CHECK LIST FOR REIMBURSEMENT CLAIM ON MEDICAL EXPENCES

CHECK LIST FOR REIMBURSEMENT CLAIM ON MEDICAL EXPENCES

KINDLY ATTENTION all RAILWAY EMPLOYEES ( SERVING & RETIRED) CLAIMING RE-IMBURSEMENT OF MEDICAL EXPENCES/ all AMO’s, & HU In charges forwarding files.

 For timely &  speedy disposal of cases claiming reimbursement of  expenses on medical treatment in ‘EMERGENCY CIRCUMSTANCES’, at the level of  Divisional Hospital, Delhi, kindly scrutinize your all papers/documents at your level before submitting at Divisional Hospital, Delhi , and attach following documents with the Performa claiming reimbursement, so that file can be forwarded to higher authorities on time without delays occurring due to non availability of documents or due to inability to  verification of reports/bills/vouchers.

1. Kindly see your treatment papers,   that you are submitting your application for  claiming reimbursement on medical expanses within the prescribed time limit , i.e. within six months of the treatment taken. If you submitting your papers after six months, kindly give an application stating reasons for the delay, and first get your case ‘Delay Condon’ from Accounts Department, and then submit it at  Divisional Hospital, Delhi ( This will save your  a lot of time).

2.Railway Employees/ Retired  Railway Employee’s application , addressed to CMS, Divisional Hospital/DLI, giving circumstances under which he/she took treatment. (Kindly do not forget to give your clear address and valid phone number in working , where you can be contacted in future whenever required.)

3.Photocopy of medical card/ RELHS I Card( all pages,Dully attested by the Gazetted  Officer).

4. Essential Certificate issued by the treating doctor of the hospital, ( not by casualty doctor ) countersigned by Medical Supdt. Of  the the Treating Hospital .

5. Discharge certificate slip in original. Kindly also submit all reports in original or photocopy  of investigations/ procedures done during the treatment. This will help in verifying the bills/ vouchers  attached with the application.

6.Bills/ Vouchers submitted in Original, dully verified & countersigned by treating doctor, ( Authorized Medical Officer)( not by casualty doctor).

7.Detailed item wise break up of all the bills( this means , all bills /vouchers submitted above should be reproduced in legible manner ), e.g

SNo	Bill no & date	Name of chemist shop	Item name	Quantity	Amount price  Rs	Remarks , if any

8. In case of referred cases attach original referral slip.

9. Your Basic Pay/ Pension at the time of availing Treatment, & claiming reimbursement. kindly submit photocopy of pay slip/ PPO pension order, to calculate your entitlement for accommodation as per CGHS/AIIMS rates, which is dependent on your basic pay ( without the inclusion of grade pay) / Pension on the date of treatment  taken .Also give details of your bank account with MICR No., where your salary/ pension is credited, so that your payments can be made to your account directly by ECS.( submit photocopy of cheque/passbook )

10. All AMO’s/ HU In charges to kindly give attention on above points before forwarding the application of patients claiming reimbursement.

11. Dealing OS at Divisional Hospital to kindly receive and submit the files for further action only after checking all points as mentioned above for speedy & timely disposal of files of reimbursement.

