1.
Basic principles of insurance claims
1.
Is health insurance guaranteed by the state?
2.
Nursing care benefits refer to medical services for diseases.
3.
Why do medical institutions hate the Health and Welfare Service?
4.
Treatment begins with qualification check (Medical Institution Information Center)
5.
Which sergeant will be the main sergeant?
6.
Find out about the excluded soldiers
7.
Regarding the processing of ‘documentation’ in the name of the patient
8.
Where can I find my sergeant code?
9.
How do I claim medical expenses? (Billing Statement)
10.
Enter specific details for each statement unit
11.
The line number unit specific details are like the caption of an Instagram photo.
12.
What to include in a prescription
13.
How to cancel a prescription and also delete the DUR
14.
Full PACS and radiology interpretation fee billing
15.
Be aware of the additional fee for specimen testing.
16.
Teacher Cheonggu is notified of the decision
17.
Find Missing Income (Supplementary Claim)
18.
Claiming missed medical bills (additional billing)
19.
There are reasons for reduction, and each reason has a code.
20.
Let's follow the retrial adjustment request!
21.
Search order for Ministry of Health and Welfare notices (medical institution business portal)
22.
Why is a medical aid request form necessary?
23.
What is a selective medical care institution?
24.
Apply special calculation exceptions
25.
Shanghai Foreigner Code
26.
The Evaluation and Assessment Service regularly evaluates medical institutions.
27.
Analysis and review
28.
Treatment and billing of patients hospitalized in other hospitals
29.
Treatment and billing of patients hospitalized in nursing hospitals

2.
Calculation of salary, non-salary, and medical examination fees
1.
Distinction between salaried and non-salary
2.
What is non-covered benefit?
3.
What is the full out-of-pocket cost for long-term care benefits?
4.
Full out-of-pocket expenses (behaviors, medications) are also included in the benefits, and there are set standards.
5.
Targets determined to be fully self-funded
6.
What is voluntary non-payment in the long-term care benefit category?
7.
Learn about selective and reserve benefits
8.
Confusing salary and non-salary items (certificate issuance, record copying)
9.
Confusing benefits and non-benefits (issuing medical referral forms and medical benefit extension applications)
10.
Confusing coverage and non-coverage (treatment on the day of vaccination)
11.
Confusing benefits and non-benefits (same-day treatment for national health checkups)
12.
Confusing Salary and Non-Salary (Other)
13.
General principles of inspection
14.
When can tests be prescribed without reimbursement?
15.
In case of prescribing a test at the full cost to the patient
16.
Confusing Covered and Non-Covered Tests (Tests Patients Want)
17.
Confusing Covered and Non-Covered Examinations (Additional Examinations Following a Non-Covered Comprehensive Examination)
18.
Confusing Covered and Non-covered Tests (Tests for Patients Referred for Surgery at Other Hospitals)
19.
Confusing Salary/Non-Salary Inspections (Other Inspection Situations)
20.
Composition and increase/decrease of examination fee
21.
Items included in the prescribed points for the examination fee (cannot be calculated separately)
22.
Confusing consultation fee calculation (consultation fee calculated twice a day)
23.
Confusing consultation fee calculation (specialty areas and consultation fees for two or more specialists)
24.
Confusing Medical Examination Fee Calculation (Other Situations)
25.
Regulations related to calculating initial and follow-up examination fees
26.
Principles for calculating initial and re-examination costs
27.
Classification of diseases according to the end of treatment
28.
Initial and re-examination judgment based on disease classification
29.
While continuing treatment, other patients are first and second visits
30.
Pay attention to the chronic disease records when calculating chronic disease management fees.
31.
Chronic disease management fees are a regular part of on-site verification and on-site investigation.
32.
What is the difference between chronic disease management fees and chronic disease management systems?

