INSURANCE & BILLING
Billing Purpose & Process
To describe how and when bills will be raised and payments would be collected from the Inpatients throughout their stay at the hospital from admission to discharge.
Timings of the Department: Round the clock 365 Days
RGCIRC broadly caters to 3 categories of inpatient who are admitted here i.e.
- Private (Paying) category patients,
- Advance paying category patients.
- Credit category patients.
The Billing process for each category is different.
Private (Paying) Category Patients:-
This includes all the patients admitted to RGCIRC paying Cash & not having authorizations from any Organizations / Insurance company / Financial Institution.
- Patient reports at admission counter with the admission slip issued by the doctor. PCE at admission desk I inform the patient about the available bed category. Patient is given the estimate accordingly (based on purpose of admission & desired bed category).
- After checking the availability of bed in desired category, PCE at the admission desk endorses the Admission Slip and directs the Patient/attendant to the cash counter to deposit the estimate amount.
- The amount up to Rs. 2 Lakhs is received as cash and balance amount more than 2 lakhs is received from other electronic mode of money transfer like NEFT, debit/credit card etc .
- All the services provided to the patient as part of procedure/investigation, are entered in the system as per specified procedure/investigation by the concerned dept. before giving services.
- At any point of time during the course of admission, Provisional bill can be generated either in the billing department or in RGCIRC Care App.
- When discharge advice is given by the Doctor and Discharge Summary is prepared, the concerned nurse forwards duly filled discharge intimation slip along with the patients’ file, after completing all the entries of the services provided during patient stay, consultants visit entries in billing module to Billing department for bill finalization & payments.
- Refunds up to Rs. 5,000/- is done in cash and more than Rs. 5,000/- by NEFT or Cheque..
- Rs. 2 Lakhs is received as cash and balance amount more than 2 lakhs is received from other electronic mode of money transfer like NEFT, debit/credit card etc .
Advance Paying Category Patients:-
This includes all the patients admitted to RGCIRC authorized for treatment by their employer with an advance Cheque / NEFT/ DD in the name of the Institute.
- When patients deposit advance cheques /DD issued by their employers for treatment, the cheque/DD/NEFT amount is updated in HMIS after confirmation is received from Finance Dept. for further reference. A receipt is issued to patient against the advance deposited / transfer.
- When admission slip is issued by the doctor and the patient approaches billing section, balance has to be verified, and if balance is available, Billing Executive makes endorsement. An authorization from billing section is necessary for getting the patient admitted in advance category.
- In case, the treatment estimate is over and above, the existing available advance amount, the patient is requested to deposit the differential amount.
- Rest of the process follow as paying category patients till discharge process started , in case Final Bill amount is more than the advance amount available than patient has to pay the difference amount & bill finalized & ischarged process completed.
Credit Category Patients:-
It includes all the patients coming to RGCIRC for treatment from various empaneled companies (Public sector undertaking, Govt. Organizations, Third Party Administrations (TPA) & Other Financial Institutions)
- When patients approach billing section with admission slip, referral letter (Credit organizations) is to be verified (authorized signatories credit limit, bed category, validity, remarks, TPA approval etc.) Accordingly authorization for admission is given.
- Rest of the process follow as paying category patients till discharge process started . In case of TPA , after updating all the entries by concern department and checking the final bill status with discharge summary forward the bill and file to TPA desk for final approval from concerned TPA. After final approval is received from concerned TPA, bill is finalized.
- PSU bills are finalized after rechecking the approval already received.
- The Original & first copies along with breakup are forwarded to the respective organizations for payment.