The document provides guidelines for treatment of patients under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) program. It outlines procedures for package selection, pre-authorization, hospitalization, and discharge of patients. Key points include:
- The empaneled hospital is to select applicable treatment packages based on diagnosis and block packages using the IT system.
- Required diagnostic reports must be uploaded for pre-authorization and claims.
- Pictures of the patient must be taken and uploaded at admission, during treatment, and discharge.
- Feedback is to be collected from patients and follow-up calls made to assess quality of care.
- Specific
Introduction
Rationale
Aim
The Initiatives
Quality of Care
Immediate Next Steps
Key Areas for Priority Action
Benificiary Level
Important Dates
Health System
Report Card
Survey
More Information
At a Glance
Introduction
Rationale
Aim
The Initiatives
Quality of Care
Immediate Next Steps
Key Areas for Priority Action
Benificiary Level
Important Dates
Health System
Report Card
Survey
More Information
At a Glance
Launched as recommended by the national health policy 2017
To achieve the vision of universal health coverage (UHC).
This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind.“
Health Care delivery system is the skeleton of meeting healthcare needs of enormous population of every country.
In order to have a clear view of community medicine, it is essential to know about different health care systems in order to fulfill learning objectives of students.
At the 2016 CCIH Annual Conference, Evan Novalis of IMA World Health discusses the organization's efforts to integrate its HIV/AIDS programs with cervical cancer screening and care.
Once upon a time India's health care system was dominated by Ayurveda- the holistic health approach to keep persons disease free by adopting healthy life style.
With so many attacks on Indian heritage Ayurveda was pushed back for centuries. Indian government never promote this health system as main health delivery tool.
Now Prime Minister Shri Narendra Modi launches a much needed mission to make Ayush as one of main health delivery system in India.
Here are salient features of National Ayush Mission
Roles and responsibilities of MIDDLE LEVEL HEALTHCARE PROVIDERSharon Treesa Antony
Mid-level health worker can be defined as ‘Front-line health workers in the community who are not doctors but who have been trained to diagnose and treat common health problems, to manage emergencies, to refer appropriately and to transfer the seriously ill or injured for further care.
Launched as recommended by the national health policy 2017
To achieve the vision of universal health coverage (UHC).
This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind.“
Health Care delivery system is the skeleton of meeting healthcare needs of enormous population of every country.
In order to have a clear view of community medicine, it is essential to know about different health care systems in order to fulfill learning objectives of students.
At the 2016 CCIH Annual Conference, Evan Novalis of IMA World Health discusses the organization's efforts to integrate its HIV/AIDS programs with cervical cancer screening and care.
Once upon a time India's health care system was dominated by Ayurveda- the holistic health approach to keep persons disease free by adopting healthy life style.
With so many attacks on Indian heritage Ayurveda was pushed back for centuries. Indian government never promote this health system as main health delivery tool.
Now Prime Minister Shri Narendra Modi launches a much needed mission to make Ayush as one of main health delivery system in India.
Here are salient features of National Ayush Mission
Roles and responsibilities of MIDDLE LEVEL HEALTHCARE PROVIDERSharon Treesa Antony
Mid-level health worker can be defined as ‘Front-line health workers in the community who are not doctors but who have been trained to diagnose and treat common health problems, to manage emergencies, to refer appropriately and to transfer the seriously ill or injured for further care.
Admission Procedure for Hospital services NABH ppt.pptxanjalatchi
Personal details of the patient are recorded. The tests ordered by the patient's doctor are charged. The room is assigned after the patient has been updated by either the Patient Accounting Department or the Customer Service Department.
Importance of financial counselling in hospital.pptxShwethaGeorge2
Hospitals are one of the most important socioeconomic activities that requires good efficiency and administration.
Patients' well-being is harmed when they face financial hardships while receiving treatment in a hospital
A financial counsellor provides financial counselling and help the patients regarding medical expenses.
The goal of this case study is to assess the value of financial counselling in healthcare industry.
The CMS Innovation Center hosted a webinar on Tuesday, March 4, 2014 to discuss the Winter Open Period. This webinar included available information about the models, as well as the process and requirements for submitting requests for participation.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Bajaj Allianz’s Extra Care Plus is a health insurance policy that can be added to your existing health insurance policy or can be taken as a stand alone health insurance policy. It comes with extremely pocket-friendly premium rates and a wide range of coverages.
ICH-E2A: Safety Reporting in Clinical Trials in Australia
Dr. Ananda Kondepati, M.D. and
Dr. Shalini Pasumarthi, M.D.
