Treatment in Emergency & issue of credit memo to HCOs

Treatment in Emergency & issue of credit memo to Health care organisations (HCOs) – PCAFYS circular dated 10.11.2020

OFFICE OF THE PRINCIPAL CONTROLLER OF ACCOUNTS (FYS)
10-A, S. K. BOSE ROAD, KOLKATA – 700 001
Ph : 033-2248-5077-5080

No: MND/1/258/ Circular

Dated: 10/11/2020

To,

01. The Secretary
OFB HO Kolkata
HQ/MB Section

02. All Sr s/GMs
Ordnance Factories

Subject: Treatment in Emergency & issue of credit memo to HCOs

Off late, it is observed that credit notes/memos are being issued abruptly in emergency admission cases by the OFB Headquarters/ Factory managements and RME claims are being forwarded to this office for admitting such claims and crediting the passed amount into the individual’s personal bank account. Moreover, in some cases it is observed that OF Medical Aid Fund are issuing credit notes to the HCO’s citing the admission in hospitals as an emergency case/s without obtaining the emergency certificate from the treating hospitals/ doctors and followed by ex-post facto sanction of the HOO, which is highly irregular and not in order.

2. In this context, the prevailing procedures in respect of CGHS beneficiaries are as under:-

“In emergency the empanelled health care organisations (HCOs) will provide treatment on production of a valid CGHS card. The HCO will not demand an advance payment from the beneficiary or his family members and will provide credit facilities whether the patient is a serving employee or a pensioner. The HCO shall submit the bill for reimbursement to the concerned Department/Ministry/CGHS.”

In such cases, the payment will go directly to the HCO concerned. A copy of MH&FW, New Delhi O.M No S.11011/29/2019-EHS dated 13.09.2019 is relevant on the subject.

3. Further, prevailing procedures in r/o beneficiaries under CS(MA) rules, 1944 Para 3 of Appendix 8 of CS(MA) Rule, 1944] are as follows:-

In case of emergency medical treatment, Controlling Authority may issue credit note to the HCO concerned on the basis of hospital’s estimate for the treatment with a stipulation that reimbursement would be made directly to the HCO concerned by the office/ department to the hospital on the admissible items of medical treatment and as per the entitlement of the official concerned.

It is therefore, requested that while submitting such claims it is to be ensured that all the conditions of the ibid orders have been fulfilled.

4. The following conditions also be fulfilled while submitting claims :-

a) In cases where credit facilities have been obtained, payment should be made to HCO concern only and not into individual’s personal bank account,

b) Amount admitted shall be as per entitlement and items admissible under relevant CGHS/CS(MA) Rules;

c) Claims of hospital admission in emergency case shall be supported by emergency certificate issued by the HCO;

d) All the RME claims may invariably be routed through the Branch Accounts Office/s duly certifying the advance / Nil advance cases.

5. Contents of this office circular my kindly be disseminated to all concerned for strict compliance please.

Dy. Controller of Accounts (Fys.)

Source: pcafys.gov.in