UNPAID Philhealth reimbursements that have ballooned to over P26 billion threaten to close down private and government hospitals amid the Covid contagion.
This has prompted Senator Imee Marcos to air growing concerns reaching her office that PhilHealth’s delayed reimbursements to government and private hospitals will weaken their capacity to deal with the mutating Covid-19 virus, if not risk their outright closure.
“Let us not wait for them to shut down nor leave them ill-prepared to deal with the possible spread of the dreaded Delta variant,” the senator said on Thursday.
She recalled that PhilHealth recently reported releasing P6.3 billion through a new system of settling hospital claims, known as the Debit Credit Payment Method (DCPM) that took effect in April.
Marcos noted, however, the hospitals were being shortchanged because the DCPM did not cover still-unpaid hospital claims for Covid-19 treatment last year.
“Nor was DCPM fully settling 60 percent of hospital claims for reimbursement as directed in the government agency’s own circulars in April and May,” Marcos added.
She also cited the case of a private hospital that was reimbursed P430 million out of the P1.2 billion it is claiming, “which is 60 percent of 60 percent—in effect, only 36 percent—of what PhilHealth said it would pay through the DCPM.”
Marcos lamented that even government hospitals have not received the full 60-percent reimbursement that PhilHealth should have released, noting that as of May 31, the Philippine General Hospital has only received a reimbursement of 0.0042 percent or only P2.56 million of its total claims for Covid-19 cases of P615.7 million.
Moreover, the Lung Center of the Philippines reported it has only been paid 40 percent of its receivables from Philhealth, with P304 million still due.
The Philippine Heart Center, in turn, said only 49 percent or P99.47 million has been reimbursed by the state health insurance corporation, leaving a balance of more than P100 million for claims up to March 31.
Marcos said “Philhealth is fudging its numbers,” citing an online ledger called Reconciliation Summary Module (RSM), to which both Philhealth and hospitals have access.
“Hospitals are complaining that the RSM shows Philhealth has paid but the said payments have not yet been deposited in their bank accounts,” Marcos disclosed.
She added that “many Northern Luzon hospitals cannot increase bed capacity because they have not been reimbursed,” noting that “complaints from hospitals in the Western Visayas have also surfaced in the news.
The senator likewise noted that the Private Hospitals Association of the Philippines (PHAPi) confirmed that partial reimbursements to its members via DCPM were concentrated in the National Capital Region (NCR) Plus bubble of Metro Manila and its neighboring provinces.
So far, she added, only about 210 hospitals have agreed to participate in the DCPM, out of the 350 hospitals in the NCR Plus bubble and 1,270 health care facilities all over the country.
The PHAPi, which has 700 members, noted that the fear of retaliation is complicating the delay in Philhealth reimbursements, as many private hospitals hesitate to be more vocal and risk waiting longer to be paid.