Tag: hospital quality

IRDAI Notification

July 21, 2022July 21, 2022by valueaddedinLeave a comment

Standards and Benchmarks for the Hospitals in the Provider Network – IRDAI Notification on Hospitals for Insurers and TPAs

IRDAI has released a notification on 20^th July, 2022 with an advisory to Non Life Insurers and TPAs about on boarding Hospitals under Cashless Empanelment Scheme and the changes to the Standards and Benchmarks Criteria laid down for the Hospitals earlier.

This advisory calls for Insurers choosing their own empanelment criteria for Hospitals and updating the same in their respective websites for the benefit of industry and stakeholders , as updated from time to time.

IRDAI has suggested to Board of Insurers to consider the Minimum Resources and Infrastructure conditions that prevail in wide range of Hospitals across the country while empanelling the Hospitals. The insurers are now empowered to empanel the network providers that meet the standards and benchmarks criteria as specified by their respective boards. The board approved empanelment criteria shall be published in the website of the insurers from time to time.

This advisory enables Insurers to extend the scope of coverage of cashless scheme to wide range of healthcare facilities in the country. While empaneling network providers for cashless facility, insurers are also advised to focus on the delivery of quality healthcare services.

These instructions come into force with immediate effect.

Download the IRDAI Advisory here

IRDAI Advisory

Source – https://www.irdai.gov.in/ADMINCMS/cms/Circulars_Layout.aspx?page=PageNo4762

To understand the requirement of IRDAI advisory on Standards and Benchmarks for the Hospitals, please download the earlier advisories as shared below :

Master circular (ref. IRDAI/HLT/REG/CIR/193/07/2020 dated 22^nd July, 2020). . Download here to read more about the Master Circular

Download the Master Circular 2020

Please read Chapter IV of the Master Circular shared above to understand the norms laid down under Standards and benchmarks for hospitals in the provider network. Reading the Master Circular of 2020 helps healthcare establishments understand the specification laid down earlier for Cashless Schemes and Reimbursement Claims .

What does the Chapter IV of the Master Circular says ?

Insurers and TPAs, wherever applicable, shall ensure that Network Providers or Hospitals which meet with the definition of ‘Hospital’ provided in Chapter I of these Guidelines shall meet with the following minimum requirements:

a. All the Network Providers as at 27th July, 2018 shall, comply with the following by 26th July, 2020:

i. Register with Registry of Hospitals in the Network of lnsurers (ROHlNl) maintained by lnsurance lnformation Bureau (llB). [https://rohini.iib.gov.in].

ii. Obtain either “NABH Entry Level Certification” (or higher level of certificate) issued by National Accreditation Board for Hospitals and Healthcare Providers (NABH) or State Level Certificate (or higher level of certificate) under National Quality Assurance Standards (NOAS), issued by National Health Systems Resources Centre (NHSRC).

iii. In respect of all the new entrants (after 27th July 2018), only those hospitals that are compliant with the requirements specified at Clause (a) (i) above shall be enlisted as network providers. These network providers shall comply with the requirements stipulated at Clause (a) (ii) above within one year from the date of enlisting as a Network Provider and this shall be one of the conditions of Health Services Agreement.

iv. lnsurers and TPAs may also endeavour to get hospitals (other than Network Providers) involved in reimbursement claims to meet the requirements stipulated at Clause (a) (i) and (a) (ii) above.

b. AYUSH Hospitals and AYUSH Day Care Centres which meet the definition of AYUSH Hospitals and AYUSH Day Care Centres defined under Chapter I of these Guidelines shall also obtain:

(i) Either “NABH Entry Level Certification” (or higher level of certificate) issued by National Accreditation Board for Hospitals and Healthcare Providers (NABH) or State Level Certificate (or higher level of certificate) under National Quality Assurance Standards (NQAS), issued by National Health Systems Resources Centre (NHSRC).

(ii) All the existing AYUSH Hospitals and AYUSH Day Care Centres shall comply with the requirements referred above within a period of twelve months from 26th November, 2019, if the said certificate
is not already obtained.

(Note: The above instructions at a and b are subject to the directions of the Hon’ble Delhi High Court in its order dated 29th May 2019 / 31st May 2019, in respect of W.P(C) 6237 of 2019, which needs to be complied with till further orders of the Hon’ble Court.)

c. The providers shall comply with the minimum standard clauses in the agreement amongst Insurers, Network Providers and TPAs applicable to providers listed in Annexure 22 of Master Circular Ref.
IRDAI/TPA/REG/CIR/130/06/2020 dated 03.06.2020 and as amended from time to time.

d. Providers shall be bound by the Provider Services—Cashless facility admission procedure laid down in Schedule A of Master Circular Ref. IRDAI/TPA/REG/CIR/130/06/2020 dated 03.06.2020 and as amended from time to time.

e. Providers shall be bound by the process of de-empanelment of providers laid down in Schedule B of Master Circular Ref. IRDAI/TPA/REG/CIR/130/06/2020 dated 03.06.2020 as amended from time to time.

f. Providers shall follow the standard discharge summary format prescribed under Schedule C of Master Circular Ref. IRDAI/TPA/REG/CIR/130/06/2020 dated 03.06.2020 and as amended from time to time.

g. Providers shall follow the standard format for provider bills prescribed under Schedule D of Master Circular Ref. IRDAI/TPA/REG/CIR/130/06/2020 dated 03.06.2020 and as amended from time to time.

h. Providers shall ensure that the standard claim form and form for request for cashless hospitalization for Health Insurance Policy provided for under Annexure 30 of Master Circular Ref.IRDAI/TPA/REG/CIR/130/06/2020 dated 03.06.2020 and as amended from time to time are adhered to in respect of all claims.