3.
Drug approval and reimbursement standards
1.
Pharmaceutical approvals
2.
Age criteria in permits
3.
Permissions vary widely
4.
Use of drugs exceeding the approved scope
5.
Understanding Pharmaceutical Notifications
6.
Notice on recognition of nursing care benefits within the scope of permission
7.
Notification of standards for medical care benefits that are narrower than the scope of permission
8.
Notice of expanded medical care benefit standards beyond the scope of approval (Colkin tablets, Denol tablets)
9.
[General Principles] Regarding the Standards for Soy Sauce Preparation
10.
[General Principles] Regarding the Standards for Covering Diabetic Drugs
11.
Relationship between drug approval and reimbursement standards
12.
Examples of how to apply drug approval requirements and reimbursement standards
13.
Claim for injection fee
14.
Injection drug reimbursement standards
15.
Practical examples of applying injection reimbursement
16.
Differential system for out-of-pocket costs for pharmacy medications (special calculation of out-of-pocket costs for total pharmacy care benefits)
17.
Combination therapy with fibrates and omega-3 supplements
18.
Neuropathic pain medication prescribed together with antiviral drugs for shingles
19.
Prescription of altitude sickness prevention medication
20.
Ginkgo leaf dried extract
21.
Pregabalin full cost-sharing
22.
Indenol prescription
23.
Evoprim prescription
24.
Dystoside prescription
25.
How many medications can be prescribed in one prescription?
26.
Administration of injections prescribed by other hospitals
27.
Claim for covered injections administered in addition to non-covered fluids
28.
Migraine medications (Triptans)

4.
Cases of local investigation and local confirmation
1.
Types of field investigations
2.
Flow chart of field investigation
3.
Business Process Procedure
4.
Seven dispositions based on the results of the on-site investigation
5.
False claims (false and increased claims for hospitalization/visit days)
6.
False claims (double claims for non-covered treatment and medical care benefits after claiming the claim)
7.
False claims (claims for acts that did not actually involve treatment (medication), etc.)
8.
Cases of false claims (examination fees, physical therapy fees, etc. for medical procedures performed by unqualified persons)
9.
False claim cases (increased medical treatment claims)
10.
Cases of violation of calculation standards (basic medical fees)
11.
Cases of violation of calculation standards (radiation-related)
12.
Cases of violation of calculation standards (medication and injection feed)
13.
Cases of violation of calculation standards (treatment and surgical fees)
14.
Cases of violation of calculation standards (pharmaceutical treatment materials)
15.
Cases of violation of calculation standards (substitution claims for medical treatment fees, etc.)
16.
Cases of violation of calculation standards (overcharge of pharmaceutical costs)
17.
Cases of violation of calculation standards (unfair collection of fees for fee notification)
18.
Cases of violation of calculation standards (unfair collection of material costs)
19.
Cases of violation of calculation standards (others, etc.)
20.
What is on-site verification at a screening institution?
21.
Screening Institutions' Rights Relief System
22.
Cases of recovery from screening institutions (violation of screening institution designation standards)
23.
Case of recovery from a screening institution (violation of the screening institution's inspection method)
24.
Cases of reimbursement from health checkup institutions (claims for items not covered by health checkups)
25.
Case of recovery from a medical examination institution (related to Full PACS)
26.
Guidance case for screening institutions

5.
The beginning and end of the national health checkup
1.
How to start the national health checkup?
2.
What if I want to stop taking the screening? - How to cancel my screening institution designation
3.
What is on-site verification at a screening institution?
4.
What are the penalties if violations are discovered during on-site inspections by health checkpoints?
5.
What are the procedures for recovering medical examination fees and taking administrative action?
6.
Can I receive medical expenses on the day of the examination/when consulting about the results?
7.
Introduction to and Preparation for Screening Institution Evaluation
8.
Training required for designation as a screening institution and training required for screening evaluation
9.
Let's avoid the trap cards.
10 Commonly Asked Questions About National Health Screenings
1.
What if a nursing assistant gets caught reading a urine protein test like Gye-Ruk?
2.
What if I don't measure my LDL when my triglyceride level is over 400?
3.
Is it safe to claim coverage for a colonoscopy on the same day as the checkup?
4.
Can pre-treatment materials for colon cancer screening be used without insurance?
5.
If a polypectomy is performed during a second colonoscopy screening for colon cancer, can the cost of sleeping and endoscope cleaning be claimed through insurance?
6.
If colon cancer screening is suspended, will stomach cancer screening also be suspended?
7.
If I am suspended from general checkups, can I also not get a stomach cancer screening?
8.
What happens to the liver cancer screening evaluation if the diagnostic testing medicine field is inadequate in the screening evaluation?
9.
How long should medical records be kept?
10.
What about the on-site inspection of the health examination institution?
supplement.
Hold on! Drug control is getting tougher.
1.
Why are psychotropic drugs controlled as narcotics?
2.
Precautions when prescribing sleeping pills
3.
Precautions for Prescribing Narcotic Appetite Suppressants
4.
Mandatory Drug Use History Inquiry Service Act and Drug Shopping Prevention Information Network

