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开封市基本医疗保险定点医疗机构医疗服务合同(2016年)

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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.1//EN" "http://www.w3.org/TR/xhtml11/DTD/xhtml11.dtd"><html xmlns="http://www.w3.org/1999/xhtml"><head><meta http-equiv="Content-Type" content="application/xhtml+xml; charset=utf-8" /><title></title><style type="text/css">body{ font-family:'Times New Roman'; font-size:1em; } ul, ol{ margin-top: 0; margin-bottom: 0; } ins{color:#2E97D3;} del{color:#FF0000;} .Normal{page-break-inside:auto;page-break-after:auto;page-break-before:auto;margin-top:0.0pt;margin-bottom:0.0pt;margin-left:0.0pt;text-indent:0.0pt;border-top-style: none;border-left-style: none;border-right-style: none;border-bottom-style: none;font-size:12.0pt;font-family:'Times New Roman';mso-fareast-font-family:Calibri;mso-bidi-font-family:'Times New Roman';} .Heading-1{text-align:center;page-break-inside:avoid;page-break-after:auto;page-break-before:auto;margin-top:14.0pt;margin-bottom:14.0pt;margin-left:0.0pt;text-indent:0.0pt;border-top-style: none;border-left-style: 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none;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;} .Table-Normal{} </style></head><body style="pagewidth:595.35pt;pageheight:841.95pt;"><div class="Section0"><div style="min-height:72pt" /> <p class="Heading-1"><span style="color:#000000;font-size:18.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;font-weight:bold;">基本医疗保险定点医疗机构医疗服务协议书</span><span style="color:#000000;font-size:18.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;font-weight:bold;">&nbsp;</span><span style="color:#000000;font-size:18.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;font-weight:bold;">&nbsp;</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">甲方:</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">        </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">法定代表人或委托代理人:</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">        </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">地址:</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">        </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">邮政编码:</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">        </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">联系电话:</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">        </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">乙方:</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">        </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">法定代表人或委托代理人:</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">        </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">地址:</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">        </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">邮政编码:</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">        </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">联系电话:</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">        </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;"> </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">2016年</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;text-decoration: underline;">    </span><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">月</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;"> </span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">为保证基本医疗保险制度实施,保障参保人员的合法权益,规范定点医疗机构的医疗服务行为,构建和谐医、保、患关系,根据《中华人民共和国社会保险法》、《城镇职工基本医疗保险定点医疗机构管理暂行办法》等法律法规及相关政策,甲乙双方经过协商,就基本医疗保险服务有关事宜签订如下协议。</span></p> <p class="Heading-3"><span style="color:#000000;font-size:13.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;font-weight:bold;">第一章 总则</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第一条 甲、乙双方应当认真贯彻国家、省、市有关基本医疗保险、医药卫生、物价等规定,保证参保人员享受基本医疗保险服务。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第二条 乙方提供医疗服务的对象包括:本统筹地区城镇职工基本医疗保险、城镇居民基本医疗保险,异地就医的参保人员以及离休参保人员。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第三条 乙方为参保人员提供医疗服务的范围,包括:门诊、住院、门诊重症慢性病等医疗服务,乙方所提供的医疗服务应当符合卫生行政部门许可的诊疗项目。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第四条 甲乙双方应当依照国家、省及市有关的政策法规,正确行使职权,有权监督对方执行有关政策法规和履行职责的情况,检举或投诉对方工作人员的违法违规行为,向对方提出合理化建议。