What Does a Medical Billing Specialist Do?

The price of medical services is a form of price for medical services as a commodity exchange. It is essentially a monetary expression of the value of medical services. It is a standard for medical services to charge medical services for patient services, including outpatient, inpatient, and various inspections. , Treatment, testing, surgical items, etc. Because medical services belong to the category of public goods, medical services are different from ordinary goods and have the duality of welfare and goods. The state does not levy taxes on them, and at the same time grants certain forms of financial subsidies. Therefore, the price of medical services is not formed spontaneously through the adjustment of market supply and demand, but adopts an incomplete production price model, that is, the relevant government departments determine the level of prices based on the theoretical price, and then according to the level of national economic development and the affordability of residents , So the price of medical services is generally lower than the value of medical services. The price of medical services is the main channel for the organization's income and the main way for medical institutions to make up for medical expenses.

Medical service prices

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The price of medical services is a form of price for medical services as a commodity exchange. It is essentially a monetary expression of the value of medical services. It is a standard for medical services to charge medical services for patient services, including outpatient, inpatient, and various inspections. , Treatment, testing, surgical items, etc. Because medical services belong to the category of public goods, medical services are different from ordinary goods and have the duality of welfare and goods. The state does not levy taxes on them, and at the same time grants certain forms of financial subsidies. Therefore, the price of medical services is not formed spontaneously through the adjustment of market supply and demand, but adopts an incomplete production price model, that is, the relevant government departments determine the level of prices based on the theoretical price, and then according to the level of national economic development and the affordability of residents , So the price of medical services is generally lower than the value of medical services. The price of medical services is the main channel for the organization's income and the main way for medical institutions to make up for medical expenses.

Chinese name

Medical service prices

Meaning

A form of price adopted by the commodity exchange

which performed

Monetary Performance of Medical Service Value

Types of

Medical

1. Price in an imperfectly competitive market ^[1]

The current price of medical services in China basically adopts the "item fee" method of charging fees based on service items as a unit of measurement. Different service items have different standards for setting prices. Medical service item days can be divided into the following four categories: ^[2]

Due to the characteristics of the above-mentioned medical service prices, the generation of medical service prices cannot be completely regulated by the market. Instead, a limited market regulation mechanism should be adopted under the guidance of the government. The effects of medical service prices are: ^[1]

1. Cost of medical services ^[2]

Medical service prices are an important part of national price management. Effectively organize, lead, and supervise the process of setting, adjusting, and implementing medical service prices in accordance with the requirements of objective economic laws and the political and economic situation in different periods. At present, the price of medical services in our country is under the unified management of the competent price department and the health administrative department. According to the principle of combining macro-control with market regulation, medical services implement a pricing method that combines government-guided prices with market-adjusted prices. The price of medical services provided by non-profit medical institutions may fluctuate by up to 10% when implementing the government-guided price, and report to the relevant price and health administrative departments for the record. The prices of special-need medical services for patients to choose voluntarily may fluctuate on the basis of government-sponsored guide prices, but they must be reported to the relevant prices and approved by the competent health department for medical services provided by for-profit medical institutions. . ^[3]

I. Principles and principles of medical service price management

(I) Adhere to the basic policy of combining government and market

Under the conditions of a socialist market economy, the medical cause cannot be completely determined by the market. The medical cause must adhere to the basic orientation of social welfare and public welfare. At the same time, the development of medical undertakings should also meet the basic requirements for the construction of a market economy system, and gradually shift to focusing on market regulation, fully mobilize enthusiasm in all aspects, and promote the rapid development of medical undertakings by means of market economics.

(2) Adhere to the policy of price stability and social stability

Price reform is the key to economic system reform. The issue of price is a hot issue in society, and price stabilization is the general policy of price work. The price of medical services is related to the health benefits of the people and is subject to people's psychological and economic affordability. Therefore, we must implement the principles of price stability and social stability.

(3) The policy of unified leadership and hierarchical management

Unified leadership and hierarchical management are the basic principles for the management of the national economy in China, and they are also the policy that must be implemented in price management. Medical service prices, as departmental prices, are generally approved by the provincial government, and supervision and inspection of medical service prices are generally performed by price departments at the same level. Hierarchical management is the principle of hierarchical responsibility for price management. Price departments at all levels replace the government's exercise of inspection and supervision power. At the same time, it also includes the vertical hierarchical management of the comprehensive price department from top to bottom and the horizontal division of labor management with the same level price agencies. The price of health care services forms a crisscross management network.

