ECHS Guidelines for Empanelled Hospitals: Undertaking unauthorized treatment/procedures/surgeries without valid referrals

ECHS Guidelines for Empanelled Hospitals: Undertaking unauthorized treatment/procedures/surgeries without valid referrals

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(All Regional Centres)

GUIDELINES FOR ENPANELLED HOSPITALS : UNDERTAKING UNAUTHORIZED TREATMENT/ PROCEDURES/ SURGERIES WITHOUT VALID REFERRAL

1. Refer Para 10 of this HQ letter No 8/49774/AG/ECHS/Referral dt 01 Dec 2009.

2. The empanelled hospital are required to administer the treatment to the ECHS beneficiaries as per the referral issued but it has been observed that empanelled hospital are performing procedures /surgeries/treatment on the patient for which they have not been referred.

3. Same of the cases wherein this type of gross deviation was observed are as under:-

(a) Patient was referred for incontinence of urine urgency, rediulopathy but the  empanelled facility performed TKR on the patient.

(b) Patient was referred for abdominal pain, loose motion and uneasiness but the procedure performed by empanelled facility was Radio ablation for Vericose veins.

4. In such cases, empanelled hospitals have to seek for a separate referral as per the ibid policy. Such a deviation in administration of treatment is not in order and the bills raised against this type of unauthorized procedures/ surgery performed by hospital will be rejected and administrative action will be initiated against the erring hospitals.

5. Once the automation process is in place, it will be possible for empanelled hospitals to seek additional referral on line if they detect another medical ailment in the patient after examinations.

6. Hence, you are requested to instruct all the empanelled hospitals under your AoR accordingly.

(IVS Gahlot)

Col

Dir (Med)

for MD ECHS