To settle issues with health-care providers amid the Covid-19 pandemic, the Philippine Health Insurance Corp. (PhilHealth) on Tuesday announced it would issue a revised circular on Temporary Suspension of Payment of Claims (TSPC).
The PhilHealth made the announcement during the continuation of hearings on House Resolution 1966 filed by House Committee on Health Chairperson Angelina “Helen” D.L. Tan.
Tan’s resolution seeks to inquire into the confusion brought about by the issuances of PhilHealth on the availment of Covid-19 related benefit packages in light of the renewed calls on the part of some hospitals to disengage from PhilHealth over its continued failure to pay reimbursement claims.
The PhilHealth Circular 2021-013 imposes a temporary suspension of claims for potential fraudulent cases.
“We do not want the bridge to collapse [between hospitals and PhilHealth]. We want to rebuild whatever trust and partnership that are left between the state health insurer and our healthcare institutions or providers. We cannot allow this conflict to persist in the face of the worsening pandemic in the country,” Tan said.
Extension
DURING the House hearing, PhilHealth Acting Senior Manager Dr. Lambert S. David said the PhilHealth has adopted almost all of the recommendations of the stakeholders.
David explained that the TSPC is the conditional stoppage of payment for claims undergoing investigation. He added “it is not a penalty but a preventive measure to avoid the loss or wastage of funds due to fraudulent acts, unethical and abuse of authority.”
According to David, the PhilHealth Executive Committee approved last November 4 the revised draft TSPC circular “for consultation with concerned external stakeholders.”
David said these recommendations include increasing the non-extendable period for health-care providers’ to submit replies to the Fact-Finding Investigation Report. He said the revised circular gives health-care providers 10 days from the previous three days.
The PhilHealth earlier said its Fact Finding Investigation and Enforcement Department is resolving issues with hospitals “with urgency.”
“That is why we imposed a 3-day period for the hospital to answer the allegations of the findings,” the physician said.
Shortened
DAVID said PhilHealth officials also agreed that not all claims of a healthcare facility should be covered by the TSPC.
He added the TSPC period shall be also revised from 120 days to “possibly” 60 days.
Under the said circular, the PhilHealth has 120 days to investigate unless extended to warrant investigation, which will not exceed 90 days. It will be automatically lifted after 120 days when no evidence of an offense was found after the investigation.
The PhilHealth also said that a grace period shall be given for in-patient claims of probable Covid-19 pneumonia cases admitted from November 26, 2020 to June 18, 2021.
According to David, the revised TSPC circular will be presented to the Philippine Hospitals Association, Private Hospitals Association of the Philippines Inc. and the Philippine Medical Association for their comments.
“[This revised] circular shall be published and implemented once all parties are in agreement on the guidelines,” he added.