(D) the principle of cost accounting

The competent price department and the health administrative department shall organize or entrust relevant departments and social organizations to carry out cost surveys in accordance with the medical service cost measurement method prescribed by the state, monitor the medical service price and cost element composition, and provide a basis for the reasonable adjustment of medical service prices. Medical institutions should establish a cost accounting system, work hard to reduce costs, and cooperate with price authorities and health administrative departments to conduct cost surveys.

(V) Principles of supervision by expert committees

The competent price department and the health administrative department jointly set up a medical service price advisory committee composed of medical experts, health economic experts and experts from other relevant departments. The expert advisory committee provides advice and suggestions on the price name, price and service content of important technical services, as well as medical technical issues.

(6) The principle of clear price

Medical services provided by medical institutions to the society must be clearly priced, and medical services that provide higher costs must be clearly stated in advance, soliciting opinions from patients or family members. The competent price department shall stop price fraud in accordance with the law. Support for-profit medical institutions to carry out industry self-regulation on medical service prices.

(VII) The principle of informed patients

Medical institutions are obliged to accept price inquiries from patients. In the settlement of medical expenses, medical service detailed bills must be provided to patients through various forms such as computer printing. Patients with requirements must provide medical service detailed bills unconditionally to accept the supervision of society and patients. (8) The principle that the law must be investigated + The competent price department shall supervise and inspect the service prices of medical institutions in accordance with laws and regulations such as the "Price Law of the People's Republic of China" and "Provisions on Administrative Penalties for Price Violations", and impose administrative penalties on illegal acts.

Inspection and supervision of medical service prices

The implementation of national price policies must be strictly inspected and supervised. The inspection and supervision of prices are the administrative means by which the state manages prices. Inspecting and supervising prices can not only conscientiously implement the state's price policies and regulations, but also safeguard the legitimate rights and interests of consumers.

(I) Objects of medical service price inspection and supervision

The objects of price inspection and supervision of medical services are mainly medical service institutions, including health administrative departments. Medical service institutions mainly refer to various types of medical institutions with fixed income, including health and epidemic prevention, maternal and child health care, drug inspection and other institutions with administrative functions, as well as blood centers, imaging centers, medical schools and other units.

(II) Contents of inspection and supervision of medical service prices

(1) Check and supervise whether the pricing method of medical service price meets the requirements. Where the calculation of the prescribed price is involved, whether the calculation formula is applied correctly, whether the calculation method meets the prescribed requirements, whether the calculated price is true, etc.

(2) Check and supervise the execution time, charge items and standards of medical service prices.

(3) Check and supervise whether the price management system of medical services is sound. The medical service price management system mainly includes a series of contents such as clear price marking, price violation handling, social dirty supervision, posting and announcement.

(4) Check and supervise the situation of charging fees for violations of the price, and check and supervise the situation of "price hikes" and violations of charging standards and scope.

(5) Examine and supervise the charge situation and pricing approval of service items. Examine and supervise the charge status, pricing approval, etc. of the service items carried out by medical service units outside the prescribed charge standards.

In addition to the main content of the above-mentioned medical service price inspection, the investigation and handling of violation charges and the coordination of price disputes also fall into the scope of inspection and supervision.

(3) The form of price supervision of medical services

1. State supervision

State supervision means that the state supervises the prices of medical services in the form of administrative orders and the legal system. State supervision is the main form of price supervision of medical services. Judging from the current situation of state supervision, the system of supervision and annual review of medical service prices is mainly through the form of fiscal, tax, and price inspections.

2. Monitoring within the health system

The supervision within the health system refers to the supervision of the medical administrative department on the price of medical services according to the requirements of the price department. This form of supervision is generally carried out every year, and health administrative departments at all levels organize personnel to carry out price supervision of the health system.

3 Social supervision

Social supervision refers to mobilizing the people to supervise medical services through social forces. The price of medical services involves the immediate interests of the general public, and social supervision is one of the effective forms of supervision.

4 Unit internal supervision

Unit internal supervision refers to the personnel of unit leaders, workers' congresses, trade unions, auditing, and price agencies who supervise the implementation of medical service prices by the unit in economic activities. The forms of internal supervision of the unit include publicizing the prices of medical and health services, organizing personnel to conduct internal inspections, implementing the activities of the reception day of the dean, and soliciting patients' opinions on the prices of medical services.