How to investigate and review medical insurance for accidental falls

If the inpatients of the new rural cooperative medical system suffer accidental injury after discharge, they shall also submit the confirmation certificate of the cause of the accidental injury signed and sealed by the village (neighborhood) where the household registration is located and the medical records of the hospital. Those who cannot provide valid certificates and records will not be accepted. The reimbursement period shall be completed within 30 working days from the date of acceptance of the new rural cooperative medical system window of the district administrative service center, and shall be reimbursed after investigation and audit by the inspectors of the new rural cooperative medical system management center. If the third party is responsible, it will not be reimbursed; If the inpatients bear part of the responsibility themselves, they shall submit their medical expenses to the new rural cooperative medical system window of the district administrative service center with the agreement or relevant certificates.

Legal basis:

Article 23 of the Social Insurance Law of People's Republic of China (PRC), employees shall participate in the basic medical insurance for employees, and the employer and employees shall jointly pay the basic medical insurance premium according to the provisions of the state. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Medical insurance audit process:

1. Out-of-town patients must submit the patient's hospitalization record, medical expense list, original hospitalization receipt, and a copy of the patient's ID card, CCB card or rural credit cooperative card to the local township medical insurance office. The patient or immediate family member carries a copy of ID card to sign the trauma commitment letter. At the beginning of each month, the township medical insurance staff reported the reimbursement materials of trauma patients to Xifeng County Urban and Rural Medical Insurance Sub-center. For the trauma patients who have been approved for reimbursement, the township medical insurance staff will take back the medical records and other reimbursement materials and file them at the end of next month, enjoy the urban and rural medical insurance reimbursement, and return the reimbursement materials to the trauma patients who do not meet the reimbursement.

2. Traumatic patients in designated medical institutions directly under the county level shall be reported by their families to Xifeng County Urban and Rural Residents' Medical Insurance Sub-center, including trauma questionnaire, the first page of hospitalization medical records and admission records (all), and the patients shall be directly examined and approved before discharge. For trauma patients who meet the reimbursement conditions, patients or their immediate family members bring a copy of their ID cards to Xifeng County Urban and Rural Residents' Medical Insurance Sub-center, sign a trauma commitment letter and handle the trauma approval form, and then go back to the hospital to enjoy medical insurance reimbursement for urban and rural residents. For trauma patients who do not meet the reimbursement conditions, they can directly go back to the hospital for self-funded discharge procedures. Legal basis:

People's Republic of China (PRC) social insurance law

Twenty-third employees should participate in the basic medical insurance for employees, and the employer and employees should jointly pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.