Công văn 6266/BYT-BH của Bộ Y tế về việc bổ sung Phụ lục 01 ban hành kèm theo Quyết định 4210/QĐ-BYT ngày 20/09/2017 của Bộ Y tế quy định chuẩn và định dạng dữ liệu đầu ra sử dụng trong quản lý, giám định và thanh toán chi phí khám bệnh, chữa bệnh bảo hiểm y tế

STT

Cases

Code of group of medical services

Unit price

Quantity

Coinsurance percentage

Amount

Notes

(TEN_DICH_VU)

(MA_NHOM)

(DON_GIA)

(SO_LUONG)

(TYLE_TT)

(THANH_TIEN)

(1)

(2)

(3)

(4)

(5)

(6) = (3) x (4) x (5)/100

(7)

1

Two patients sharing a hospital bed

15

90,000

1

50

45,000

If two patients share a bed, total cost of bed shall be equal to 50% of the primary cost of bed; the patient shall not pay the remaining 50% amount. Therefore, Quantity = 1; coinsurance percentage = 50;Amount = Quantity*unit price*coinsurance percentage/100

2

Three patients or more sharing a hospital bed

15

90,000

1

30

27,000

If three patients, or more, share a bed, total cost of bed shall be equal to 30% of the primary cost of bed; the patient shall not pay the remaining 70% amount. Therefore, Quantity = 1; coinsurance percentage = 30;Amount = Quantity*unit price*coinsurance percentage/100

3

From the second examination to the fourth examination

13

20,000

1

30

6,000

When taking the second, third or fourth examination, total cost of medical examination shall be equal to 30% of the primary cost, and the patient shall not pay the remaining 70% amount. Therefore, Quantity = 1; coinsurance percentage = 30;Amount = Quantity*unit price*coinsurance percentage/100

4

For the fifth examination

13

20,000

1

10

2,000

When taking the fifth examination, total cost of medical examination shall be equal to 10% of the primary cost, and the patient shall not pay the remaining 90% amount. Therefore, Quantity = 1; coinsurance percentage = 10;Amount = Quantity*unit price*coinsurance percentage/100

5

Using the second technical service in the one surgery (performed by the same surgical team)

8

2,460,000

1

50

1,230,000

When using the second technical service in the one surgery (performed by the same surgical team), total cost of such medical service shall be equal to 50% of the primary cost, and the patient shall not pay the remaining 50% amount. Therefore, Quantity = 1; coinsurance percentage = 50;Amount = Quantity*unit price*coinsurance percentage/100

6

Using the second technical service in the one surgery (performed by another surgical team)

8

2,460,000

1

80

1,968,000

When using the second technical service in the one surgery (performed by another surgical team), total cost of such medical service shall be equal to 80% of the primary cost, and the patient shall not pay the remaining 20% amount. Therefore, Quantity = 1; coinsurance percentage = 80;Amount = Quantity*unit price*coinsurance percentage/100