MEDICAL CONDITION CONSIDERED AS EMERGENCY FOR REIMBURSEMENT BY RAILWAYS REIMBURSEMENT OF MEDICAL EXPENSES- PROCEDURE OF DISPOSAL Copy of RAILWAY BOARD’s letter no No. 2005/H/6-4/Policy-II dated: 31.01.2007 The issue of bringing in objectivity, consistency and transparency in disposal of reimbursement cases, where the treatment has been taken in emergency without consultation with the Authorized Medical Officer, has been under consideration of the Board The Railway Board after thorough review of the whole subject of reimbursement has taken the following decisions which are to be implemented with immediate effect. Any instructions on this subject as available in IRMM 2000 or any office order issued prior to this office order and will stand modified accordingly. I The cases to be considered for sanction of reimbursement claim To provide proper medical treatment, the Indian Railway Health Care Delivery system has 121 number of Railway Hospitals and 586 No. of Railway Health Units established all over India. In addition to this, all Govt. Hospitals and more than 115 private hospitals all over the country have been recognized to provide necessary medical treatment to Railway beneficiaries. As per extant rules, a railway beneficiary must report to Railway Medical Officer for his/her and dependents’ medical treatment. The Authorized Medical Officer will make necessary arrangements for medical treatment through Railway Hospital/Govt. Hospital / Pvt. Recognized Hospital. In exceptional situations, CMOs of Zonal Railways can obtain special permission from Railway Board for treatment in any Private Hospital on case to case basis. Hence, there is no scope available for any railway beneficiary to go to any private hospital himself/herself or their dependents on their own volition, except in case of real emergency situation. “Emergency” shall mean any condition or symptom resulting from any cause, arising suddenly and if not treated at the early convenience, be detrimental to the health of the patient or will jeopardize the life of the patient. Some examples are- Road accidents, other types of accidents, acute heart attack etc. Under such conditions, when the Railway beneficiary feels that there is no scope of reporting to his/her authorized Railway Medical Officer and avails treatment in the nearest and suitable private Hospital, the reimbursement claims are to be processed for sanction, after the condition of the emergency is confirmed by the authorized Railway Medical officer ex-postfacto. In order to establish the emergency condition, following parameters are to be examined on record:- (a) Admission details:- (i) Date and time of admission. (ii) Admitted through OPD service/ emergency service. (iii) Admitted to an ICU bed or general bed or cabin bed. (b) Clinical findings at the time of admission. Following findings should be made available and critically evaluated:- (i) Pulse rate. (ii) B.P. (iii) Level of consciousness (iv) Any convulsive feature. (v) Urine output (vi) Any other feature of shock. (vii) Body temperature (viii) Extant of external wound (ix) Extant of active bleeding. (x) Extant of Chest pain or pain in other parts of the body. I. Types of medical treatment given immediately after admission. (i) List of Emergency medicines used immediately after admission. (ii) Type of surgical procedure done immediately after admission. II. Calculation of the amount of reimbursement to be sanctioned out of the claimed amount:- Once the emergency is established beyond doubt, then the case should be further processed for calculating the amount/money to be sanctioned. For that, following guidelines are given:- a) Treatment taken in Govt. Hospital – Full admissible amount should be recommended for sanction. b) Treatment taken in Recognized Private Hospital for an ailment for which it is recognized – Rate as approved by Railway should be processed for sanction. c) Treatment taken in a Recognized Private Hospital but for an ailment for which it is not recognized or Treatment taken in a non- recognized Private Hospital:-Reimbursement should be made at the CGHS rates of that city or nearest city. CGHS (Central Govt. Health Scheme) approved rates are to be recommended/processed as an upper limit for sanction. III. The approved rates of private hospitals recognized by Railway should be put on the Web sites of the Zonal Railways so that at all levels of processing/sanction these are accessible to all concerned. IV. In Medical Science, no list can be fully exhaustive. Hence, it is likely that there will be few occasions when a claim has been submitted which is not appearing exactly in the CGHS rate list. On these cases, the MD/CMS/MS in charge of Divisions will apply their mind and will come to a logical conclusion. Then, they will pass a speaking order to certify the rate/s being recommended, in consultation with Associate Finance. V. All the reimbursement cases be processed as per check-list issued earlier to avoid back reference. VI. These instructions shall be effective from the date of issue of this letter. Past cases, already decided, shall not be re-opened. FOR DETAILED CLARIFICATION - PLEASE SEE FURTHER REPLY BELOW REG. MEDICAL CONDITIONS CONSIDERED AS EMERGENCY BY RAILWAYS

