Clarification on billing queries in respect of CGHS Rate List -2014

ESIC Circular on Clarification on billing queries in respect of CGHS Rate List-2014.

ESI Corporation has issued a circular regarding Clarification on billing queries in respect of CGHS Rate List.

HEADQUARTERS’ OFFICE

EMPLOYEES’ STATE INSURANCE CORPORATION

PANCHDEEP BHAVAN: C.I.G. ROAD: NEW DELHI – 110002.

(ISO 9001-2000 Certified)

U-16/30/580/2016-Pro.Cell(SST)/WUL-290

Dated: 05.04.2017

To,

Director (Med.) Delhi, Director (Med.) Noida

MS’s- All ESIC Hospitals

SSMC’s/SMC’s- All States

Sub: Clarification on billing queries in respect of CGHS Rate List -2014-reg

Sir/Madam,

As per policy, ESI Corporation follows listed rates of CGHS for clearing bills of Empanelled Hospitals. In this context, ESIC Headquarters is receiving numerous representations from field units as well as tie-up hospitals regarding issues pertaining to defined CGHS package rates. As per clarifications received from CGHS Hqrs, New Delhi, the decisions are as under:

S.No.	Queries Raised	Decisions
1.	Whether 10% deduction on rates admissible for General Ward is done for Radiotherapy, Physiotherapy Echocardiography, Dobutamine Stress Echocardiography.	No deduction or enhancement for Radiotherapy, Physiotherapy Echocardiography, Dobutamine Stress Echocardiography.
2.	Whether immunosuppressant therapy for Kidney Transplantation (Related) is included within the package rates.	Yes, the rate is inclusive of immunotherapy.
3.	Whether any charges for the consumable (balloon) are to be paid additionally over the package rate for Balloon Mitral Valvotomy/PTMC- (CGHS 547)	No additional Charges need to be paid.
4.	Whether charges for the dye/medicine are to be paid additionally over the Package rates for Radio-Isotope Therapy- (CGHS 1364-1370)	Rates are inclusive of the dyes. No additional charges need to be paid.