The Ministry of Health and Family Welfare (MoHFW) stated in an Office Memorandum dated 10 November 2022 that CGHS-paneled hospitals cannot prepare two separate bills for the same period of treatment. As per the most recent order of the MoHFW, empanelled hospitals cannot prepare two separate bills, one to be paid by the beneficiary and one to be paid by CGHS/Department.
"Any violation of these guidelines will be taken seriously, and appropriate action will be taken according to the terms and conditions of the MOA, including removal from the CGHS panel," the Ministry stated.
The allocation of wards in hospitals participating in the CGHS is based on the respective 7th Pay Commission basic pay level for Central Government Employees.
The Health Ministry clarified in 2013 that empanelled hospitals cannot ask the beneficiary or his/her attendant to purchase separately the medicines/sundries/equipment or accessories from outside sources and will provide treatment within the CGHS-set package rate, which includes the cost of all items.
In addition, the Health Ministry has issued the following treatment and billing guidelines for CGHS recipients:
- Prescriptions for medications issued by specialists of hospitals on the participating list must include the generic name.
- Specialists at accredited hospitals are prohibited from prescribing medications with dubious efficacy or nutritional substances.
- Antibiotic policy (of the hospital) must be adhered to, and antifungal agents and other high-end antibiotics must be used prudently. Antibiotics of the highest quality, including antifungal agents, should be used based on the recommendations of a committee formed for this purpose.
- There are prescribed guidelines for the use of intravenous albumin that must be followed.
- Maximum utilisation of disposable items is necessary.
- Medicine is a scientific discipline, and it should only be practised scientifically.
- The investigation and treatment of a patient must be based on a documented differential diagnosis and provisional diagnosis derived from the patient's complaints, medical history, and clinical examination findings.
- Repeated investigations must add value to the treatment or be proportional to the treatment. Utilize a well-established form of therapy. The trial procedure/drug should not be used. If a new or newer drug/procedure is used, it should be indicated specifically for that patient due to its decisive superiority over the existing drug/procedure.
The ministry said that the documents in the bill should be arranged in the following order:
- Copy of CGHS Card
- Copy of Permission Letter in non-emergencies / beneficiaries up to 75 yrs age
- Emergency Certificate – with details
- Copy of the Discharge Summary- in detail
- Copy of valid NABH/NABL certificate
- Hospital Bill for payment – consolidated followed by break-up bill in chronological order
- Legible Copy of day-to-day medical notes signed by treating Doctor and progress chart in chronological order
- Copies of investigation in chronological order
- Copy of invoice pertaining to Implant along with sticker if any- even if hospital purchased in bulk, copy of invoice relevant to the batch number shall be enclosed.
- Any other relevant document.
In case documents are not arranged in proper chronological order, the bill may be returned.
“CGHS scrutinizes the credit bills received in respect of the above items and if, it is considered that there are unjustified use of certain items, they shall be deducted from approved bills. CGHS also reserves the right to take suitable action in case of deviation,” the ministry said.