Research Program Director:
Pr. Peivand Pirouzi
Bajaj Allianz’s Extra Care Plus is a top-up policy that can be added to your existing health insurance policy or can be taken even without any base health insurance. It comes with extremely pocket-friendly premium and a wide range of coverages.
Ca cervix epidemiology,screening and preventionDrAnkitaPatel
CA CERVIX IS PREVENTABLE AND CURABLE IF DETECTED AT EARLY STAGE .VACCINATION, PAP SMEAR AND HPV VACCINATION ARE KEY COMPONENTS FOR PREVENTION AND EARLY DETECTION.
CA CERVIX, DR ANKITA PATEL , APEX HOSPITAL ,SYMPTOMS, DIAGNOSIS,STAGING, NCCN GUIDELINES FOR THE MANAGEMENT, SURVIVAL , MULTIMODALITY APPROACH , CHEMOTHERAPY , RADIOTHERAPY , SURGERY
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
6. क्या आपके पास आयुष्मान कार्ड है ?
इससे आपके इलाज़ में सुविधा होगी.
PM SWASTHYA CARD
CM SWASTHYA CARD
7.
8. • PMRSSM would be at any of the empanelled
cashless & paperless hospitals.
• The beneficiaries shall not be required to pay
any charge for the hospitalization expenses.
The benefit also includes pre- and post-
hospitalisation expenses.
9. The beneficiary shall be either be prescribed medical
drugs, directed for further diagnostics or
hospitalization.
Beneficiaries prescribed medical drugs and not
requiring hospitalization will pay relevant
consultation and drug charges if and as
applicable
10. For a beneficiary who has been suggested
diagnostics:
I. The beneficiary should avail the diagnostic facility within the
EHCP or from a EHCP empaneled diagnostic provider.
II. The hospital will not collect any money from the
beneficiary before the diagnosis and shall ensure that the
empaneled diagnostic provider also does not collect any
money from the beneficiary
III. The beneficiary is informed of the amount of charges for
diagnosis they may have to bear in case they are not
hospitalized. Only in case of not being hospitalized the
beneficiary would be required to pay the relevant charges for
diagnosis.
11. • PLEASE ADVICE SPECIFIC, LIMITED AND
BARE MINIMUM INVESTIGATIONS.
12. For beneficiaries
requiring hospitalization:
• The standard template for pre-authorization will be filled by the
treating specialist doctor / MEDCO (medical coordinator).
(Every EHCP may nominate a medical doctor who shall act
as a coordinator between the PMAM and the treatment
doctor)
• The treating doctor / MEDCO will be responsible for providing
the necessary documents (filled pre-authorization form,
diagnostic reports, clinical notes etc.) to the PMAM
• The PMAM shall click a picture of the beneficiary / patient on
the hospital bed and upload the picture on the TMS portal .
13. • The PMAM shall select the medical package recommended
by the specialist doctor / MEDCO and upload the necessary
documents required for processing the pre-authorization
request in the Transaction Management System. The
PMAM shall also be responsible for handling any follow up
queries from the ISA / Trust:
• For packages requiring a pre-authorization from ISA, the
request generated shall be approved by within a
maximum time of 6 hours by the ISA / Trust.
• For packages not requiring a pre-authorization from ISA,
the request shall be approved automatically. However, there
needs to be a pre-authorization filed and updated on daily
basis. Subsequent pre-authorizations will be required as
applicable if beneficiary needs to remain hospitalized for
more than authorized period.
14. • During the treatment period or post surgery, the PMAM
shall click another picture of the beneficiary / patient on
the hospital bed and upload the picture on the TMS
portal
• Once the treatment is complete and the beneficiary is
ready to be discharged, the PMAM shall collect the
necessary documents such as the discharge summary
(Attached as Annexure II) , clinical notes, medical
scans etc. which will be required for filing claims.
Additionally, the PMAM shall click another picture of
the beneficiary / patient at the time of discharge and
upload the picture on the TMS portal. A physical copy of
discharge summary and other documents such as
diagnostic reports etc. may also be provided to the
patients.
15. • Post-discharge, the EHCP will provide the beneficiary with
relevant medication and diagnostics as per the package
for upto 15 days as applicable. The PMAM will be
responsible for informing the beneficiary about these
entitlements.
• The PMAM will be responsible for collecting feedback from
the beneficiary in a standard feedback form. The feedback
shall be further studied by the SHA / NHA to improve upon
the overall quality of care.
• Also, to further improve the quality of care, the call centre
shall shall also be assessing feedback by contacting a
sample set of discharged beneficiaries.
16. • Post-discharge, the EHCP will provide the beneficiary with
relevant medication and diagnostics as per the package
for upto 15 days as applicable. The PMAM will be
responsible for informing the beneficiary about these
entitlements.
