7th Pay Commission issues new clarifications for the CGHS bill payment rules. Find out what has been changed

7th Pay Commission introduces new clarity on CGHS bill payments

New clarifications on CGHS bill payment

The Central Government Health Scheme (CGHS) provides health insurance coverage to Central Government employees and their family members. The scheme is reviewed by the government from time to time to keep it relevant in these changing times.

Recently, the 7th Pay Commission issued new guidelines and clarifications for bill payments under the CGHS scheme. Let’s find out what changes have been made.

New clarifications for CGHS bill payments

The new rules state that hospitals empanelled under the CGHS scheme cannot issue two separate bills for medical expenses. Usually, hospitals issued one bill to the government for payment of medical expenses and the other to the insured government employees. However, per the new rules, two bills have been disallowed. Hospitals will, now, have to issue only one bill for claiming the settlement of medical expenses. If the guideline is not followed, severe action will be taken against the hospital, including removal from the panel list.

Related - Know how insurance helps in saving tax

Other CGHS rules

Besides the change in CGHS billing, other rules have also been issued. These are as follows –

  • Doctor’s prescriptions containing medicine names should specify the medicine’s generic name too
  • Empanelled hospital specialists should not prescribe any medicine having an equivocal value nor should they prescribe items categorized as nutritional substances
  • The antibiotic policies of each hospital should be strictly followed. High-end antibiotics, including anti-fungal agents should be used judiciously and preferably if they have been recommended by a relevant committee.
  • The guidelines regarding the use of IV Albumin should be strictly followed
  • Disposable items should be used in optimized quantities.
  • Medicine should be scientifically practiced.
  • Investigations and treatments should be done on differential and provisional diagnoses deduced on the basis of the patient’s complaints, history, and findings of clinical examinations.
  • Repeated investigations should add value to the medical treatment or be commensurate with it.
  • Established therapies should be used and on-trail treatments are discouraged.

Documents required for CGHS bills

When submitting the medical bills for a claim under the CGHS scheme, the documents required, and their priority are as follows –

  • CGHS card copy
  • For non-emergency cases or beneficiaries aged up to 75 years, a copy of the Permission Letter will be required.
  • Emergency Certificate, containing all relevant details
  • Discharge Summary copy, containing all relevant details
  • NABH/NABL certificate copy
  • Consolidated hospital bills along with segregated bills showing the breakup of costs.
  • Daily medical notes and progress chart signed by the treating doctor
  • Investigation copies, chronologically
  • Implant invoice copy
  • Any other document required

All of the aforementioned documents should be arranged in priority and chronologically for easy claim settlements. If any document is missing or if the documents are not properly arranged, the claim might be returned.

So, know the new CGHS rules if you are a Central Government employee or are a family member of one and covered under the scheme. File your claim correctly so that it is settled without hassles.

Related - Also know important facts about the Ayushman Bharat scheme

Check out the video to know what the 7th Pay Commission is offering CGHS employees

The Central Government Health Scheme (CGHS) provides health insurance coverage to Central Government employees and their family members. The scheme is reviewed by the government from time to time to keep it relevant in these changing times.

Recently, the 7th Pay Commission issued new guidelines and clarifications for bill payments under the CGHS scheme. Let’s find out what changes have been made.

New clarifications for CGHS bill payments

The new rules state that hospitals empanelled under the CGHS scheme cannot issue two separate bills for medical expenses. Usually, hospitals issued one bill to the government for payment of medical expenses and the other to the insured government employees. However, per the new rules, two bills have been disallowed. Hospitals will, now, have to issue only one bill for claiming the settlement of medical expenses. If the guideline is not followed, severe action will be taken against the hospital, including removal from the panel list.

Related - Know how insurance helps in saving tax

Other CGHS rules

Besides the change in CGHS billing, other rules have also been issued. These are as follows –

  • Doctor’s prescriptions containing medicine names should specify the medicine’s generic name too
  • Empanelled hospital specialists should not prescribe any medicine having an equivocal value nor should they prescribe items categorized as nutritional substances
  • The antibiotic policies of each hospital should be strictly followed. High-end antibiotics, including anti-fungal agents should be used judiciously and preferably if they have been recommended by a relevant committee.
  • The guidelines regarding the use of IV Albumin should be strictly followed
  • Disposable items should be used in optimized quantities.
  • Medicine should be scientifically practiced.
  • Investigations and treatments should be done on differential and provisional diagnoses deduced on the basis of the patient’s complaints, history, and findings of clinical examinations.
  • Repeated investigations should add value to the medical treatment or be commensurate with it.
  • Established therapies should be used and on-trail treatments are discouraged.

Documents required for CGHS bills

When submitting the medical bills for a claim under the CGHS scheme, the documents required, and their priority are as follows –

  • CGHS card copy
  • For non-emergency cases or beneficiaries aged up to 75 years, a copy of the Permission Letter will be required.
  • Emergency Certificate, containing all relevant details
  • Discharge Summary copy, containing all relevant details
  • NABH/NABL certificate copy
  • Consolidated hospital bills along with segregated bills showing the breakup of costs.
  • Daily medical notes and progress chart signed by the treating doctor
  • Investigation copies, chronologically
  • Implant invoice copy
  • Any other document required

All of the aforementioned documents should be arranged in priority and chronologically for easy claim settlements. If any document is missing or if the documents are not properly arranged, the claim might be returned.

So, know the new CGHS rules if you are a Central Government employee or are a family member of one and covered under the scheme. File your claim correctly so that it is settled without hassles.

Related - Also know important facts about the Ayushman Bharat scheme

Check out the video to know what the 7th Pay Commission is offering CGHS employees

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