BILLING POLICY AND GUIDELINES MAX HOSPITAL - SAKET FY 16-17 As on 01.01.2017 Billing policy & Guidelines GENERAL INSTRUCTIONS 1. Out Patient Consultation & follow up visits a) Bands to be followed : Bands Sr. Consultant/Director Consultant/Associate Attending Consultant Consultant / EMO’s Consultation 900- 1800 Rs 600 – 900 Rs.300-Rs. 600 fees b) Any exception to the recommended bands shall be highlighted to the pricing cell on quarterly basis by unit billing team. c) Any procedure done in OP shall follow the respective Specialty procedure tariff. d) During the day if a Stat report for any investigation (Pathology) is required 20 % extra shall be charged. In the night between 22:00 hrs and 7:00 hrs 20% extra as Emergency charges would be levied on all Investigations/Diagnostics/ Diagnostic procedures. e) On call: Between 22:00 hrs and 7:00 hrs an Emergency call to a Specialist doctor (On call), an Additional Fee of 100% of Normal Tariff will be charged. f) For administering an injection, a supportive Prescription is mandatory. In case Patient is not carrying a prescription then he needs to consult the EMO/SR by paying the consult first and get a Prescription then only will the injection be administered. g) Admission following OP consultation in the Specialty Doctor who offered OP consult, then only one IP visit shall be booked for the same Specialty Doctor during first 24 hrs of OP Consult for the same Patient. h) All OPD/Post Discharge Reports, if not collected by the patient within a month of investigation will be destroyed. i) Rs. 150 per registration to be charged from all cash patients coming to Max hospital for the first time. This shall not be applicable to the patients in Triage (Non admission), Max Employees & Dependent, PSU Patients and New born baby in max hospital. j) One follow-up OPD Consultation with 100% discount within 7 days of a surgical case or within 5 days of a Medical case shall be billed as "First free follow-up consult after discharge" and Post Discharge Suture & Staple removal will be complimentary but consumables will be charged on actual. Max Super Specialty Hospital - Saket Page 2 Billing policy & Guidelines 2. Equipment charges a) Any specific equipment hired from outside the Max Hospital would be charged additionally on actual. b) If two equipments (Max equipment and outside Max equipment) are used in same surgery then patient will be billed for the both (for Max equipment as per pricing policy and outside equipment on actual or unless specified otherwise). Special Equipment Charges Classic Equipments Economy Double Single Deluxe Suite Laparoscope 1,900 2,200 2,700 3,500 4,700 Cystoscope 1,000 1,100 1,400 1,800 2,700 Hysteroscopy 1,000 1,100 1,400 1,800 2,700 Ureteroscope 1,000 1,100 1,400 1,800 2,700 C - Arm less than 1Hr. 1,400 1,600 2,000 2,600 4,000 C - Arm more than 1Hr. 1,900 2,000 2,700 3,600 4,700 Endoscope 1,000 1,100 1,400 1,800 2,700 Brain Suite 25,000 25,000 25,000 25,000 25,000 Minimally Invasive Tech. 10,000 10,000 11,000 14,300 18,590 C-Arm (Neuro Cases) 1,200 1,200 1,400 1,800 2,300 One Time Charges Rejuvenation & Reflexology Session (1 Hour and 35 Minutes) 4,000 Rejuvenation & Reflexology Session (1 Hour) 2,800 Rejuvenation & Reflexology Session (Half an Hour) 1,500 3. Triage Billing Policy a) Triage Bed Charges: Triage stay (Emergency) charges @ 500/- per hour (First Hour Free) up to a maximum of eight hours. Beyond 8 hrs if the patient stays in the hospital, charges will be applicable as per opted room category. Max Super Specialty Hospital - Saket Page 3 Billing policy & Guidelines b) Patient is admitted as inpatient from Emergency, Triage bed charges shall not be levied. c) Patient is admitted as inpatient from Emergency, EMO charges shall be levied. d) Resuscitation charges: Rs. 2,500/- e) Procedure charges will be as per the pricing policy. f) Triage tariff do not include EMO/ SR/ Specialty doctor Visit/ Investigation / Procedure/ Consumables / Medicines, which will be billed additionally. g) Visit charges of in house EMO will be Rs 300/-. If a Consultant visits Triage, the charges are as per the Pricing Policy and only one consultation visit either EMO/SR or Consultant shall be charged. h) Day Emergency / Triage Visit i.e. between 07:00 & 22:00 hours will be charged as per OP Tariff Table. Night emergency visit in the triage area (On call consultants) will be charged an additional charge of 100% on the OP tariff table. 