₹600 cr pending, Punjab pvt hospitals stop treatment under Ayushman Bharat

The payment for each case must be completed within 15 days of a patient’s discharge, according to the memorandum of understanding between the state health agency and the empanelled hospitals.

The private hospitals and nursing home association (PHANA) Punjab here on Wednesday announced that it has stopped all treatments under the Ayushman Bharat scheme across all the empanelled private hospitals in the state. The hospital’s body claimed that the government owed over ₹600 crore for various treatments availed under the scheme.

Due to technical glitch, the payment settlements slowed down for a couple of months, which led to the piling up, says state health agency’s chief executive officer Babita Kaler.

The payment for each case must be completed within 15 days of a patient’s discharge, according to the memorandum of understanding (MoU) between the state health agency (SHA) and the empanelled hospitals.

“We complete the claim settlement, including uploading documents on the SHA software, on the day the patient is discharged. The SHA then has 15 days to process the claim, dismiss or accept it and disburse the amount to the hospital,” said Dr Vikas Chabra, PHANA president, while addressing a press conference here on Wednesday.

“For every payment that remains pending after 15 days, it incurs 1% interest,” Chabra added.

Adding APL families led to a claims glut

Chabra said initially only the below poverty line (BPL) card-holding families were entitled to the benefits of the scheme, which came to around 13 lakh families in the state.

Before the 2022 assembly elections, the then state government extended the benefits to 29 lakhs above poverty line (APL) card holders also.

While the Centre covered 60% of the payment in the BPL cases, for the newly added families the entire cost of treatment was to be borne by the SHA.

“The inclusion of APL cardholders have, who now increased the SHA’s burden stretching it thin and has affected the poor patients, who were to be the real beneficiaries,” he added.

PHANA accepted that before also there used to be pendency but “it never ballooned to such a huge sum.”

Hospitals going bankrupt, claims PHANA

The body said that while the SHA was holding up the payments, the hospitals had to keep buying surgery essentials like implants, which has badly impacted the finances of many hospitals.

“We have been spending on these surgical inputs to keep the treatments going. But since we haven’t been reimbursed, it has taken a toll on our finances,” said PHANA state secretary Dr Divyanshu Gupta.

Many hospitals have even taken loans to pay the manufacturers to avoid being taxed on the dues under the new Micro Small and Medium Enterprises (MSME) rules.

“The manufacturers are government under the MSME rules, and if we don’t pay them within 45 days, the amount is not considered an expense but a profit and we’d have to pay 30% interest on it,” Gupta added.

The body demanded that the SHA pay the interest as stipulated in the MoU so that they could be compensated for the taxes.

Software glitch led to delays: SHA

SHA chief executive officer Babita Kaler, said, “We switched to a new software for claim settlements a few months ago. Due to technical glitch, the settlements slowed down for a couple of months, which led to the piling up.”

Kaler added that the SHA clears payments daily and gets around 2,500-3,000 cases every day. “SHA has cleared ₹286 crore claims this financial year so far,” she added.

PHANA president added that the piecemeal payments of ₹2-3 crore daily are far less to address the pendency.

Meanwhile, health minister Dr Balbir Singh said that to ensure timely payments to empanelled hospitals under the Ayushman Bharat Mukh Mantri Sehat Bima Yojana scheme, the SHA will hire medical professionals to expedite claims processing.

Chairing a review meeting of the sub-committee of SHA to discuss policy-related matters, shortage of manpower and various other ongoing issues, Dr Balbir Singh said: “The recruitment of medical professionals is aimed at streamlining the claim process, reducing delays and improving overall efficiency, besides, alleviating the current workload and reduce delays in claims assessment. The recruitment drive will focus on qualified medical professionals who can effectively assess and process claims, thereby facilitating prompt reimbursements to healthcare providers.”

He added that apart from this training will also be provided to all present staff to ensure they are up to date with best practices and procedural updates.