A Hospital offers a large number of clinical services and
some non-clinical services as well. Patients availing these services can be Out-Patient,
Emergency Patient or In-Patient. In-patient can further be of categorized as per their choice of accommodation, such
as deluxe, semi-deluxe or general ward patient. Justified charging of services and facilities
availed by different categories of patients can be confusing at times, as it
requires a clear understanding of what services or components to be charged and
how to differ the charges for different category of patient. In this post, a
simplified explanation of how to price hospital services to charge it to
patient, is presented. This will also help hospitals in developing a comprehensive
document on hospital’s tariff and relevant policies for billing. In addition, you may also like to check this post on 'How much does it cost to run a hospital?'
For pricing various services of a hospital, services can be grouped under following head.
- OPD services
- Emergency services
- IPD services
- ICU services
- Surgical services
- Medical/Surgical Procedures
- Diagnostic services
- Use of Medical Equipment
- Materials and Consumables
- Packaged services
- Other services and facilities
A brief description of each of these services group
along-with how are they charged is described below.
1. OUT-PATIENT SERVICES
Most of these services are generally availed by an out-patient and
includes following
Note – The hospital can have a policy on whether the patient be required to vacate the IPD accommodation when shifted to ICU. In case, IPD accommodation is retained, charges applicable for the same should be specified. Hospital can chose to charge at a higher price for retaining IPD accommodation, to discourage non-medical use of their rooms.
6. MEDICAL/SURGICAL PROCEDURES
- First consultation fee – This fee can differ from specialist to specialist or from clinic to clinic and consultation fee of each specialist doctor/clinic should be specified. However, hospital can choose to have a policy of standardized rates. For example all speciality consultation at Rs. 500/- and Super-speciality consultation at Rs. 800/-
- Follow up consultation fee – This can either be same as first time consultation fee or lesser. Many hospital also offer one free follow up consultation, if follow up is done within one week. This can also vary with individual specialist’s choice, if hospital allows for consultant specific pricing.
- Day Care bed charges – Day care services are generally managed under OPD. The beds in day care are charged at per hour basis and for maximum of 12 hours.
- Medical certificates – A rate for issuance of various types of medical certificates, such as fitness certificate, sickness certificate etc. can be specified
- Medical/Surgical procedures, use of equipment and diagnostic services – These services, if used by OPD patient, should be charged as per their standard tariff for OPD patients.
- Materials and consumables – These should be charged as per actual, not exceeding the MRP.
2. EMERGENCY SERVICES
Patients’
seeking certain hospital services on emergency services can be charged on
following components.
- Emergency consultation fee: Generally charged at 1.5 to 2 times of first time consultation fee, specified in OPD. Another practice is to charge a fix fee for emergency (like Rs. 500/-) in addition to the first time consultation fee specified in OPD. Hospital should preferably not charge the patient for repeat visit to emergency if the patient is returning within specified duration (say 72 hours), with same presenting complaints.
- Triage bed charges – Per hour basis
- Emergency ward / Observation unit – Per hour basis. Maximum duration should be specified
- Ambulance Charges – Ambulance services can be charged for per kilometre distance, with a fixed minimum charge. ALS and BLS ambulance can be charged at different rate. For example ALS ambulance at Rs. 35 per km, subject to minimum Rs. 2000 and BLS ambulance charged at Rs. 25 per km, subject to minimum Rs. 1200/-. If doctor or paramedical staff has to accompany the patient, there charges can be added additionally.
- Medical/Surgical procedures, use of equipment and diagnostic services – These services, if used by emergency patient, should be charged as per their standard tariff for emergency patients.
- Materials and consumables – These should be charged as per actual, not exceeding the MRP.
