WBCE Rules 19Chapter II · Chapter II

Section 19 · User charge Standards

(1)

The clinical establishment shall have a right to impose different rates of user charges in consideration of the provision of different kind of services to be rendered by it subject to declaration of a rate-chart of user-charges describing item-wise charges for all services along with concession, if any, which shall be published in the Information brochure and shall be displayed as a part of mandatory display under rule 22:Provided that, the clinical establishment shall have no right to impose any fine or penalty from the Patient or party for any reason whatsoever.Explanation. - user charges are charges for service(s) rendered by the clinical establishment including diet-charges which is the maximum payable amount for that service and may include any charges towards the recovery of cost of any damaged property from the patient or any subscription for any sort of membership to avail any benefit offered by that clinical establishment but does not include any tax, surcharges levied by the government.

(2)

Subject to the provisions of the rule 20, the clinical establishment shall have the right to collect, on issuance of a proper receipt, the amount payable as user-charges as per the payment option and schedule mutually agreed upon beforehand between the establishment and the patient/patient party:Provided that, the clinical establishment may collect as deposit or any form of advance the part or whole amount likely to be payable which is to be adjusted before settlement of final payment.Provided further, that, the patient/patient party shall be given the opportunity to choose from such different payment options as may be declared by the clinical establishment beforehand.Provided also, that, the clinical establishment shall not request, solicit or demand any deposit or any other form of advance payment as a prerequisite for providing such Emergency medical treatment as mentioned under rule 25 and any act of such request, solicitation or demand shall be treated as a major deficiency under section 29 of the Act. However the clinical establishments shall also abide by the conditions laid down in section 7 of sub-section 3 (v) of the Act.Explanation 1. - Proper receipt means a receipt bear unique number and the name of the clinical establishment along with the License number showing the exact amount paid against the bill.Explanation 2. The term "collect" includes demand, charge or accept or try to demand, charge or accept any consideration in the form of cash, kind or service.

(3)

Before collecting the user-charges, the clinical establishment shall have the obligation to produce a claim in the form of a proper itemized bill(s) prepared by that clinical establishment which is reasonably accurate:Provided that, such claim of bill shall not contain any amount of user charges in excess of the rate of charges declared beforehand or any amount of user charges payable against any services, which were not actually rendered by that clinical Establishment.

(4)

Beside declaring the rates for separate item wise services under sub-rule (1), the clinical establishment shall have the right to determine and declare the rate for a whole package of service combining together such different services likely to be provided to the patient during the course of her treatment and care:Provided that, while offering any such package rate, the clinical establishment shall have the obligation to:

(a)

clearly mention the inclusion, exclusion or add-on components of services which can be dovetailed with the package; and

(b)

clearly declare that the rate is the lump sum, maximum payable amount.

Explanation 1. - "package" or "package of service" means a collection of related healthcare services and non-healthcare services that are usually paid separately under a fee-for-service system, but which may be combined by a provider in delivering a full diagnostic or therapeutic procedure to a patientExplanation 2. - 'package rate' is a rate contract where a basket of services are being offered by the clinical establishment in exchange for a lump sum payment of an assured sum by the service recipient;

(5)

The clinical establishment shall ensure that prior to the initiation of care or treatment, the patient and party have been informed and explained without any ambiguity about-

(a)

the estimate of user-charges likely to be payable at the rate either for the whole Package of service or separate item wise service; and

(b)

other anticipated user-charges for services that is routine, usual and customary including any kind of tax payable to the Government; and

(c)

the estimated expenditure due to medical supplies likely to be consumed for the patient under rule 17; and

(d)

the billing and payment procedures including options for payment; and

(e)

any concession or free treatment facilities available.

(6)

The Commission shall be empowered to issue Regulations for the clinical establishments to provide proper estimates to service recipients or their representatives for treatments not covered under package rates and the final bill shall not exceed certain percentage of estimate provided

(7)

The patient or party shall have the right-

(a)

to obtain a written statement of such estimate under sub-rule (5) on demand at any point of time without any delay; and

(b)

to be informed of the extent to which payment may be expected from any Insurance Company or third party and any charges for which the patient may be personally liable; and

(c)

to obtain and examine, on demand, an itemized common bill for all the services charged by the clinical establishment, including the cost of medical supplies consumed for the patient along with a thorough explanation of such bill, at no extra cost, regardless of the manner and source of payment.

(8)

All debit and credit vouchers including the duplicate copy of bill and payment shall be retained by the clinical establishment for a period not less than five years which shall be available to the supervisory authority for inspection, and to the patient party on demand.The clinical establishments shall abide by the conditions laid down in section 7 of sub-section 3 (o, p and q) of the Act.

(9)

Proper books of account including cashbook shall be generated and maintained by the clinical establishment which shall be available to the supervisory authority for inspection.

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