Please visit www. Punjabhealth.org THE PUNJAB HEALTH
SYSTEMS CORPORATION State Institute of Health & Family Welfare, Near Civil Hospital, Phase VI, Mohali (India)
Phone No.0172- 2266937, 2267315
Fax-0172-2266938, E-Mail phscchd@yahoo.com
Ref. No. PHSC/GMFA/09/4549-94
Dated: 25/9/09
To
All the Civil SurgeonMedical Superintendent
In the State of PunjabMKH Patiala and C.H. Jalandhar
All the Dy. Medical Commissioner
In the State of Punjab
SUBJECT:GUIDELINES REGARDING COLLECTION, UTILIZATION AND ACCOUNTING OF THE FUNDS UNDER RASHTRIYA SWASTHYA BIMAYOJANA (RSBY).
Dear Sir / Madam,
As you are already aware the State Government is implementing the above-mentioned scheme under which treatment for indoor services as well as certain daycare services are being provided to eligible BPL families possessing the smartcard issued to them by the Insurance Company. Mainly, the following services are being provided to the BPL families.
i)Cashless interventions / procedures covered under the scheme while a PBL family member is availing indoor facilities or daycare facilities (as specified).
ii)Reimbursement of conveyance charges incurred by the BPL family for bringing the patient to the hospital i.e. Rs. 100/- per visit maximum up to Rs. 1000/- p.a. Please note that these charges have not to be given for follow up visit. These charges are being given at the time of admission.
2. Kindly note the following guidelines.
i)GENERAL GUIDELINES:
Whenever a BPL family approaches any health instution covered under RSBY, the doctor has to examine the patient and see whether indoor / daycare treatment is required. A list of the different interventions / daycare produces can be downloaded from website however, we are enclosing a copy of the same for your ready reference as ANNEXURE-I.
In case the intervention is not covered then the hospital has to obtain a pre-authorization for the required treatment from the Insurance Company on line, which will be received within 6 hours.
After ensuring that the intervention required by BPL family member is covered or has been authorized then by swapping the card on the scanner provided in the hospital is to be done. On swapping of the card the card credit will reduce by the amount of intervention mentioned or the Insurance Company will make the equivalent deductions.
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In case the hospital online system is not functional or not installed in that case as per the provision contain in the agreement with the Insurance Company, the hospital can submit the claims manually. A format for sending the manual claim is enclosed as ANNEXURE-II.
The claim has to be honoured by the Insurance Company within 30 days in case claim is submitted manually and 7 days in case claim is sent online.
ii) ACCOUNTING GUIDELINES:
After the swapping of the card, immediately entry should be made in Recoverable Claim Register (RCR) as per the column specified as ANNEXURE-III.
On receipt of the claim, a corresponding entry should be made in the RCR and the amount recovered should be booked under collection of user charges with the head “RSBY Collection”.
As the patient has to be provided cashless facilities thus following type of expenditure may be involved.
i)Diagnostic and hospital charges available within hospital itself. For providing such facilities, such patients have to be treated as a free category under RSBY. Like we treat government employees or other notified categories.
ii)Diagnostic tests including scanning to be got done from open market in case such facilities are not available in the hospital. These tests and scanning can be got done at a negotiated prices from private laboratories. Please note that the laboratories should be enrolled in a transparent manner. The rates of each test should be reasonable commensurate with the Government rates.
iii)Medicines and consumable. The medicines and consumables can be provided from the hospitals in case these are not available purchases can be made from open market by the following due procedures i.e. comparing the prices. The quotations for such purchases should be called by the committee which should be valid for three months. After the approval of the rates and source, the medicines and consumables can be purchased by sending requisition specifying the RSBY Claim No. (to be generated by entering the claim particulars in the RSBY RCR ANNEXURE-III).
iv)Hiring of specialized services. Exceptional cases, the hospital has to call Anesthesiologist for any intervention. Such Anesthesiologist can be requisitioned by the hospital on the rates already in vogue under outsourcing.
v)The hospital authorities can make expenditure on stationary, photostating, fax,Internet, repair of equipment relating to RSBY etc. out of the collections. These expenses should not be more than 5% of the total collection under the RSBY.
The expenditure involve should be booked under the category of “RSBY Expenditure” with the following sub heads.
i)Diagnostic and hospital charges
ii)Medicines and consumables.
iii)Hiring of specialized services
iv)Contingencies (for stationary etc.)
Please note that all the expenditure in above four sub heads should be made through cheque. Also, efforts should be made for payment of stationary, Photostat, fax expenses through cheque. In this regard, monthly bills can be called and payment can be made through cheque.
vi)In case the requisite funds are not available from the “RSBY collection” head as mentioned above, to provide services, temporary advance can be drawn either from the user charges or from the Annual Maintenance Grant under United Fund / RKS fund which should be recouped after the receipt of the claim from the Insurance Company. This arrangement should be settled within one month. In case of any overdue settlement position may be sent to the H.Q.
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- All these accounts are subject to any type of internal / external audit.
- This issue with the concurrence of the Secretary to the Government of Punjab cum Chairman, PHSC.
- These instructions should be brought to the notice of all the Government Hospitals covered under RSBY for strict compliance under copy to PHSC H.Q.
Thanking you,
Yours sincerely,
GENERAL MANAGER (F&A)
For Managing Director
Encls:- As above
Cc to:
i)The Secretary to Government of Punjab, Department of Health & Family Welfare for information.
ii)The Assistant Manager (Audit) PHSC for information and record.