Note - As per the law, patients must be given life-saving treatment by the hospital, irrespective of payment
3. IN-PATIENTS SERVICES
Following charges will be applicable on the patients getting admitted in
hospital for any treatment
- Accommodation charges – Per day charge, as per category of accommodation
- Nursing charges – per day charge for each category of accommodation
- Assessment charges – This charge is applied toward detailed clinical assessment of the patient and the regular re-assessments during the duration of hospitalization
- Consultant’s visit charges (professional charges) – Per visit charge of the consultant. This could vary from consultant to consultant, or hospital may choose to standardize the rates and differentiate the rates only on the basis of specialists and super-specialists consultant. The fee charged by a referred doctor should also be considered under this head.
- Junior doctor’s visit fee – Per visit charge of the junior doctor.
- Off hour visit charges – If the specialists visit is required outside the working hour of the doctor, a separate fee is charged, which is higher than the normal visit charge
- Drug administration charges – This can be linked to the total medicine issued to the patient, for example 5% of the total cost of the medicine issued to the patient. Some hospital provide this as a part of nursing charges.
- Medical Record Charges – To create and maintain the individual medical record of the patient (generally charged about 300-500 rs.)
- Visitor Pass and Attendant Pass – Generally the visitor and patient’s attendant pass is issued free of cost, however, if the same is lost, a fee of Rs. 100 to Rs. 300 can be charged for re-issuing the same
- Insurance claim support fee – A fixed or variable fee can be charged for carrying out insurance claim process or cashless process, if the patient is insured. This cost covers the photocopying and stationary cost and cost of the manpower involved in this.
- Materials and consumables – These should be charged as per actual, not exceeding the MRP.
- Medical/Surgical procedures, use of equipment and diagnostic services – These services, should be charged as per their standard tariff applicable for the category of accommodation in which the patient is admitted.
Note – Hospital
should have a policy on what charges will be applicable in case, the patient
changes the category of accommodation during hospitalization period. Many
hospital, charge the applicable price of the service for the category of
accommodation in which the patient was admitted when the service was rendered. Some
hospital, however, charge the services at the rate of highest category of
accommodation in which the patient was admitted irrespective of category of
accommodation in which the patient was staying when the service was rendered.
Hospital also should have a policy on what charges should be
applicable, if the category of accommodation required by patient is not available
and hospital is offering another category temporarily, with an understanding of
shifting the patient to his/her desired category as soon as it becomes
available. Practice is that the patient
is charged for the lower of the category sought and category offered, till the
time patient is not transferred to the desired category.
4. ICU SERVICES
These
are applicable in case the patient had to avail intensive care services
- Accommodation charge – Per day accommodation in ICU. This could differ depending upon type of ICU, like ICU, CCU, Burns ICU, Neonatal ICU, HDU etc.
- Nursing Charges, Assessment charges, Consultant visit charges should be specified as is done in IPD, However the charges in ICU can be different and generally priced similar to one of the higher category of accommodation.
- Ventilator Charges – Per hour and per day ventilator charges to be specified
- Oxygen charges – Per hour and per day Oxygen charges to be specified. Oxygen charges are generally not applied for patients on ventilator
- Monitor charges – Per and per day basis
- Other equipment charges – As per standard tariff of equipment used applicable to ICU category
5. SURGICAL SERVICES
Patient who undergo major surgeries as a part
of their treatment, has to pay certain charges towards the surgical services
availed by them. These charges typically include surgeon’s fee, operation
theatre charges, Anaesthesiologist’s fee and materials cost.
- Surgeon’s fee – The surgeon’s fee (primary surgeon) can differ from surgeon to surgeon and as per the level of surgery. Depending upon the risk and complexity, surgeries are classified into different levels. Surgeon’s fee is often linked to the level of surgery, with higher level demanding higher fee.
- Assistant surgeon’s fee – If assistant surgeon is required, then a fee relative to the primary surgeon’s fee can be charged. For eg. 20% of the primary surgeon’s fee
- Anaesthesiologist fee – This can be fixed, depending upon the type of anaesthesia. However, with increasing role of anaesthesiologists in patient safety, expertise and commitment of anaesthesiologist is becoming more and more important. Hence, there is a trend of linking the anaesthesiologist’s fee to the primary surgeon’s fee. Generally 25% to 35% of surgeon’s fee is charged as Anaesthesiologist’s fee.
