Western Visayas. Hospitals in Region VI expressed their gratitude to the Philippine Health Insurance Corporation (PhilHealth) for the speedy processing of their claims for medical reimbursement.
The desire to reduce the turn-around time (TAT) for claims processing had been a continuous struggle in the past which inevitably caused hostility of the hospitals towards PhilHealth.
“With regards to claims processing, this has been an ongoing struggle of the hospitals before, because I think it’s almost like part of the hospital especially on financing,” said Dr. Elmer Pedregosa, President of the College of Hospital Administrators and Private Hospitals Association in the Philippines (PHAP) Western Visayas, and Administrator of Iloilo Mission Hospital.
Worried about the backlogs that irate the hospitals, PhilHealth VI gave added attention to its claims processing cycle. Region VI Vice President Dennis Mas, PhDURP pursued improvements in management systems, increased employee productivity and strengthened partnership with health care providers.
Before, it took PhilHealth VI almost 60 to 90 days to process claims for reimbursement. Now, claims for Case rates are processed within 28 days and claims under Fee-for-Service are processed within 32 days.
This is a major feat considering that the normal processing period prescribed by PhilHealth is 60 days from the time a completely filed claim is received. Before, PhilHealth VI receives an average of 1,000 claims per day, less than the current number of 1,900 claims per day.
With the increase in volume of claims and with no additional manpower provided, PhilHealth VI increased the daily quota of claims processors. It encouraged additional and overtime services of employees until the backlog was eliminated and the operations normalized. Personnel from other units augmented the encoding, medical evaluation and proof reading processes. Mas also tapped college students from different schools to have their on-the-job training at PhilHealth VI to beef up the workforce.
The Return-to-Hospital (RTH) claims in previous years were of substantial percentage said Pedregosa. “Two things more likely,” he said, “because I think a lot of patients are coming in the hospitals, and probably because of the deficiencies in achieving completeness in the documents.”
Seeing the need for the hospital clerks to be retrained, PhilHealth VI scheduled a training and immersion of hospital clerks at the PhilHealth Claims Section where PhilHealth processors themselves served as mentors.
Mas also conducted periodic dialogues with hospital administrators and officials and attended their conferences to address PhilHealth issues.
“PhilHealth refund is the life of the hospital. With the new leadership, there is a huge improvement in the turn-around-time for claims processing. We have no complaints, money is coming in,” Jo Marie Crisix Muyco, Administrator of Iloilo Doctor’s Hospital stressed.
Capiz Emmanuel Hospital Administrator Jessie Contreras relayed their gratitude to PhilHealth VI’s management in responding to their long and overdue concern.
“We have no more problems with our claims with PhilHealth. Our people in the hospital and even our doctors are happy because they are being paid on time, simply because we are also receiving on time payment from PhilHealth,” said Contreras.
The same reaction was also shared by Arlene Ledesma, President and CEO of Pablo Torre Memorial Hospital based in Bacolod City, Negros Occidental.
Western Visayas Medical Center Chief Dr. Jose Mari Fermin and Negros Occidental Provincial Hospital Head Dr. Girlie Pinongan are also delighted with the decrease in the number of days in processing of claims. “It’s a nice improvement that helped us in our cash flow and everything like payment for our suppliers. I am happy, and I thank PhilHealth for this,” Fermin quipped.
Both the government and private hospitals acknowledged the impact of the services of the newly-deployed PhilHealth Customer Assistance, Relations and Empowerment Staff (CARES) to provide on–site assistance to members, address issues and queries raised by PhilHealth members. Each health care facility in Western Visayas provided them with a place inside the hospital premises. (END)
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