7th Pay Commission : CGHS bill payment

7th Pay Commission News: The Ministry of Health and Family Welfare (MoHFW) said in an Office Memorandum dated 10th November 2022 that an empanelled hospitals cannot prepare two separate bills for same time of treatment otherwise one separate bill to claim payment from CGHS/Department and another to be paid by the beneficiary. This is to inform for all hospitals and staff also.

“Any violation against these guidelines shall be viewed seriously and suitable action as per the terms and conditions of MOA, including removal from CGHS panel, shall be taken against erring hospital(s),” the Ministry said.

The ward allotment in hospitals under CGHS is done as per 7th Pay Commission basic pay level of Central Government Employees.

The Health Ministry had clarified back in 2013 that empanelled hospitals cannot ask the beneficiary or his/her attendant to purchase separately the medicines/sundries/equipment or accessories from outside and will provide the treatment within the package rate, fixed by CGHS which includes the cost of all the items.

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The Health Ministry has also issued the following guidelines for CGHS beneficiaries related to treatment and billing:

  1. Specialists of empanelled hospitals shall not prescribe medicines of equivocal value nor items that come under the category of nutritional substances..
  2. Prescriptions issued by specialists of empanelled hospitals in respect of medicines must mention generic name.
  3. Antibiotic policy (of the hospital) must be followed and care should be taken for judicious use of high end antibiotics including anti-fungal agents. High-end anti-biotics including antifungal agents should preferably be used on recommendations of a Committee constituted for the same.
  4. There are prescribed guidelines for use of IV Albumin and they should be adhered to.
  5. Disposable items must be utilized in optimum quantity.
  6. Medicine is a branch of science and it should be practiced scientifically only.
  7. Investigations and treatment provided to the patient must be based on the differential diagnosis and provisional diagnosis arrived at on the basis of complaints, history of the patient and clinical examination findings which must be documented.
  8. Investigations which are repeated must add value to the treatment or appropriate with the treatment. Healthy established form of therapy should be used. Procedure/ drug on trial should not be used. If a new or newer form of drug/procedure is used, it should be specifically indicated for that particular patient because of the decisive superiority over the existing drug/procedure.

Submission of Hospital Bills

The ministry said that the documents in the bill should be arranged in the following order:

a. Copy of CGHS Card

b. Copy of Permission Letter in non-emergencies / beneficiaries up to 75 yrs age

c. Emergency Certificate – with details

d. Copy of the Discharge Summary- in detail

e. Copy of valid NABH/NABL certificate

f. Hospital Bill for payment – consolidated followed by break-up bill in chronological order

g. Legible Copy of day-to-day medical notes signed by treating Doctor and progress chart in chronological order

h. Copies of investigation in chronological order

i. Copy of invoice pertaining to Implant along with sticker if any- even if hospital purchased in bulk, copy of invoice relevant to the batch number shall be enclosed.

j. Any other relevant document.

In case documents are not arranged in proper chronological order, the bill may be returned.

“CGHS scrutinizes the credit bills received in respect of the above items and if, it is considered that there are unjustified use of certain items, they shall be deducted from approved bills. CGHS also reserves the right to take suitable action in case of deviation,” the ministry said.

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