04-16-2009 05:32 PM

administrator Administrator Posts: 1,378 Joined: Nov 2008

Post: #2 MEDICAL CONDITION CONSIDERED AS EMERGENCY BY RAILWAYS Rly. Bd’s letter No.2006/H-1/13(RTI) dated 17.4.07 (RTI CeIl / 2007/60) to Sh Harchandan Singh, Secy. RSCWS Q (1). Whether following conditions are considered to be an “emergency” by the Railways, for reimbursement of medical expenses for treatment in Private/Government Hospitals; CONDITIONS OF EMERGENCY – UNDER ECHS * Acute Cardiac Conditions/Syndromes including Myocardial Infaraction, Unstable Angina, Ventricular Arrhythmias, Paroxysmal Supra-ventricular Tachycardia, Cardiac Tamponade, Acute Left Ventricular Failure/Severe congestive Cardiac Failure, Accelerated hypertension, Complete dissection. * Vascular Catastrophes including Acute limb ischemia, Rupture of aneurysms, medical and surgical shock and peripheral circulatory failure. * Cerebro-Vascular Accidents including Strokes, Neurological Emergencies including coma, cerebro meningeal infections, convulsions, Acute paralysis, Acute visual loss. * Acute respiratory Emergencies indulging respiratory failure and decompensated lung disease. * Acute abdomen including acute obstetrical and gynecologist emergencies * Life threatening injuries including Road traffic accidents, Head Injuries, Multiple Injuries, Crush Injuries and Thermal Injuries. * Acute poisoning and Snake bite * Acute endocrine emergencies including Diabetic Ketoacidosis * Heat stroke and cold injuries of Life threatening nature * Acute Renal Failure * Severe infections, leading to life threatening sequel-including Septicemia, disseminated TB. * Any other condition, in which delay could result in loss of life or limb. Ans. All the conditions enlisted in the application as “emergency” (under ECHS) are considered as emergency conditions by Railways also. While issuing the circular No. 2005/H/6­ 4/Policy-I1 dated 31.01.07 by Railway administration, all the conditions (under ECHS) have been included and considered by defining in a separate pattern. The pattern in which they are considered is given in the above mentioned circular. The copy of the said Board’s letter dated: 31.01.07 is attached (Annexure ‘A’) for ready reference.

Happy Holi

Delhi Division Medical Department Wishes Everyone a Very Happy and colourful Holi. May God bless all of us with the light spirit of Holi throughout the year..........Amen

GM XI Vs. DRM XI

A Cricket Match was played at Karnail Singh Stadium on 20.02.2010 between GM XI and DRM XI. Mr. Ashwani Lohani, the captain of DRM XI won the toss and elected to bat first. Mr. Vivek Sahai, the fielding captain, led from the front and bowled two restrictive overs demontrating great control over the line and length. He mobilised his men well to restrict the the batting side to a modest score of 125 in the allotted 25 overs, a score which was overhauled by GM XI rather easily. The atmosphere in the stadium was that of a carnival, a lot of bonhomie was there on display. Yours truly clicked some photographs at the awards ceremony, held at the end of the match, with mobile phone camera. The photographs can be viewed at the following link. http://picasaweb.google.co.in/aeronarun/CricketMatchOn20022010?feat=directlink

Links to Important Documents

Here are two links

1. This link will take you to the list of Pending Medical Board cases of Delhi Division as on 02.02.2010;
http://docs.google.com/View?id=dgh4zxhn_33hc9thrc2

2. The second link is for the MCDO of the Medical Department of Delhi Division;
http://docs.google.com/View?id=dgh4zxhn_32dbnjdfg4

Every MO may go through these documents and if anybody has a suggestion/correction to make may do so to the CA to CMS

Work in Focused Way

It is said that to achieve anything you have to direct your efforts in a focused way in right direction. Uploaded alongside is the list of Immediate focus areas for Delhi Division. Everybody is advised to go through it and make efforts to maximise achievements in the identified focus areas.

Casualty need your number

Our Casualty Doctors are facing problems in contacting the doctors sometimes. Everybody is requested to give their contact details to the casualty including mobile and land line number.