The Philippine Health Insurance Corporation (PhilHealth) and members of the Private Hospitals Association of the Philippines Inc. (PHAPi) made headway on claims issues that would ensure the continuing health insurance of the public especially during this pandemic.
The biggest state insurer and private hospitals agreed on the immediate release of the second wave of Debit-Credit Payment Method to hospitals that will signify intention to avail themselves of such.
PhilHealth CEO Dante Gierran vowed that a corresponding internal memo would be released soon to inform and prepare all regional offices for the second wave of applications.
Using PhilHealth data, 60 percent of in-process claims shall be released to hospitals that have not yet availed themselves of DCPM.
The remaining 40 percent will be released upon processing and reconciliation of initial payment.
For hospitals that have availed themselves of the DCPM, PhilHealth agreed to lower the liquidation threshold to 20 percent of the initial tranche of payment to enable them to immediately avail of the second wave of DCPM.
In addition, PhilHealth said the “Undertaking” that hospitals sign and submit as attachment to qualify for DCPM payments shall be amended based on suggestions from the hospitals.
The hospitals have likewise emphasized the need for regularity and predictability of payments to ensure uninterrupted hospital operations.
A series of steps to solve the issue given PhilHealth’s current challenges was submitted for consideration by the state agency.
PHAPi President Dr. Jose Rene de Grano attended the meeting with PhilHealth to jointly resolve the claims payments issue and to end public fears over some hospitals’ plan of not renewing accreditation next year.
Aside from Gierran, those who attended the meeting were Dr. Jose Rene de Grano, The Medical City PCEO Dr. Eugene Ramos; St. Luke’s Hospitals PCEO Dr. Art dela Pena; and Mt. Grace Hospitals, Inc. PCEO Carlos C. Ejercito and Executive VP and COO Rhais Gamboa.
It was agreed the meeting would be the first step towards more frequent dialogues and collaborations to address pain points and operational issues that brought challenges to both the Insurer and service providers.
Both parties agreed to work together on the issue of returned and denied claims through a Technical Working Group composed of representatives from the Philippine Medical Association, Philippine Hospital Association, PHAPi and PhilHealth.
Responding to the appeal of Gierran for support on its IT concerns, the hospitals led by Mt. Grace agreed to aid and expedite claims processing.
Earlier, Senator Juan Edgardo Angara warned of a possible health system failure as he called on PhilHealth to expedite processing of claims of hospitals.
If PhilHealth continues to fail to settle their obligations, Angara said hospitals might shut down operations and the public would be prejudiced against those needing health services.
“They have long been complaining about the slow-paced reimbursements of expenses incurred by hospitals to patients (PhilHealth beneficiaries),” said Angara.
PHAPi had threatened to withdraw from the PhilHealth system due to the delayed reimbursements of claims.
Meanwhile, a legislator has asked PhilHealth to find ways to enable the elderly to easily register and to make it a Standard Operating Procedure in all hospitals to enroll unregistered seniors when they show up for checkup or treatment.
Rep. Rodolfo Ordanes, nominee of the party-list group Senior Citizens to the House of Representatives, made the appeal to the state health insurer owing to the inability of many seniors to register online, and the gross inconvenience of requiring seniors to go to PhilHealth offices.
Ordanes, chairperson of the House committee on senior citizens, said the mobility of the elderly has been limited by the various restrictions on the movement of people caused by the COVID-19 pandemic.
He said that seniors, together with the young, have been prevented from moving around for fear of getting infected by the virus.
He called on hospitals accredited by PhilHealth to assist seniors who are not yet enrolled in the state so that they too can avail themselves of the benefits provided by the insurer.
As for PhilHealth, Ordanes asked the state health insurers to deputize local governments, particularly barangays, in enrolling seniors in their localities.
“One way is for PhilHealth to deputize or authorize barangays to serve as PhilHealth registration centers,” he said.