Announcement from NABH

August 23, 2021August 23, 2021by valueaddedinLeave a comment

For Small Healthcare Organisations

NABH has issued a notification recently for Small Healthcare Organisations (SHCOs) which are Accredited, under Quality Management Systems Program.

Notification calls for Self Declaration cum Undertaking from already Accredited organisations / organisations under accreditation process, on the Bed Capacity declared to NABH for Accreditation purposes.

Content of the notification in a nutshell is shared here :

It has been brought to notice of NABH that many hospitals and nursing homes that have enrolled under the SHCO accreditation program of NABH, despite having sanctioned bed strength of more than 50. Notification has clarified that the bed strength of the organization will be considered only on the basis of the sanctioned beds mentioned in the statutory licenses obtained by the organization from the competent authorities. All the hospitals and nursing homes which are accredited by NABH or are in the process of getting accreditation are hereby informed to declare the bed strength and submit an undertaking signed by head of the organization to this effect to NABH secretariat within 45 days of issue of this notice.

The format for submission of the declaration is enclosed herewith and the same needs to be printed on the stamp paper of value of Rs 100/-.Further the signed declaration has to be uploaded on the ‘HCO document’ section on the respective portal account of SHCO. In case, the hospital fails to submit the declaration as mentioned above, NABH may be constrained to initiate adverse decision against the non-conforming
hospitals as per the policy of NABH.

Download the Notification from here :

Notification

NABH Certifies, Accredits organisations which fall under the category of Healthcare Organisations and Small Healthcare Organisations which are defined as below :

Healthcare Organisation :

Healthcare organization (HCO) that should be above 50 beds to fall under the definition of Healthcare Organisation as per NABH

Small Healthcare Organisations :
Hospitals and Nursing homes or day care centres with bed strength less or equal to 50 Sanctioned beds.

Exclusions to the above definition :
a) Polyclinic Diagnostic Centres
b) Super Speciality Centres

Certification / Accreditation Framework :

The Certification / Accreditation Framework for each segment differs as the criteria set by NABH varies accordingly.

Essence of the Recent Notification :

NABH’s definition of Beds in the case of SHCO is “Sanctioned Beds” meaning number of beds approved, sanctioned by the Regulator, State / Central Licensing Authorities.

Infact Hospitals apply for various empanelments with State Govts, Central Govt agencies, PSUs, Pvt Health Insurers, Corporates etc for business purposes. Sanctioned beds is the statutory norm and should be quoted with all agencies .

However , it was repeatedly discussed in various industry forums , market place conversations that beds shown for empanelment purposes & for accreditation purposes is most often different and not same as the sanctioned beds approved by the licensing authorities.

Hospitals were declaring less number of beds to NABH while applying for Accreditation which is technically not correct. Infact this was pointed out by various other healthcare organisations at the market place frequently.

Way forward :

NABH has announced a roadmap for such hospitals which are covered under Accreditation Program for implementation by SHCOs , as follows :

The hospitals which are not eligible to be covered under SHCO accreditation program due to sanctioned bed strength more than 50 should switch over and apply under hospital accreditation program. Considering the fact that there could be a break in accreditation while switching over to hospital program, NABH has decided to give a transition period of 18
months from the issue date of this notification.

The hospitals are encouraged to implement NABH 5th edition of hospital standards with in
the given transition period and apply for accreditation under hospital program.

Further, during the transition period hospitals shall also be required to pay the shortfall of the
applicable annual accreditation fee based on the sanctioned bed strength of the hospital.

Knowledge Series for Small Hospitals

May 7, 2021May 31, 2021by valueaddedinLeave a comment

How to Manage your Hospital Effectively

Smart Hospitals is the Knowledge Sharing Platform created to educate Small and Midsized Hospital owners about ease of doing healthcare business in more efficient ways. We have been conducting series of knowledge sharing initiatives in the form on Conferences, Round Table Meets, Meet ups etc as part of our Learning and Development initiatives for Small Hospitals spread across the country.

Performing Business Healthchecks will emerge as main KPI for healthcare businesses slowly. Monitoring of Real time data matters and analysing the same matters much more. Business Healthchecks are closely connected to Operations , Quality and Financial Management of hospitals.

These L&D series from Smart Hospitals will empower Hospital Owners, Medical Professionals, Operations Head, Management Teams, Functional teams at hospitals to LEARN, UNLEARN and RELEARN more.

Pandemic has brought glaring gaps in the hcare ecosystem to sharp focus – be it building safe healthcare facilities, doing procurement the right way, upskilling of human resources to use tech in hospitals more effectively, managing finances judiciously as we are all living in a VUCA world now.

So planning and managing medical facilities in times of uncertainity matters. Sessions like these will help us to decode the spec and offer solutions to move forward.

We are planning series of Knowledge Sessions like Virtual Trainings, Virtual Workshops on Operational and Financial Management topics. These sessions are powered by Healthcare Events

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