PhilHealth expedites reimbursements, provides HCFs with needed funds

Recognizing the crucial role of the hospitals in providing unimpeded delivery of health care services to those who need it, the Philippine Health Insurance Corporation (PhilHealth) recently announced the implementation of the Debit-Credit Payment Method (DCPM) to fast-track payments to its partner-hospitals.

Under the DCPM, PhilHealth shall facilitate the settlement of accounts by paying 60% of the total amount of applicable HCF receivables minus withholding tax of 2%, while the remaining 40% (minus 2% withholding tax) of the total amount of good claims shall be paid following compliance to existing claims processing requirements and procedures, and full reconciliation of the 60% initially paid to the HCF.

Atty. Dante A. Gierran, PhilHealth President and CEO, said that, “The idea behind this [DCPM] is to immediately pay 60% of the total P7.01 billion of hospital claims in the National Capital Region (NCR) Plus area.”

Reimbursements through the DCPM only apply to in-process claims filed from March 8, 2020 to April 7, 2021. However, claims that were returned to hospitals, denied, and under further investigation shall not be paid under the DCPM. Likewise, claims approved for payment by April 7, 2021 were excluded from the payment.

The accelerated payment method shall afford hospitals sufficient cash flow to continue providing the sick with quality health care during the pandemic. In view of this, hospital funds are augmented to enable them to increase their capacity in managing more COVID patients.

All PhilHealth-accredited hospitals in the NCR Plus bubble (NCR, Bulacan, Cavite, Laguna, and Rizal) including Pampanga and Batangas treating COVID-19 patients may avail of this payment method. In compliance to the Inter-Agency Task Force (IATF) Resolution No. 111 dated April 22,2021 and IATF Resolution No.113-A dated April 29, 2021, PhilHealth is expanding the DCPM to high and critical areas that include the Cordillera Administrative Region (CAR) provinces of Abra and Ifugao and Region II cities of Santiago and Quirino.

Eligible HCFs must submit a properly accomplished undertaking duly signed by their respective owner or medical director subject to the concurrence of PhilHealth. “The DPCM is now on-going, and our Regional Offices are awaiting the facilities’ filing of their Letter of Understanding,” said Gierran. “Kapag na-submit ninyo iyong Letter of Understanding na pirmado ng may-ari ng ospital, medical director, o sinomang authorized representative ng ospital, meron tayong automatic credit na dapat bayaran ng PhilHealth sa ospital.”

 Upon receipt of payment, the HCFs shall issue an electronic copy of the official receipt (OR) to the concerned PhilHealth office within five days and the original OR must be submitted within 15 days. PhilHealth shall withhold all succeeding payments to HCFs should they fail to submit the OR.

 As of April 29, 2021, PhilHealth has disbursed payments to 114 HCFs under the DCPM amounting to P5.14 billion.

PhilHealth continues to provide ways to be responsive to the health needs of its stakeholders