PhilHealth clarifies mismatch with hospital claims
Discrepancies in records mostly stem from improper data on return to hospital claims and denied claims. ‘Definitely, there are figures that will be different from those recorded by hospitals. But we already started reconciliation of data last year.’
The Philippine Health Insurance Corporation or PhilHealth will continue meeting with private hospitals to discuss discrepancies in hospital receivables.
“There will be some negotiations. We’ll sit down with the hospitals so we can understand how they are keeping records on PhilHealth claims,” Renato Limsiaco Jr., PhilHealth’s senior vice president for fund management, said Friday in a media conference in Pasig City.
Limsiaco’s statement came after Private Hospital Association of the
Philippines Inc. President Dr. Jose Rene De Grano said on 15 February that some hospitals are still waiting for their receivables from PhilHealth amounting to P7 billion.
Improper data on RTH claims
Limsiaco said discrepancies in records mostly stem from improper data on return to hospital claims and denied claims.
RTH claims are claims with deficiencies which hospitals must first fulfill and could result either in a releasable claim or a denied claim after further evaluation by PhilHealth.
“Definitely, there are figures that will be different from those recorded by hospitals. But we already started reconciliation of data last year,” he said.
Limsiaco said processing of claims takes 60 days but this could be extended due to RTH claims.
Few to zero complaints
With the continued discussions and workshops on record keeping between PhilHealth and private hospitals, he said the state agency expects few to zero complaints from the latter after two to three months.
PhilHealth president Emmanuel Ledesma Jr. said payments to hospitals already amounted to P20 billion from 1 January to 23 February or year-to-date.
Historically, he said such payments amounted to only P14 billion.
Limsiaco also stressed PhilHealth has distributed timely payments to hospitals with accurate claims.
“We ensure that we meet that deadline because we’re being monitored by the Governance Commission for Government Owned or Controlled Corporations that publishes scorecards on GOCCs’ performance,” he said.