- Operation Theatre Charges – Operation theatre can be charged at an hourly rate and can vary with the type of operation theatre. Another way of charging operation theatre is as a percentage of Surgeon’s fee. Generally 75% to 100% is charged towards OT charges.
- Charges in case of multiple procedure or multiple surgeon in one sitting – In surgeries that involves multiple procedures in one go, or requires more than one surgeon, a policy is necessary to determine the charges. Many hospital follow the rule on following lines
In
multiple procedures in one sitting, the procedure with highest surgeon’s fee is
charged at 100%, second highest procedure at 50% and third procedure onwards at
25% of their tariff. Other linked charges, such as OT charges, Anaesthesia
charges are calculated on the basis of total fee calculated for the primary surgeon
In
procedure involving two or more surgeons, the second or third surgeon’s fee is
determined at a percentage of primary surgeon (like 25%). Other linked charges are
only calculated on the basis of primary surgeon’s fee.
- Surgical materials – The instruments and sterile packs used for surgery is generally covered under the operation theatre charges. However, things like stents and implants used in patient is charged as per actual cost, not exceeding the MRP.
A large number of medical procedures are carried out in hospitals. A standard
tariff for each procedure (speciality wise) should be developed and used while
billing a patient. For each procedure, the tariff applicable in OPD, Emergency,
day care, ICU and IPD can vary and should be specified. Within IPD the tariff generally
differs between categories of accommodation, with lower category charged at
basic price and higher category are charged at premium price.
7. USE OF MEDICAL EQUIPMENT
Various type of equipment can be used on patient during his/her
hospitalization, such as Alpha bed, CPAP, Incubator, Nebuliser, Syringe pump,
water bed etc. For each equipment, the charges should be specified as per time
use, per day or per hour, as applicable for the equipment. The charge can be
different for OPD, Emergency, Day care, ICU, and various categories of IPD
patients.
8. DIAGNOSTIC SERVICES
A standard tariff should be available for all the tests available under Laboratory
and Imaging department. Like medical procedures and equipment charges these can
also differ for OPD, Emergency, Day care, ICU, and various categories of IPD
patients. In addition, an additional fee can also be charged for carrying out a
procedure bed-side, such as bed-side X-ray.
9. MATERIALS AND CONSUMABLES
Various
materials and consumables used on patient can be charged as per actual (not
exceeding MRP), if not already included in package price or any other head. Generally
the materials charges are not linked to the patient’s category of accommodation
10. PACKAGED SERVICES
It is a trend to develop a package of certain services and offer it at a fixed price.
Very commonly packages are developed for surgical treatments and for health
check-ups.
Surgical packages - These package price generally covers, all basic
services that is required by patient to undergo surgery such as accommodation
for specified number of days, medical assessment, investigations, surgery,
basic drugs etc. It is important to clearly describe the inclusions and
exclusions in the package, and conditions under which additional charges will
become applicable.
Health Check-up Packages. Health check-up is a highly sought after
services from the hospital. A hospital can design various type of health check-up
packages and specify a fixed price for the same. Inclusion and exclusion must
be mentioned in such packages.
11. OTHER SERVICES AND FACILITIES
Following are the other services and facilities that are offered
by hospital and can be charged to patient, as per hospital’s policy.
- One time registration fee – This is charged to the patient who has come to the hospital for the first time. This is to register the basic details and maintain the unique ID of the patient in hospital records. About 100 to 200 Rs. Can be charged for this. Some hospital also chose to offer free registration to patient.
- Food for patients – Charges for routine food, special food, different types of restricted diets etc.
- Food for patient’s attendant and visitors –According to type of food requested
- Cafeteria charges – Item-wise prices
- Telephone charge – For use of STD/ISD/Local calling using hospital’s phone
- Internet Charges – Generally offered complimentary through WiFi
- Mortuary charges – Per hour/Per day basis
- Fee of allied health professionals – Physiotherapist, Dietitian, Occupational Therapists, etc.
