CGHS Bills: The Center has taken measures to ensure that hospitals providing treatment under the Central Government Health Scheme (CGHS) do not commit any irregularities. From allotment of wards to prescription of drugs and treatment procedures, guidelines have been released. It has warned that strict action will be taken if found guilty of violations in this regard. Hospitals selected under CGHS cannot prepare two separate bills for the same treatment period. This was stated in an office memorandum issued by the Ministry of Health and Family Welfare (MoHFW) on November 10, 2022. According to MoHFW’s latest order, selected hospitals cannot issue one bill to claim payment from CGHS/department and another bill for the amount due by the beneficiary.
Strict action against violations
Violation of these guidelines will result in strict action, the ministry said. According to the terms and conditions mentioned in the orders, appropriate action will be taken against the erring hospital and it will be removed from the CGHS panel. Allotment of wards in selected hospitals under CGHS is done as per the basic pay scale of Central Government employees of the respective Seventh Pay Revision Commission. The Ministry of Health clarified in 2013 that hospitals should not ask the beneficiary or their attendants to purchase medicines and accessories separately. CGHS said that the treatment will be provided at the fixed package rate.
Ministry of Health Billing Guidelines
Generic name must be written in prescriptions issued by specialists of selected hospitals for medicines. Hospitalists should not prescribe items that fall into the category of high cost or nutritional content. Antibiotic policy (hospital) must be followed. Care should be taken for judicious use of high end antibiotics including antifungal agents. These should be used as per the recommendations of the committee constituted for this purpose.
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The matter should be told to the patient
Adhere to the prescribed guidelines for the use of IV albumin. Non-reusable items should be indicated within the limits. The problems reported by the patient and the details of the treatment given to them must be documented. Investigations, which are often necessary, must be added to the treatment and be consistent with the treatment. An established treatment regimen should be used. The benefits of a new drug or procedure should be clearly explained to the patient.
Instructions for submitting the bill
Copy of CGHS card, copy of permission letter upto 75 years of age in non-emergencies / beneficiaries, emergency certificate, discharge copy, copy of valid NABH/NABL certificate is required. Hospital bill for payment, clear copy of daily medical notes signed by doctors, chronological progress chart, trial copies, invoice for implant, any other relevant document should be submitted as per the order. CGHS examines the credit bills received on the specified items. If some items are found to be used unnecessarily, it will be deducted from the bills.
Tags: Central govt employees