COVID test reimbursement is PhilHealth’s ‘new speed test’

How fast it can reimburse the hospitals for COVID-19 screening is the “new speed test” that PhilHealth should pass to debunk the mounting complaints that it had been slow in paying frontline facilities, an official said Thursday.

Senate President Pro Tempore Ralph Recto issued the statement after he made “a side-by-side comparison” of the payments that PhilHealth had made for COVID-19 tests with the total tests conducted nationwide.

He said added to this were the complaints of the mayors and hospitals in the most populous five provinces in Southern Tagalog that the reimbursements had been delayed, further straining their resources to cope with the pandemic.

“As of August 10, the total payout of PhilHealth for COVID tests was P380 million. It is a mere drop in the billions of pesos that we’ve been hearing that PhilHealth had spent or keeps in reserve,” Recto said.

“If PhilHealth can give cash advances to dialysis clinics, how come this scheme does not seem to work on a procedure that is vital in fighting this virus?” Recto said, referring to PhilHealth’s assailed Interim Reimbursement Mechanism or IRAM.

“’Yan ang sinasabi ko. IRM as a policy is good. Nasa implementation ‘yan. Hindi pwedeng prepaid ang iba, pero ang postpaid na marami ay naghihintay nang matagal ng bayad,” Recto said.

The latest official reports pegged at 1,830,234 the RT-PCR samples tested from 1,712,143 individuals.

“Based on this, wala pa sigurong 10 percent ang nareimburse ng PhilHealth,” Recto said.

He said PhilHealth and the Health department should jointly do “diagnostics” on the delay in order to remedy the causes.

“May problema ba sa electronic filing? Dahil sa lockdown, hirap bang mag-submit ng requirements? Is the validation hampered by the need to classify the claims, whether the test kits are donated or not? Is the [Health department] sharing test data?” Recto said.

PhilHealth would also be remiss in its duties if it would rubber-stamp its approval on all claims. “It must vet and conduct due diligence in the wake of fraud reports. But it must do this expeditiously,” Recto said.

He is hoping that the numbers would go up once the big recipients of the IRM started submitting their liquidation reports.

Among those awaiting reimbursements are government laboratories in Southern Tagalog, with their claims amounting to tens of millions of pesos.

In Cavite, Imus City Mayor Emmanuel Maliksi said the state insurer owed the molecular laboratory of Ospital ng Imus between P25 million and P30 million for the RT-PCR tests on PhilHealth members, the Philippine Daily Inquirer reported.

The laboratory at the University of the Philippines-Los Baños in Laguna also had yet to claim reimbursements, the Inquirer said in the same report, quoting the Department of Health’s regional director.

The cost of RT-PCR at government facilities is between P1,800 and P3,500.

Topics: COVID-19 , PhilHealth , Ralph Recto , Interim Reimbursement Mechanism
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