After the rejection of 4,574 claims under the Ayushman Scheme at Doon Hospital, the hospital administration has sprung into action. It will now request the State Health Authority to review these claims. Officials argue that these claims were held up due to changes in the rules. To address this issue, a workshop for doctors will be organized. These rejected claims amount to ₹5.59 crore.
The hospital administration has decided to request a “one-time settlement” from the State Health Authority for a review of these claims. The rejection is being attributed to amendments in the rules. To prevent future issues, compliance with NHA (National Health Authority) guidelines will be ensured. The head of the Radiology Department has been instructed to ensure that CT and MRI reports are only handed to patients after being countersigned by the respective doctor. Starting December 1, all departments must provide Ayushman query data on a daily basis.
Principal Reviews Rejected Claims
After claims worth ₹5.59 crore were rejected, Principal Dr. Geeta Jain held a meeting with department heads on Tuesday to review the issue. It was decided that a formal letter would be sent to the State Health Authority to resolve the problem. Earlier, in a workshop conducted by the State Health Authority, instructions were given to increase the number of beneficiaries under the Ayushman Scheme. However, a significant number of claims have now been rejected, particularly for radiology and other day-care investigations.
The State Health Authority will be requested to review these claims under the “one-time settlement” scheme. Medical Superintendent Dr. Anurag Aggarwal, Deputy Medical Superintendent Dr. N.S. Bisht, and several department heads were present during the meeting.
Delay in Documentation by Doctors
One major reason for the rejection of claims is the delay by doctors in completing the necessary documentation. It has been mandated that admitting doctors must fill out pre-authorization forms when a patient is admitted. Strict adherence to NHA guidelines for pre-authorization and discharge will be ensured. Incomplete documents will not be accepted under any circumstances.
Department-Wise Review of Rejected Claims
It was revealed that many claims were rejected due to delays in pre-authorization, discharge, and queries. The BFA (Billing and Finance Authority) has been instructed to resolve these issues promptly. The Ayushman section will now provide weekly updates on rejected claims or any objections raised. A department-wise list of rejected claims will be shared with the respective departments, and weekly meetings will be conducted to review the progress.
Stricter Measures for MRI and CT Scans
Most of the rejected claims involve cases where MRI, CT scans, or other tests were conducted without admitting the patient. The Principal has emphasized that these investigations should only be performed after a 24-hour admission period unless explicitly required under NHA guidelines. Detailed notes must also be available for all such cases.