• The PMAM will be responsible for collecting feedback from
the beneficiary in a standard feedback form. The feedback
shall be further studied by the SHA / NHA to improve upon
the overall quality of care.
• Also, to further improve the quality of care, the call centre
shall shall also be assessing feedback by contacting a
sample set of discharged beneficiaries.
17.
18.
19.
20.
21. Package Selection
• The operator will check for the specialty for which the hospital is
empanelled. Hospitals will only be allowed to view and apply treatment
package for the specialty for which they are empanelled.
• Based on diagnosis sheet provided by doctor, operator should be able to
block Surgical or Non-Surgical benefit package(s) using PMRSSM IT
system.
• Both surgical and non-surgical packages cannot be blocked together, either
of the type can only be blocked.
• As per the package list, the mandatory diagnostics/documents will need to
be uploaded along with blocking of packages.
• The operator can block more than one package for the beneficiary. A logic
will be built in for multiple package selection, such that reduced payment is
made in case of multiple packages being blocked in the same
hospitalization event.
22. • Certain packages as mentioned will only be reserved for Public EHCPs as
decided by the SHA. They can be availed in Private EHCPs only after a
referral from a Public EHCP is made.
• Packages as indicated may have differential pricing for NABH and Non-
NABH, for Hospitals running PG/ DNB Course, for rural and urban EHCPs
and for EHCPs in aspirational districts as identified by NITI Aayog.
• If a registered mobile number of beneficiary family is available, an SMS
alert will be sent to the beneficiary notifying him of the packages blocked
for him.
• At the same time, a printable registration slip needs to be generated and
handed over to the patient or patient’s attendant.
• If for any reason treatment is not availed for any package, the operator
can unblock the package before discharge from hospital.
23. Cardiology
• Pre-authorization remarks:
• Specific Pre and Post-op Investigations such as ECHO, ECG, pre/
post-op X-ray, label/ carton of stents used, pre and post-op blood
tests (USG, clotting time, prothrombin time, international normalized
ratio, Hb, Serum Creatinine), angioplasty stills showing stents &
post stent flow, CAG report showing blocks (pre) and balloon and
stills showing flow (post) etc. will need to be submitted/ uploaded for
pre-authorization/ claims settlement purposes. The costs for such
investigations will form part of the approved package cost.
• It is prescribed as standard practice to use medicated stents
(approved by FDA/DCGI) where necessary. Further the carton/
sticker detailing the stent particulars needs to be submitted as part
of claims filing by providers.
• - It is also advised to perform cardiac catheterization as part of the
treatment package for congenital heart defects.
24. CTVS
• Pre-authorization remarks: Specific Pre and Post-
op Investigations such as ECHO, ECG, pre/ post-
op X-ray, post-op scar photo, CAG/ CT/ MRI
reports etc. will need to be submitted/ uploaded for
pre-authorization/ claims settlement purposes. The
costs for such investigations will form part of the
approved package cost.
• - It is also advised to perform cardiac
catheterization as part of the treatment package for
congenital heart defects.
25. UROLOGY
• Prior approval must be taken for surgeries requiring use of
Deflux injection, Botox Injection, inflatable penile prosthesis,
urinary sphincter and metallic stents.
• Further it is also mandated to get approval for all non-
surgical conditions (involving evaluation/ investigation/
therapeutic management / follow-up visits) as indicated.
• - For any procedure whose charges are Rs. 15,000 or
higher, extra costs (in the sense other packages) cannot be
clubbed/ claimed from the following: cystoscopy, ureteric
catheterization, retrograde pyelogram, DJ stenting,
nephrostomy – as they would form part of such packages
costing Rs. 15,000 or higher as per the need.
26. • Prior approval must be taken for all elective
Surgeries/Procedures. Although the following
packages, namely C-Section, High Risk Delivery,
Hysterectomy are primarily for government facilities,
they are open to the private hospitals upon referral
by government hospitals/Doctors.
• Packages will include drugs, diagnostics,
consultations, procedures, stay and food for patient.
Medical conditions during pregnancy such at
Hypertension, Diabetes etc are to be treated as per
medical packages
27. Certain Queries which are very
frequently coming up..
• Stamp and signature on each document
daily updation of
EACH patient is
MANDATORY• Anaesthesia notes , OT notes mandatory
• No patient can be discharged from ICU ,He has to be step downed to HDU followed by discharge.
• If a patient is in ICU , and need ICU care on the next day, justification and proof of it is required.
• They also ask for spo2 chart, temp chart, ventilator notes etc.