Hospital Billing Software: Complete GST Compliance Guide

Hospital billing in India is complex—GST exemptions, TPA claims, multiple payment modes, and e-invoicing requirements. This guide covers everything your hospital billing software needs for complete compliance.

GST in Healthcare: What's Taxable?

Understanding what's exempt and what's taxable is crucial:

Exempt from GST (0%)

• Healthcare services by clinical establishments
• Doctor consultation fees
• Surgery charges
• Diagnostic tests (when part of treatment)
• Hospital room charges
• Nursing care

Taxable under GST

• Medicines sold (retail): 5-12% GST
• Medical equipment sold: 12-18% GST
• Food & beverages: 5% GST
• Cosmetic procedures: 18% GST
• Hair transplant: 18% GST
• Wellness services: 18% GST

Key Features of GST-Compliant Billing Software

1. E-Invoicing Compliance

Mandatory for turnover above ₹5 crore (as of 2026):

• Direct integration with GST e-Invoice portal
• Auto-generation of IRN (Invoice Reference Number)
• QR code on invoices
• Real-time validation

2. Correct HSN/SAC Codes

Common healthcare HSN codes:

• 9993: Human health services (Exempt)
• 3003/3004: Medicines (5-12% GST)
• 9019: Medical equipment (12-18%)
• 9997: Wellness services (18%)

3. Split Billing

Hospitals need to split bills correctly:

• Exempt services (consultation, treatment)
• Taxable items (pharmacy, equipment)
• Different GST rates on same bill

TPA & Insurance Billing

Essential features for insurance billing:

• Pre-Authorization: Digital pre-auth requests to TPA
• Rate Master: TPA-specific rate management
• Claim Submission: Electronic claim filing
• Tracking: Claim status monitoring
• Reconciliation: Payment matching and follow-up

Multiple Payment Modes

Your billing software should handle:

• Cash payments with proper receipts
• Card payments (POS integration)
• UPI payments (QR generation)
• Bank transfers
• Split payments (part cash, part insurance)
• Advance deposits and adjustments
• Refund processing

Essential Reports

• Daily collection report
• Department-wise revenue
• TPA outstanding report
• GST summary (taxable vs exempt)
• GSTR-1, GSTR-2, GSTR-3B
• Discount analysis
• Outstanding dues report

Package Billing

Modern HMS should support:

• Pre-defined treatment packages
• Inclusive vs exclusive items
• PMJAY package rates
• Corporate package discounts
• Auto-upgrade when package limits exceed

Integration Requirements

• Tally: Export to Tally for accounting
• GST Portal: Direct e-invoice generation
• Payment Gateway: Online payment collection
• TPA Portals: Claim submission
• ABDM: Health records linking