4. In-Patient Billing Policy a) Billing Cycle will start from 11:00am to 11:00am. Therefore, 11:00 am is the check out time for discharge. This policy however is not applicable in case of day care. b) Up to 8 hours of Stay will be billed as Half Day Stay. c) Economy tariff is applicable for 4 bedded, 3 bedded. d) Day care room charges are only for 12 hours. If the stay of patient is more than 12 hrs then the charges of economy room will be charged. e) Room / ICU Tariff include standard fittings in the Room according to the Type of occupancy / Patient’s diet (as prescribed) / Housekeeping Services. Max Super Specialty Hospital - Saket Page 4 Billing policy & Guidelines f) In IPD, nursing Charges up to 10% of Net Bill shall be applicable for all admissions except day care. g) Hospital shall levy additional charges of up to 30% of Net Bill for High Risk or complex package, surgeries and procedures. h) Dietician’s Charge: Dietician charges of Rs. 400 will be applicable once in every four days during patient Stay in the hospital from each Inpatient (excluding Day Care, CGHS/PSU Patients, All Package cases, New Born Baby in Max Hospital and children below the age of 2 years, All ICU's where patient is in Ventilator and Bipap and Other Patients where these services are not provided and shall be ordered in the beginning of new cycle. i) Medical History Assessment Charge: One time charges of Rs.950 to be charged as Medical History Assessment charges from all IP admissions except those who are admitted in Triage (Non admissions), Pre-ADT (Non admission), New born baby in Max Hospital, Daycare patients, Max Employee’ & Dependent and CGHS/PSU’s patients. j) MLC Charge: In MLC cases an additional charges of Rs. 1,000 shall be levied to cover extra cost incurred by hospitals. This shall only be applicable for MLC cases where patient gets admitted to our hospital and also applicable for Oust side registered MLC cases. This shall not be applicable for cases where there is direct discharge from Triage/ER and CGHS/PSU patients. k) Medical Evaluation for TPA: One time charges of Rs.300 to be charged as Medical Evaluation for TPA charges from all IP admissions routed through TPA and for Day-Care Sitting (Dialysis / Chemotherapy) Rs. 50 to be charged. l) R.M.O Fees: RMO Fees of Rs. 600 will be applicable once in a day during patient Stay in the hospital from each Inpatient (excluding Day Care, any ICU/HDU/NICU/PICU stay, Max Employee’s & Dependent, CGHS/PSU patients and Package Days. m) If the patient’s Attendants retain the Room (single / classic / Deluxe / Suite) subject to availability and approval from Duty Manager, while the patient is in ICU Additional charges for the Room and Food and Beverages( if any) are to be paid. Valid for Package patients also. Max Super Specialty Hospital - Saket Page 5 Billing policy & Guidelines n) Additional Food and Beverage, if supplied in Room, shall be charged on actual. o) Bed Transfer: In the event of Bed Transfer during course of treatment, the higher category of bed charges will be charged from the billing cycle applicable at the time of transfer. p) In case the Patient is transferred from Lower to Higher category of Room following the Surgery/ Procedure, the surgical procedure charge would be revised according to higher bed category. q) In case the Patient is transferred from Higher to lower category of room following surgery / procedure, the surgery / procedure would be charged as per Higher Bed category. r) In case of room transfer, consultant’s fee will be charged according to room where consultant takes the visit physically. s) If the patient is transferred to Intensive Care Unit/s during course of IP stay, then the surgery/ procedure charges will be applicable as per higher bed category. However, ICU charges will be levied during actual duration of stay in the ICU. t) In case, due to non availability of room if patient is shifted to higher category in that case also charges will be applicable as per desired category and when the desired category becomes available, patient gets shifted there. u) If more than one procedure are carried out and the patient decides to opt for the lower category before the procedure and accordingly lower category rates should be charged. v) Admission directly to ICU: Where a patient is admitted to ICU bed, the charges for procedure shall be according to the tariff rates applicable to Double occupancy type. However, at the time of transfer from ICU if the patient opts for an occupancy, which is higher than the Double occupancy, the cost of procedure shall be charged according to the tariff applicable to the respective higher occupancy level. In case at the time of transfer from ICU if the patient opts for an occupancy, which is lower than the Double Occupancy, the cost of procedure shall remain the same as charged while the patient was in ICU.