided into 5 parts and a total of 20 digits, which are expressed in a specific order by capital English letters and Arabic numerals. The first part is the identification code of consumables, the second part is the classification code, the third part is the generic name code, the fourth part is the product feature code, and the fifth part is the manufacturer code.

Part 1: Consumables identification code, represented by a capital English letter "C".

Part 2: Classification code, which is divided according to the subject, purpose, location and function of medical consumables, and is represented by 6 Arabic numerals.

Part 3: Generic Name Code, to create a national unified universal name code for medical insurance and medical consumables, represented by 3 Arabic numerals.

Part 4: Product feature code, a code assigned according to the material and specifications of the consumables, expressed with 5 Arabic numerals.

Part 5: Manufacturing company code, which is a unique code assigned to the consumable manufacturer based on the medical device registration certificate or filing certificate, and is represented by 5-digit Arabic numerals.

A total of 32,554 codes for medical insurance medical consumables were included this time, covering 9,404,543 actual specifications of medical consumables.

3. Local medical insurance departments shall not adjust without authorization

On June 8, the National Medical Insurance Administration issued the Interim Measures for the Management of Medical Consumables for Basic Medical Insurance (Draft for Solicitation of Comments). The structure mainly includes two parts: legend and catalog.

The legend is an explanation and description of the format, name and coding specification, payment scope, etc. of the "Basic Medical Insurance and Medical Consumables Catalog". The catalog includes serial number, function classification, medical insurance code, payment scope, pricing unit, payment standard, method of determining payment standard, remarks, etc.

The "Draft for Solicitation of Comments" emphasizes that, except for special regulations, local medical insurance departments will all implement the national "Basic Medical Insurance and Medical Consumables Catalog" and shall not adjust without authorization.

It is understood that the medical consumables referred to in these Measures refer to medical consumables that are approved by the drug regulatory authority, can be charged separately, and have a uniform code for medical security medical consumables. These Measures shall apply to the medical insurance access, payment and corresponding management and supervision of medical consumables.

According to the "Draft for Solicitation of Comments," medical consumables in the catalogue will not be paid by the medical insurance fund if one of the following conditions exists. 1. Used for non-disease diagnosis and treatment projects; 2. Used for various scientific research and clinically verified diagnosis and treatment projects; 3. Exceeding the scope of reasonable use; 4. Others that do not meet the requirements of the basic medical insurance payment scope.

For medical consumables in the catalog, if one of the following conditions is met, neither the medical insurance fund nor the patient will be paid. 1. The use of consumables is unsuccessful due to their own reasons; 2. The cost of implantable consumables exceeding the actual number of implants.

The medical consumables in the "Basic Medical Insurance Medical Consumables Catalog" must meet the following conditions at the same time before the medical insurance fund can pay. 1. For the purpose of disease diagnosis and treatment; 2. Compliance with the applicable scope of registration or filing with the drug regulatory authority; 3. Compliance with the payment scope defined by the "Basic Medical Insurance and Medical Consumables Catalog"; 4. Designated medical institutions with corresponding qualifications Issued by medical personnel (first aid and rescue can be appropriately relaxed to non-designated medical institutions); 5. Other conditions stipulated by the state.

4. Consumables coding involves payment and settlement

It can be seen that the coding of medical consumables, which the medical industry has been paying attention to, has officially begun. By 2020, on the basis of the construction of a unified national medical security information system, 15 information service coding standards such as disease diagnosis and surgical operations will be gradually implemented.

Different from medicines, consumables are not only numerous and diverse, the same product has different names when bidding and purchasing in different regions, and various local policies and regulations on consumables have caused many inconveniences in the bidding, procurement and payment of consumables.

Under such circumstances, there are many companies that use this to evade price regulation, and some areas even form mixed business formats. In recent years, the consumables procurement alliance that has emerged in the industry has implemented consumable procurement prices and data sharing practices to circumvent the practice of enterprises.

The emergence of the coding standards for medical consumables will inevitably make changes and amendments to certain links in the consumables industry chain to match the coding standards for medical insurance disease diagnosis and surgical operation information that were also focused on in the early stage. In fact, because there is no uniform standard, companies themselves often don't know the names and information of products in bidding and purchasing in multiple places. For example, the product name is a in Beijing, but it becomes b in Nanjing.

Conclusion

This "consensus" will directly affect the bidding, procurement and payment of consumables. It turns out that the consumables are complicated, and the coding standards will change the chaotic situation and eliminate the problems caused by poor product information in the previous bidding and procurement links, which will affect the payment link.

Source: Cyber ​​Blue Equipment