Shillong: Meghalaya is cracking down on hospital billing. The state-sponsored Megha Health Insurance Scheme, known as MHIS, has shifted toward digital and risk-based audits. A new study in the Indian Journal of Medical Research tracks this transition between Phase V and Phase VI of the program. Authorities started using a mobile app to audit claims in September 2023.
The system now mandates specific formats for inpatient, outpatient, daycare, and mortality cases. Auditors set the discrepancy tolerance at 15 per cent. Hospitals face a 5 per cent financial penalty if they cross that line. Researchers interviewed 27 stakeholders, including state officials, insurers, and medical staff to gauge the results. Tighter checks led to better medicine availability and improved record management.
Patients should see more accurate billing. The system verifies if provided services match official claims. Some facilities even reported lower out-of-pocket costs for residents. However, the move triggered new headaches for medical providers. Clinics now struggle with a heavier load of paperwork. Many also face claim processing delays and poor internet access. Enrolling patients in remote areas remains a persistent challenge.
The study notes a split result. Increased oversight protects public funds but slows down the system. The researchers stated, "The researchers said further work involving patients would be necessary to determine the scheme’s direct impact on their experiences and health outcomes." Experts have yet to measure how these administrative shifts truly change actual patient health.
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