Ahead of new Senate investigation, PhilHealth reports 166 billion peso payout to hospitals

The Philippine Health Insurance Corporation (PhilHealth) said on Thursday that it had already paid a total of 166 billion pesos for claims it had received from accredited government and private hospitals from last year to June 30 this year. .

State Health Insurer Statement as Sen. Juan Edgardo Angara filed Senate Resolution 774 to verify reports and find out what is causing prolonged delays in PhilHealth reimbursements and resolve the issue in case it arises. would require remedial legislation.

The resolution noted recent complaints from the Hospital Association of the Philippines, comprising 2,000 private and public hospitals, regarding PhilHealth’s unpaid reimbursement claims.

PhilHealth said the amount already covers 13.6 million claims, or 76.4% of the nearly 18 million claims received during the period.

The remaining percentage of claims included those referred to hospitals for compliance with identified deficiencies (8%) and those denied due to non-compliance and various violations of applicable rules and regulations.

“The Company is working twice as hard to process the remaining 12%, or 25.6 billion pesos, which are in varying levels of processing in its offices,” PhilHealth said in a statement released Thursday.

Of the total claims received during the period, PhilHealth said nearly 10 million claims were from accredited private hospitals, of which 8.2 million claims amounting to nearly 96 billion pesos were paid, while the rest of the claims amounting to 14.4 billion pesos are still pending. to treat.

In the same statement, PhilHealth also clarified that the 6.3 billion pesos it paid to 206 hospitals, as claimed by the Association of Private Hospitals of the Philippines Inc. (PHAPi), refers to partial payments made by the state health insurer in the context of payment by debit-credit. (DCPM) to hospitals with Covid-19 cases in identified critical areas.

Public health insurance also attributed the discrepancy in the numbers between PhilHealth and the hospitals primarily to “differences in accounting treatments.”

“During claims data reconciliation meetings with a number of hospitals, it was noted that hospitals include claims denied and returned to the hospital in their accounts receivable, while PhilHealth only recognizes good claims. claims as its debts in accordance with applicable government accounting rules and regulations. This accounting practice was validated earlier during the House Committee on North Luzon Growth Quadrangle hearing with Hospitals and PhilHealth in June this year,” a- he declared.

On Monday, Senator Angara said the 6.3 billion pesos in hospital claims paid by PhilHealth to health facilities was a “paltry amount” compared to the 28 billion pesos in unpaid claims, as PHAPi said.

The BusinessMirror has asked PhilHealth to clarify the amount still to be paid under the DCPM program, but it has not yet provided a response on the matter as of press time.

In terms of Covid-19 related claims, PhilHealth said it paid almost 12 billion pesos, or 56% of the total Covid-19 related claims received from affected areas.

These claims consist of testing packages (including testing conducted by the Philippine Red Cross), community isolation benefit packages, and hospitalization cases.

During a recent Senate hearing, Dr. Jaime Almora, President of PHAPi, told senators that member hospitals’ outstanding claims now range from 50 to 700 million pesos.

Almora added that some hospitals had to resort to borrowing and depleted their savings just to maintain hospital operations.

This comes as Angara, the incumbent chairman of the Senate Finance Committee, shared senators’ concerns about the possibility of a growing number of patients who may have the Delta variant of Covid-19.

He recalled that it is the responsibility of the government to ensure that there is enough capacity in private and public hospitals.

The senator pointed out that the piecemeal payments from PhilHealth would not be enough, as it would only lead to hospitals reducing services and the bed capacity and operating hours of hospital staff.

Norman D. Briggs