6.
War on Paperwork/Administrative Disposition
1.
Medical Law and Personal Information Protection Act
2.
Medical record keeping
3.
Consent and explanation obligation
4.
Proxy prescription by guardian
5.
Issuance of copies of medical records
6.
Responding to public institution documents
7.
Issuance of diagnosis, opinion, and medical certificate
8.
Notification of non-covered expenses, etc.
9.
Transfer of documents in case of business closure or transfer
10.
Mandatory legal education
11.
Administrative disposition

7.
Endoscopy request
1.
Composition of claims after endoscopy
2.
How much does it cost to take the premedication and injections required for an endoscopy?
3.
Premedication and injection fee billing
4.
Billing for sedation endoscopy patient management fees
5.
Propofol and midazolam
6.
Flumazenil
7.
Endoscope cleaning and disinfection agent
8.
Upper gastrointestinal endoscopic foreign body removal
9.
Upper gastrointestinal bleeding hemostasis
10.
Upper gastrointestinal tumor surgery (polypectomy, mucosal resection)
11.
Colonoscopic hemostasis
12.
Colonoscopic oncology surgery (polypectomy, mucosal resection)
13.
Polypectomy and biopsy fees
14.
Claim for histopathological examination fee
15.
Helicobacter pylori (HP) related tests
16.
Helicobacter pylori (HP) eradication treatment
17.
Summary of various additional systems in the field of endoscopy
18.
Claim for gastric cancer screening endoscopy at the Industrial Complex
19.
Claim for colon cancer screening endoscopy at the industrial complex
20.
Claim after tumor resection during colonoscopy for colorectal cancer screening at the Industrial Complex
21.
Things to keep in mind when applying for a colon cancer screening program at the Industrial Complex
22.
What procedures (Qxxxx800) can be billed for during the industrial complex cancer screening endoscopy?
23.
Billing after various procedures during endoscopy (so-called package examination) based on the patient's request
24.
Sedation management fee for upper gastrointestinal endoscopy for those with special calculation
25.
Can the same-day examination be treated at the clinic level at night, on Saturdays, or on public holidays?

8.
Ultrasound billing
1.
The process of covering ultrasound examinations
2.
Are you currently considering whether to cover ultrasound examinations or not?
3.
Types of ultrasound examinations covered by insurance - Diagnostic ultrasound
4.
Types of ultrasound examinations covered by the salary - Basic ultrasound (simple ultrasound I, II)
5.
Types of ultrasound examinations covered by the salary - guided ultrasound
6.
Is it necessary to print and keep the ultrasound diagnosis report?
7.
Is it necessary to obtain a non-covered consent form when performing an ultrasound examination without insurance coverage?
8.
Application requirements for precision ultrasound
9.
What are the limited ultrasound coverage criteria?
10.
What are the indications for Doppler addition during ultrasound examinations for each part?
11.
What are the billing codes (EDI codes) for ultrasound for each part?
12.
The Meaning of "One Time" and "Episode" in the Ultrasound Examination Benefit Standards
13.
The meaning of the 'year' unit in the ultrasound examination benefit standard
14.
What is the format of the separate interpretation report written after performing a diagnostic ultrasound or limited ultrasound?
15.
Criteria for applying adjacent areas during multi-site ultrasound examination
16.
What is the coverage for an upper abdominal ultrasound examination for a 39-year-old patient with chronic hepatitis B?
17.
Follow-up examination of patients diagnosed with fatty liver disease
18.
'Complex renal cyst requiring observation' for which annual benefits are applicable
19.
Transabdominal prostate ultrasound cannot be covered by insurance for all patients with benign prostatic hyperplasia.
20.
How is breast ultrasound coverage applied to patients with fibroadenoma?
21.
Coverage for dense breasts without other symptoms in mammography during health checkups
22.
How do I file a claim after undergoing a chest ultrasound examination for suspected rib fracture?
23.
Coverage of cardiac ultrasound examinations for surgical risk assessment
24.
Can ultrasound examinations be covered by insurance for patients with thyroid nodules?
25.
Cervical ultrasound examination of a 20-year-old patient who visited the hospital with a lump in the neck
26.
Record the reason for performing multi-site ultrasound in the medical record or interpretation report.
27.
Coverage of carotid ultrasound