Govt to revise medical procedures rates for CGHS empanelled hospitals

Written By kom nampultig on Minggu, 29 Desember 2013 | 07.20

NEW DELHI: In a good news for lakhs of beneficiaries under the Central Government Health Scheme (CGHS), the government is in the process of revising the rates of medical procedures offered by empanelled hospitals and diagnostic centres and giving them early payment assurance to encourage more medical institutions join the scheme.

The ministry of health and family welfare has floated e-tenders for empanelment of hospitals and decided that the rates of various medical procedures would be fixed by an average of rates quoted in e-tenders instead of the old system where the lowest quotation became the rate.

Rates of all medical procedure centres under CGHS would be revised by April next year.

Not just that, the Government is also revising its policy by providing empanelled hospitals assured upfront payment of 70 per cent of the total bill within five days of its presentation and balance admissible amount within a maximum period of 30 days.

The direction for a 10 per cent deduction in case of early/cash payment to hospitals under CGHS has also been done away with, highly-placed sources in the ministry told.

"These measures will put an end to the problems of delayed payments which discourage hospitals from getting empanelled under the scheme," a health ministry official said.

Under the new policy finalized by the ministry, the category of super specialty hospitals empanelled under the CGHS has also been done away with.

"Now, hospitals, exclusive eye hospitals/centres, exclusive dental clinics and diagnostic centres shall be empanelled for all facilities available in the health care organisation as approved by National Accreditation Board for Hospitals/National Accreditation Board for Labs and the Quality Council of India and shall not be empanelled for selected specialities/facilities," the new policy says.

The changes will help rope in more hospitals, clinics and diagnostic centres under the CGHS as many renowned and big hospitals were shying away from being empanelled under the scheme due to pending payments and low rates for medical procedures.

Sources said payments of bills amounting to around Rs 100 crore of private hospitals are pending with the government under CGHS alone, even though hospitals are crying hoarse that pending payments are to the tune of over Rs 400 crore.

Officials, however, say this huge amount is not pending under CGHS and it may include payments under ECHS, ESI and health bills of other big departments like Delhi Police and others.
There are over 750 private hospitals, clinics and diagnostic centres empanelled with the CGHS at present. A total of around 35 lakh government employees and pensioners are beneficiaries under the CGHS.

Recent rationalisation of rates of various treatments and delay in payments has led to removal of some top private hospitals from the list of CGHS empanelled hospitals, causing problems to lakhs of government and PSU employees and officials who were beneficiaries under the scheme and were unable to get medical treatment in top private hospitals.

A committee headed by director general health services had rationalized the CGHS rates recently triggering objections from various hospitals which said the rates were not remunerative.

At least 10 top private hospitals had been removed from the list this year, and more had conveyed their unwillingness to continue their empanelment under the CGHS scheme on account of rationalization of rates and pending payments.

"Rationalisation of rates of various treatments made it non-remunerative for them to provide medical facilities to CGHS beneficiaries. Delays in payments made to such hospitals by the government, also forced many such private hospitals in Delhi and around to withdraw from the list of CGHS empanelled hospitals," an official admitted.

The government is however hopeful that the hospitals earlier reluctant to join CGHS would now come forward for empanelment.

Lack of adequate quality medical treatment in government hospitals has forced government employees to seek treatment in private hospitals.

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