MANILA - The Philippine Hospital Association questioned Thursday PhilHealth's slow release of payments to medical facilities with COVID-19 claims not made under the debit-credit payment method (DCPM).
The DCPM was created last month following President Rodrigo Duterte's order to PhilHealth to speed up the reimbursement of hospital claims in high and critical risk areas as COVID-19 cases surged.
Under the DCPM, hospitals need to apply and sign an undertaking stating that healthcare facilities will receive 60 percent of the total amount of receivables subject to 2 percent expanded withholding tax.
PHA president Dr. Jaime Almora, however, noted that the undertakings "have provisions that are not clear to medical facilities."
"Kagaya ng IRM (interim-reimbursement mechanism) nun mabilis magbigay pero yung pagprocess ng claim sa 'di nag-apply ng debit-credit payment method ay mabagal. Maraming nadedeny at narereturn to hospital. 'Yung non-COVID claims binabayaran naman," he told ABS-CBN's Teleradyo.
(It's like IRM, the release of payment is fast but the processing of claims not made under the debit-credit payment method is slow. Many are denied and returned to the hospital. Non-COVID claims are paid.)
"Nagulat ang mga ospital kung bakit ganun kasi ang in-expect lang naman i-expedite ang payment ba't kailangan may magapply pa at magsign ng undertaking. May provisions kasi na di malinaw sa kanila."
(Hospitals were surprised because we only expected that payment would be expedited, why do we have to apply and sign an undertaking? There are provisions not clear to them.)
PhilHealth owes private hospitals more than P28 billion, according to this month's assessment of the Private Hospitals Association Philippines Inc.
The state insurer also pays only 35 percent instead of 60 percent of their claims under the DCPM, PHAPI President Jose Rene de Grano earlier said.
The state insurer has released some P6 billion to 182 hospitals who have availed of the DCPM, said Shirley Domingo, PhilHealth vice president for corporate affairs.
Claims not made under the DCPM undergoes regular assessment, Domingo said. These are reconciled by regional PhilHealth offices with the hospitals, she added.
"Meron po tayong processing ng claims na sinusunod po. Hindi naman lahat ng claims na binibigay nila bayad agad kasi may sinusunod na assessment po yun and all of that," she said.
(We follow a process on assessing claims. We can't pay for all claims right away.)
"Naapektuhan di po ang PhilHealth sa pandemic, maraming nagkasakit, naisolate at naapektuhan ang processing natin."
(PhilHealth was also hit by the pandemic. Many personnel became sick, underwent isolation and our processing suffered because of this.)
Almora said PhilHealth should give hospitals more time to explain their side.
"Tawagin itong mga ospital at ipakita ang mga problema para masettle. Bigyan ng pagkakataon ang ospital para i-explain ang side nila. 'Yun ang lacking part sa pagreconcile sa mga ospital at pagbigay ng time sa mga ospital, time to explain," he said.
(Summon hospitals and show them the problems so it can be settled. Give them a chance to explain their side. That's the lacking part: reconciling and giving time to hospitals to explain.)
"Meron sa ibang area pero by large yun ang lacking approach."
(It's done in some areas but by large it's the lacking approach.)