Công văn 2539/BHXH-CSYT năm 2020 về thanh toán chi phí xét nghiệm COVID-19 theo chế độ bảo hiểm y tế do Bảo hiểm xã hội Việt Nam ban hành

On July 30, 2020, the Ministry of Health issued Official Dispatch No. 4051/BYT-KHTC on payment for Covid-19 testing costs, and the Vietnam Social Security sent copies of the above-mentioned Official Dispatch to provincial social security agencies for study and coordination with the health facilities that accept health insurance in provinces to implement this Official Dispatch. And further request provincial social security agencies to comply with guidelines in Official Dispatch No. 2146/BYT-BH dated April 17, 2020 and Official Dispatch No. 2276/BYT-BH dated April 24, 2020 of the Ministry of Health on payment of healthcare expenses covered by health insurance related to the COVID-19 pandemic.

However, in Official Dispatch No. 262/TB-VPCP dated July 29, 2020 of the Government’s Office announcing the conclusion of the Prime Minister at the standing meeting of the Government on prevention and control of COVID-19, the Prime Minister instructed the Ministry of Health to "soon report in writing to the Prime Minister on the payment for testing costs".   Therefore, on August 7, 2020, Vietnam Social Security issued Official Dispatch No. 2525/BHXH-CSYT requesting the Ministry of Health:

- To report and consult with the Government and the Prime Minister on payment for COVID-19 testing costs from the health insurance fund;

- While waiting for the guidance of the Government, the Prime Minister, the Vietnam Social Security will instruct the provincial social security agencies to temporarily advance funding to promptly initiate the COVID-19 tests for holders of health insurance cards coming to health facilities which sign a contract to accept health insurance (hereinafter referred to as contracting health facilities) under the Official Dispatch 4015/BYT-KHTC and Official Dispatch No. 4068/BYT-KHTC dated July 30, 2020 of the Ministry of Health.

To ensure payment of healthcare costs under health insurance in accordance with regulations, Vietnam Social Security requests provincial social security agencies to:

1. Make payments for healthcare costs covered by heath insurance in accordance with guidelines in Official Dispatch No. 2146/BYT-BH dated April 17, 2020 and Official Dispatch No. 2276/BYT-BH dated April 24, 2020 of the Ministry of Health on payment of healthcare expenses covered by health insurance related to the COVID-19 pandemic.

For people infected with COVID-19 treated at a newly established field hospital:  The provincial social security agency shall pay for health costs within the scope of payment by the health insurance fund according to the instructions in Official Dispatch No. 2146/BYT-BH and Official Dispatch 2276/BYT-BH with contracting health facilities in the administrative divisions assigned by competent authorities to be the focal point in managing and supplying drugs and medical supplies ... serving the examination and treatment at that field hospital.

2. For the COVID-19 testing costs

2.1. The provincial social security agency shall coordinate with the contracting health facilities to record the COVID-19 testing costs of the cases in which the holder of the health insurance card tests for COVID-19 in the cases specified in Clause 1 of Official Dispatch 4051/BYT-KHTC of the Ministry of Health, in specific:

a) Patients must take medical isolation measures or forcible medical isolation at health facilities.

b) People infected with COVID-19 are receiving medical treatment at health facilities that accept health insurance.

c) Cases designated by contracting health facilities to perform tests under the guidance of the Ministry of Health on diagnosis and treatment of acute respiratory syndrome caused by nCoV together with Decision No. 3351/QD-BYT dated July 29, 2020.

2.2. Aggregation of COVID-19 testing costs

The provincial social security agency shall coordinate with the contracting health facilities in aggregating the COVID-19 testing costs according to the price specified in Clause 2 of Official Dispatch No. 4051/BYT-KHTC, health insurance payout to entities as if they are examined and treated in health facilities with proper levels as follows :

a) At the health facility that has signed a contract to accept health insurance in examination and treatment: aggregate the cost according to the number of orders to do tests and number of tests done concerning holders of health insurance cards.

b) At the field hospital:  The provincial social security agency shall coordinate with the contracting health facilities in the province which are assigned by competent authorities to be the focal point for management and supply of drugs and medical supplies ... in providing examination and treatment at the field hospital to aggregate the cost of testing COVID-19 of the holders of health insurance cards.

If a contracting health facility mentioned in item a and item b above fails to do tests for COVID-19, it shall transfer the specimens to a qualified health facility to test for COVID-19 as prescribed in Clause 1, Clause 2 and 3, Article 3 of the Circular No. 09/2019/TT-BYT dated June 10, 2019 of the Ministry of Health. If the health facility which receives the specimen for COVID-19 testing has not been issued with a health facility code, that health facility shall request the Department of Health (or the Ministry of Health) to issue a medical facility code as the basis for social security agency to encode medical procedures in accordance with Clause 4, Article 3 of Circular No. 09/2019/TT-BYT.

c) Encoding COVID-19 tests

Provincial social security agencies shall add ".SC2" at the end of the character sequence code of medical procedures, in specific:

- For COVID-19 tests done at that medical facility:  XX.YYYY.ZZZZ.K.SC2.

- For COVID-19 tests done by another health facility through transfer of specimens: XX.YYYY.ZZZZ.K.WWWWW.SC2.In which the characters XX.YYYY.ZZZZ.K.WWWWW shall be written in accordance with the instructions in Clause 4 Article 3 of Circular No. 09/2019/TT-BYT.

3. Provincial social security agencies are responsible for scrutinizing and aggregating COVID-19 testing costs in accordance with the above guidance, noting that the COVID-19 testing costs which have been paid by other sources of funds shall not be aggregated; and health facilities must purchase chemicals and medical supplies to do COVID-19 tests in accordance with regulations or under the guidance of competent authorities in the COVID pandemic prevention and control. Based on the statistics of COVID-19 testing costs, the provincial social security agency shall advance sufficient funds for health facilities to do COVID-19 tests for holders of health insurance; and the provincial social security agency shall only pay the COVID-19 testing costs to the health facilities in full with the consent of the Prime Minister and the guidance of the Ministry of Health and Vietnam Social Security./.

---------------

This document is handled by Dữ Liệu Pháp Luật . Document reference purposes only. Any comments, please send to email: [email protected]