In a letter to the CEO of the Nagaland Health Protection Society (NHPS), the Finance Department has issued guidelines regarding the proposed deduction of 20% from the total claims amount due to public hospitals under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
This refers to the total financial amount that public hospitals are entitled to receive as reimbursement for medical services provided to patients covered under the AB-PMJAY scheme. When patients receive treatment, hospitals submit claims to the relevant health authorities to get paid for their services
The proposal suggests that 20% of this total claims amount will be deducted or withheld. This means that hospitals will receive less money than they are claiming, specifically, they will receive only 80% of the total claims they submit.
In a communication directed by S. Tainiu, NCS, the Additional Secretary to the Government of Nagaland conveyed that 20% of the total claims will be allocated as incentives for healthcare service providers, including doctors and nurses, involved in patient treatment.
Furthermore, 30% of the claims amount is to be utilized for purchasing medicines and consumables for outpatient department (OPD) patients, as well as for acquiring necessary equipment. There will also be provisions for clerical assistance to handle paperwork related to claims submitted to the insurance company on an honorarium basis, as needed.
The remaining 50% of the claims amount will be deposited into the government account to address the shortfall in the Government of India’s contribution under the AB-PMJAY scheme.
The Additional Secretary urged the NHPS to supervise and ensure adherence to these guidelines as directed by the Finance Department.