Medical institution practice license：Application conditions、办理流程与医保报销规则

社会各行业的规范运行，有赖于严格的规章制度。商店开业需办理营业执照，医疗机构的设立则必须取得执业许可证。以下就医疗机构执业许可证的申请条件、Required information、办理流程及有效期，以及住院医疗保险报销的时间限制与规则进行说明。

承办机构：县级以上地方人民政府卫生行政部门。办理事项：Medical institution practice license application。Consultation hotline：12333。Legal basis：《医疗机构管理条例实施细则》《医疗机构管理条例》。

医疗机构执业许可证申请审批条件

1. Approval letter for setting up a medical institution；
2. Meet basic standards for medical institutions；
3. Have a suitable name、Organization and location；
4. Have funds commensurate with the business they carry out、facility、Equipment and professional health technicians；
5. There are corresponding rules and regulations；
6. Ability to independently bear civil liability。

医疗机构执业许可证申请所需资料

1. "Approval Letter for Establishing Medical Institutions" or "Reply Receipt for Registration of Establishing Medical Institutions"；
2. Proof of property ownership or use of medical institution；
3. Medical institution architectural design plan；
4. Capital verification certificate、Asset appraisal report；
5. Medical Institution Rules and Regulations；
6. List of legal representatives or principals of medical institutions and heads of departments and relevant qualification certificates、Copy of practicing certificate；
7. Medical institution applies for practice registration；
8. Province、autonomous region、Other materials required by the municipal health administration department。

医疗机构执业许可证办理流程

The unit manager can bring the above information to the health administrative department to apply.。Qualified after review，Issue a "Medical Institution Practice License"；Unsatisfactory review，Notify the applicant in writing of the review results and reasons for disapproval。

医疗机构执业许可证有效期

General hospitals with more than 100 beds、Traditional Chinese Medicine Hospital、Integrated Traditional Chinese and Western Medicine Hospital、Ethnic medical hospitals and specialized hospitals、nursing home、rehabilitation hospital、Maternal and Child Health Hospital、emergency center、The calibration period for clinical laboratory centers and specialized disease prevention and control institutions is three years.；The verification period for other medical institutions is one year。

住院医疗保险报销的时间限制

Medical insurance insured persons who are hospitalized in designated network hospitals，出院时可以直接进行现场结算。But due to special circumstances，For example, the insured person seeks medical treatment in a medical institution in another province or city.，则必须由参保人先行支付医疗费用，再前往参保地社会保险机构办理医疗费用报销手续。In this case，出院时办理医保报销是有时间限制的。

不同城市的报销时间限制有所不同。For example，现行深圳医疗保险政策规定，参保人先行支付医疗费用的，应在费用发生或出院之日起十二个月内申请报销，No reimbursement will be given after the due date。Another example，《上海市城乡居民基本医疗保险结算办法》规定，The insured person should apply for sporadic reimbursement within 3 months from the date of receipt issued by the medical institution.。

零星报销的医疗费用按费用结算时所在年度的医疗费用处理。in short，出院后医保报销时间有限制，Insured persons must complete medical insurance reimbursement procedures within the specified time。

urban residents、职工医保报销规则

1. Urban residents who are hospitalized for more than two times in one accounting year，From the second hospitalization，不再收取起付标准的费用。Transferred to another hospital or hospitalized for two or more times，Make up the difference according to the prescribed minimum payment standard for transfer or readmission to the hospital。
2. student、Children in a billing year，发生符合报销范围的18万元以下医疗费用，The minimum payment standard for tertiary hospitals is 650 yuan，The reimbursement rate is 50%，The upper limit is 2,000 yuan；The minimum payment standard for secondary hospitals is 300 yuan，The reimbursement rate is 60%；There is no minimum payment standard for first-level hospitals，The reimbursement rate is 65%。
3. 年满70周岁及以上人员在一个结算年度内，Incurred medical expenses of less than 100,000 yuan that are within the scope of reimbursement，The minimum payment standard for tertiary hospitals is 650 yuan，The reimbursement rate is 50%，The upper limit is 2,000 yuan；The minimum payment standard for secondary hospitals is 300 yuan，The reimbursement rate is 60%；There is no minimum payment standard for first-level hospitals，The reimbursement rate is 65%。
4. 其他城镇居民在一个结算年度内，Incurred medical expenses of less than 100,000 yuan that are within the scope of reimbursement，The minimum payment standard for tertiary hospitals is 659 yuan，The reimbursement rate is 50%，The upper limit is 2,000 yuan；The minimum payment standard for hospitalization in a secondary hospital is 300 yuan，The reimbursement rate is 55%；There is no minimum payment standard for first-level hospitals，The reimbursement rate is 60%。

住院报销流程

参保人出院时，到医院住院收费处办理出院费用结算。Then send the hospitalization receipt、Charge receipt、Insured medical insurance card and ID card，Go to the medical insurance office set up in the hospital for on-site settlement。报销条件必须符合居民医保报销条件，报销比例根据医院等级确定，且医院设有报销起点。具体标准依据各地政策执行。