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50% instant claim reimbursement on anvil for PM-JAY listed hospitals
Hospitals with clean records will be instantly reimbursed 50 percent of the bill for any treatment under India’s public health insurance scheme through a green channel, a top official said
Hospitals with clean records will be instantly reimbursed 50 percent of the bill for any treatment under India’s public health insurance scheme through a green channel, a top official said.
The National Health Authority is creating the priority channel for empanelled hospitals under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) to attract more of these health care facilities to get empanelled under the government’s flagship health insurance scheme. There are some 24,000 hospitals currently empaneled under PM-JAY.
“For more hospitals to get attracted to the Ayushman Bharat scheme, we are doing things such as reducing the turnaround time for reimbursement. For that to happen, we are creating something called a green channel, which will be applicable to those hospitals that have not forwarded any fraudulent claims so far and who have a clear record,” said RS Sharma, chief executive of the National Health Authority that implements PM-JAY. “The moment they submit their claim, we will release 50% of the amount instantly to them.”
It now takes at least two weeks to reimburse the treatment cost to a hospital under the scheme.
“Fifteen days is our norm, but at some places it was going beyond that, so we are making changes as early as possible. More hospitals are going to be empanelled so that people have access to nearby hospitals,” Sharma said. “Apart from releasing the claim amount, we are also rationalizing the rates of the packages.”
The authority on Tuesday revised beneficiary packages of around 400 procedures under the public health scheme, and included surgical treatment for mucormycosis.
Mucormycosis is a rare fungal infection that is being reported from across India as a common post-Covid-19 complication during the second wave of the pandemic. By the end of June, close to 30,000 cases of mucormycosis were reported nation wide, government data show.
In the revised benefits package, rates of some treatments have been increased by 20 to 400 percent. The revised rates will be rolled out from November.
The revisions have been done in the fields of radiation oncology; medical management procedures such as procedures for dengue, acute febrile illness, etc.; and other procedures such as right and left heart catheterization, PDA (patent ductus arteriosus) closure, arthrodesis, cholecystectomy, appendicectomy, etc.
Currently, PM-JAY covers 1,669 procedures, out of which 1,080 are surgical, 588 medical and one unspecified package.
The public health insurance scheme was launched in 2018 with 1,393 packages. It provides free and cashless health care services up to ₹500,000 per family a year to at least 107.4 million poor and vulnerable families. Total beneficiaries number over 530 million, according to the Socio-Economic Caste Census 2011 database.
More initiatives are planned, Sharma said. “First of all, everybody who is a beneficiary should be aware of Ayushman Bharat,” he said. “We are distributing about 4 crore (40 million) cards this year, and the process is being accelerated so that people can just walk in with a card and can claim benefit under the scheme.”
The move to create a green channel will help drawing in more partners to offer treatment under the government scheme.
“These are two important aspects that any hospital willing to be a part of any public health insurance schemes will look at — reasonably priced treatment packages and quick reimbursement of claims. Most of the time, reimbursement claims are stuck with the government for months. We have seen this with CGHS (central government health scheme) claims,” a senior administrator at a prominent hospital in New Delhi said, requesting anonymity. “If this issue is taken care of, then many hospitals would come forward to offer treatment under Ayushman Bharat.”
