Run the numbers on your own cases
Take your actual case mix, price it at scheme package rates, subtract your actual cost per case. Some specialties clear positively, some don’t. Empanelment can be selective where rules allow — the decision is per service line, not per hospital.
Cash-flow is the second question
Scheme settlement cycles differ from private cashless. Model the receivable days against your working capital honestly; a profitable rate with an unaffordable cycle is still unaffordable.
| Item | Standard | Consequence / owner |
|---|---|---|
| Package-rate margin | Your cost vs scheme rate, per line | Finance, per specialty |
| Settlement cycle | Days receivable, modelled | Working capital plan |
| Verification workflow | Beneficiary + biometric steps | Desk staffing |
| Package discipline | Booked package governs billing | Billing training |
| Exclusion clarity | What the scheme won’t pay | Patient communication |
Volume has operational prerequisites
Scheme patients arrive with scheme documentation workflows: beneficiary verification, package booking, discharge protocols. The desk that isn’t staffed for the workflow converts good volume into denied files.
What to do on Monday
- Price last quarter’s cases at scheme rates; read the margin by line.
- Model receivable days against your cash position.
- Staff the verification workflow before the first patient.
Worked examples on this page are illustrative arithmetic on stated assumptions, not measured market statistics.