In a fresh update for CGHS beneficiaries, the Centre has issued some clarification over OPD consultation charges. The Ministry of Health and Family Welfare has come out with this much-needed clarification as it was continuously receiving questions around the confusion when the Rs 700 and Rs 350 OPD fees would apply.
This clarification is also significant because a major revision was made to CGHS rates last year, after which there was confusion among many hospitals and beneficiaries regarding OPD consultation charges.
What does the new CGHS clarification say?
The Ministry of Health, after consultation with the Directorate General of CGHS, has clarified that the Rs 700 OPD consultation fee will be valid only in cases where the patient has been seen by a Super Specialist (DM/MCh) doctor. The doctor holds a recognized DM or MCh qualification and the consultation is provided in the relevant super-specialty discipline.
This facility will be applicable only in CGHS-empanelled hospitals.
The Rs 350 OPD consultation fee generally applies to OPD services provided by Specialist doctors who do not have a super-specialist qualification (DM/MCh).
What are the rules for consultations for IPD patients?
CGHS has also clarified that in In-Patient Department (IPD) cases a maximum of two consultations per specialist will be admissible per day. This rule is already in effect under existing CGHS norms and no changes have been made to it.
What changed in the CGHS rate revision last year?
Last year, CGHS made comprehensive revisions to its CGHS rate list. This included linking OPD consultation fees to the doctor’s qualification and specialization, setting a higher ceiling for Super Specialist services and instructing empanelled hospitals to follow a clear billing structure.
However, after the new rate structure, it was unclear in many hospitals whether the Rs 700 fee could be charged for every OPD visit. The clarification issued now makes it clear that the Rs 700 fee will not apply to all cases, but only to DM/MCh super-specialist consultations.
What should CGHS beneficiaries keep in mind?
CGHS beneficiaries should ensure the following:
Check the doctor’s qualification (DM/MCh) before the OPD visit.
Verify whether the hospital is CGHS-empanelled.
Ensure that the consultation category (Specialist or Super Specialist) is clearly mentioned on the billing receipt.
This new clarification is considered a significant step towards increasing transparency and preventing incorrect billing for both CGHS beneficiaries and hospitals.