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PhilHealth Interim Reimbursement Mechanism releases are above board

“Extraordinary times need extraordinary measures” PhilHealth President and CEO Ricardo C. Morales stressed, citing that PhilHealth was one of the first responders in this pandemic referring to the grant of the IRM (Interim reimbursement Mechanism) to health facilities.  Consistent with this, PhilHealth earlier announced that it is in the process of evaluating a second wave of IRM to high Covid-19 concentration areas such as NCR and Regions III, IV, VII and VIII where bed capacity either reached full capacity or is in critical levels resulting from the easing of quarantine levels. 

PhilHealth clarified that IRM releases are based on the historical claims of hospitals, and undergo a process of application, evaluation, validation and recommendation at the level of the PhilHealth Regional Offices, and approval at its Head Office.  All transactions on IRM are aboveboard and within the guidelines set by the Corporation.

The Agency asserted that the IRM is strictly subject to the usual stringent government accounting and auditing rules, and requires reconciliation and liquidation contrary to reports that hospitals are not required to liquidate their advances. “Liquidation is definitely a must but since we are in unusual times, we made the timing of liquidation flexible with such options left to the good judgement of the Regions given the situations that hospitals are in” the PCEO said.    

The Corporation belied reports that its Senior Vice President for Fund Management Sector Renato Limsiaco Jr. favored certain hospitals or has quickly released the IRM in record time, clarifying that Limsiaco’s authority is limited to vetting the release of funds only in terms of completeness of documents, and not in determining which hospitals will be given the fund. 

Having been able to release some P15 billion to 711 facilities of late also disproves unfounded claims that he abandoned his post during the Extreme Community Quarantine where he was marooned by the locked down in his hometown in Region VIII. 

PhilHealth reiterated that early in the pandemic with no pattern of geographical distribution of cases still identified, the IRM funds was offered to all healthcare facilities including lying in centers and dialysis clinics to ensure unhampered health services to all Filipinos. It necessitated funds even in facilities with pending cases as long as they were licensed by the DOH.

“This is not to say that they will no longer be penalized once proven guilty of any infraction of rues and policies. The whole point here is to ensure that we are able to help in making sure that as many facilities are open and able to serve patients” Morales added.

In late May 2020, PhilHealth revised its strategy in IRM releases by scaling down releases only to areas with high concentration of Covid-19 and the presence of government facilities directly handling patients. The pivot was to ensure that sufficient funds are available for all citizens needing healthcare as well as provide sufficient support to the country’s expanded targeted testing strategy against the pandemic.

Morales explained that the pandemic Covid-19 is not yet over and it is premature to conclude that these hospitals will not be treating infected patients in the weeks or months to come.

“Remember that we have to contain yet the transmission. With LSIs retuning home en masse, a spike in cases is still a very real possibility” the Chief added.

Supporting expanded targeted testing

The Agency also explained that its partnership with the Philippine Red Cross (PRC) is pursuant to the Bayanihan We Heal As One Act, and in compliance to the call of the Office of the Executive Secretary addressed to government heads in late March to partner with PRC “as the primary humanitarian agency that is auxiliary to the government in giving aid to the people, subject to reimbursement, in the distribution of goods and services incidental in the fight against COVID-19.”

Under the partnership, PhilHealth will prospectively pay PRC for its testing services pro hac vice, or only for this occasion. The Agency said that the advance financing arrangement with PRC is consistent with the Universal Health Care Act that authorizes PhilHealth to paying providers using performance-driven, close-end, prospective payments.

The engagement is but one of the many activities being pursued by the state health insurer to mitigate, if not contain, the transmission of Covid-19, to prevent the overburdening of the healthcare system, and to ensure that there is sufficient, adequate and readily available funding for these initiatives.

“We are always on the lookout for developments in the field. We do not have a complete picture yet of the true behavior of this contagion so it is incumbent upon PhilHealth to be agile and swift in decisions to be more responsive to population areas needing support.” Morales ended.

Topics: PhilHealth , COVID-19 , Philippine Red Cross , Bayanihan We Heal As One Act , Universal Health Care Act , Interim reimbursement Mechanism , Ricardo Morales
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