장기요양기관 업무안내 (2018)

차례
제1장 장기요양기관 설치 및 지정
1. 장기요양기관이란? ················································································ 5
2. 시설급여를 제공하는 장기요양기관 ··················································· 6
3. 재가급여를 제공하는 장기요양기관 ················································ 10
4. 겸직ㆍ병용 규정 ·················································································· 21
제2장 장기요양기관 운영
1. 장기요양기관 준수사항 ······································································ 25
2. 협약의료기관 및 촉탁의사 운영관리 ·············································· 29
3. 장기요양기관 현황통보서 제출 ························································ 31
4. 공인인증서 발급관리 ·········································································· 32
5. 장기요양기관 정보의 게시 ································································ 34
6. 비급여 대상 항목 세부기준 ······························································ 37
7. 복지용구사업소 운영 및 소독관리 ·················································· 41
8. 장기요양기관 변경신고 ······································································ 44
9. 장기요양기관 휴ㆍ폐업 신고 ···························································· 47
10. 휴ㆍ폐업 장기요양기관의 급여제공자료 이관 ······························ 48
제3장 장기요양급여 제공기준 및 급여비용 산정기준
1. 총칙 ········································································································ 51
2. 장기요양기관 및 종사자의 준수사항 ·············································· 52
3. 재가급여 제공기준 및 급여비용 산정방법 ···································· 53
4. 시설급여 제공기준 및 급여비용 산정방법 ···································· 63
5. 급여비용의 가산 및 감액산정 기준 ················································ 65
6. 치매전담형 장기요양기관 급여비용 산정방법 ······························ 69
7. 의사소견서 및 방문간호지시서 발급비용 ······································ 71
8. 복지용구 급여비용 산정방법 ···························································· 72
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제4장 장기요양급여 계약관리
1. 장기요양급여 계약 체결 ···································································· 74
2. 장기요양급여 계약통보서 작성 및 통보 ········································ 76
제5장 장기요양급여비용 청구
1. 장기요양급여비용 청구 ······································································ 81
2. 장기요양급여비용 청구방법 신청 ···················································· 83
3. 급여비용 청구관련 제출자료 ···························································· 85
4. 청구서 및 청구명세서 작성 및 청구방법 ······································ 87
5. 청구서 및 청구명세서 작성 요령 ···················································· 88
6. 청구구분에 따른 청구방법 ································································ 94
7. 청구서 목록 ·························································································· 98
8. 청구ㆍ심사 게시판 ············································································ 101
9. 재가급여전자관리시스템(RFID) ······················································ 102
제6장 장기요양급여비용 심사
1. 장기요양급여비용 심사 ···································································· 131
2. 현지확인심사 ······················································································ 135
3. 재심사 조정청구 ················································································ 139
4. 장기요양급여 대상여부 확인 ·························································· 140
제7장 장기요양기관 평가
1. 장기요양기관 평가개요 ···································································· 145
2. 장기요양기관 평가 종류 및 대상 ·················································· 147
3. 평가절차 및 결과공표 ······································································ 148
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작성일 : 2017. 12. 8.
※ 수록내용은 작성일 현재 기준이므로 발간 이후 관련 법령ㆍ고시의 변경사항이
있을 경우 수록내용과 다를 수 있습니다. 최신 법령ㆍ고시에 대한 내용은
노인장기요양보험 홈페이지 법령자료실을 참고하여 주시기 바랍니다.
제8장 장기요양기관 현지조사
1. 현지조사 개요 ···················································································· 152
2. 현지조사 실시 ···················································································· 155
3. 현지조사 사후절차 ············································································ 157
4. 부당청구 장기요양기관 신고포상금 제도 ···································· 160
제9장 권리구제제도
1. 권리구제제도 개요 ············································································ 163
2. 노인장기요양보험 이의신청제도 ···················································· 164
※ 참고․서식 ························································································ 166