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第五条 甲方应当履行以下义务:</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">(一)及时向乙方通报基本医疗保险法规政策和管理制度、操作流程的变化情况,并接受乙方咨询。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">(二)组织乙方基本医疗保险管理相关人员进行医疗保险政策培训。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">(三)加强基本医疗保险基金预算管理,完善付费方式及结算方法,及时审核并按规定向乙方拨付应当由基本医疗保险基金支付的医疗费用。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">(四)应当通过媒体、政府网站、服务场所等向社会开展医疗保险宣传。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第六条 乙方应当履行以下义务:</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">(一)建立健全医疗保险管理服务部门,由一名院级领导分管医疗保险工作,配备专兼职管理人员,明确并履行管理职责,配合甲方开展医疗保险管理工作。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">(二)乙方不得有对外承包或合作科室,不得转借医疗保险信息服务终端。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">(三)为参保人员提供合理、必要的医疗服务,合规收费。采取有效措施控制医疗费用不合理增长,减轻参保人员个人负担。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">(四)向甲方提供与基本医疗保险有关的材料,及时传输参保人员就医、结算及其他相关信息,保证材料和信息的真实、准确、完整。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">(五)乙方应当在本机构显要位置悬挂“基本医疗保险定点医疗机构”标牌,根据医疗保险政策法规制定相应措施加强内部管理,设置导医服务台,公布院内医疗保险咨询电话和社会医疗保险监督电话,并通过宣传栏、电子屏等向就医的参保人员宣传基本医疗保险主要政策、就医流程及医疗服务项目和药品的名称、价格等。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第七条 甲方建立并及时维护为参保人员服务的医生库,对纳入医生库的医务人员所发生的符合规定的医疗费用,甲方予以支付。乙方应向甲方提供医师信息,并对医务人员开展医疗保险培训。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第八条 甲方通过医疗保险信息监控系统对乙方的医疗服务行为及医疗费用进行实时智能监控。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">甲方定期或不定期开展监督检查,并将监控和监督检查情况及时反馈给乙方。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">乙方应当对甲方在监督检查中查阅参保人员病历及有关资料、查询当事人等予以配合。对乙方提供的资料。甲方应当予以保密。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第九条 甲乙双方应当为参保人员提供相关的咨询服务。</span></p> <p class="Heading-3"><span style="color:#000000;font-size:13.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;font-weight:bold;">第二章 就医管理</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第十条 社会保障卡和医疗保险病历本是参保人员就医的身份证明、结算凭证和乙方记录参保人员诊疗情况的载体。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">参保人员就医时(出入院和转诊转院等),乙方应当对其身份与社会保障卡进行核验,发现证件无效、人证不符的,不得进行医疗保险结算;有骗保嫌疑的,应当及时报告甲方。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">参保人委托他人代为购药的,乙方应当按基本医疗保险有关规定执行。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第十一条 乙方应当为参保人员就医建立病历,并妥善保存备查。门诊与住院病历的诊疗记录应当真实、准确、完整、清晰,化验检查须有结果分析。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">乙方应当做到住院医嘱、病程记录、检查结果、治疗单记录和票据、费用清单等相吻合。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第十二条 乙方应当按规定完善有关医疗文书,所开具的医保处方各项填写完整、规范、清晰,单独装订并保存一年备查。使用电子处方(普通处方、重慢病处方)时,应当同时打印出纸质处方并签字或加盖签章备查,其格式与手写处方一致;各种检验(检查)报告单应由检验(检查)者亲笔签名,否则视为无效报告,复印件无效。住院病历中应如实填写患者参保单位、通讯地址、联系电话等基本情况。费用较高的检查、主要治疗及手术应及时记录并分析,否则甲方有权拒付相关费用。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第十三条 乙方应当充分利用参保人员在其他定点医疗机构所做的检查化验结果,避免不必要的重复检查。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第十四条 乙方应执行门诊处方外配制度,参保人员要求到定点零售药店购药的,乙方不得拒绝。外配处方应当书写规范,字迹工整,并加盖乙方专用章。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第十五条 甲方确定乙方为门诊重症慢性病定点单位的,乙方应按照重症慢性病相关文件要求,确定相应的科室及医生为参保人员提供门诊重症慢性病医疗服务。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第十六条 乙方收治参保人员住院应遵照所患主要疾病与科室业务相应的原则,承包科室、暂停医保服务的科室,不得收治医保病人,否则统筹基金不予支付。乙方属于定点专科医疗机构的,应遵循“专病专治”原则。经甲方同意的康复科室可以按相关规定收治医保病人。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第十七条 乙方应向办理入院的参保人员发放“致参保人员一封信” 宣传医保政策规定,保证参保人员知情同意权,向参保人员提供门诊、住院费用结算清单和住院日费用清单,建立并执行自费项目参保人员知情确认制度。不得要求参保人员到门诊缴费或药店购药。若由于目录对应错误而导致参保人员自费现象发生,或未提前告知签字的,参保人员有权拒付,由此导致的费用由乙方负担。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第十八条 乙方应当在参保人员住院当天完成入院信息录入及《开封市参保人员住院报告单》的填写,特殊情况应在五个工作日内录入信息。参保人员入院当日的急诊费用应与本次住院费用合并计算(限本院急诊),经医保科长签字同意及时录入医保系统,急诊项目清单随病历报医保中心。参保人员发生急诊时,乙方要先抢救,不能以手续不全为由延误诊治,否则由此产生的医疗纠纷由乙方负责解决。</span></p> <p class="Normal--Web-"><span style="color:#000000;font-size:12.0pt;font-family:Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">第十九条 乙方应严格执行出、入院和重症监护病房收治标准,不得推诿和拒绝符合住院条件的参保人员住院治疗;不得将不符合入院标准的参保人员住院治疗;不得要求未达到出院标准的参保人员提前出院或自费住院;为符合出院条件的参保人员及时办理出院手续,参保人员拒绝出院的,应当自通知出院之日起,停止医疗保险费用结算。严格杜绝“挂床”住院。本市同类级别医院间原则上不允许转院(专科除外)。</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">&nbsp;</span><span style="color:#000000;font-size:12.0pt;font-family:Simsun;mso-fareast-font-family:Calibri;mso-bidi-font-family:Simsun;">&nbsp;</span><a id="_GoBack" /></p> </div></body></html>

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