13 September 2021 – The Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF) approved the recommendation of the Anti-Red Tape Authority (ARTA) and the Philippine Health Insurance Corporation (PhilHealth) to lift the limitations on the coverage of the debit-credit payment method (DCPM).
This will allow PhilHealth to be more flexible in applying the DCPM’s coverage, should its board decide to do so. This is part of the plan to make the DCPM available to all hospitals, that will expedite the release of payment for COVID-19 claims made by both public and private hospitals.
IATF Resolution No. 138, Series of 2021 rescinded the provision in IATF Resolution No. 111, Series of 2021 with regard to the applicability of the DPCM under PhilHealth Circular No. 2021-0004.
“The nationwide applicability of the DCPM shall be left to the sound business judgment of PhilHealth Board,” the recent issuance, released on 9 September 2021, read.
Prior to this, the DCPM was only available to high and critical risk areas as determined by the Two Week Growth Rate (TWGR), Average Daily Attack Rate (ADAR), and Health Care Utilization Rate (HCUR).
In one of ARTA’s hearings with PhilHealth, Secretary Jeremiah Belgica, ARTA Director General, suggested the expansion of the DCPM’s coverage as one of the ways to expedite the disbursement of unpaid COVID-19 reimbursement claims of both public and private hospitals.
The DCPM allows hospitals to receive 60 percent of their reimbursement claims even if PhilHealth is not yet done in processing their documentary requirements.
In an interview over ANC on Friday, Belgica said PhilHealth is now making headway in clearing its backlog of unpaid COVID-19 hospital reimbursement claims.
This, after the state insurer adopted some of ARTA’s recommendations to streamline its processes.
“ARTA and PhilHealth have already made some significant headway, especially with the meeting with IATF yesterday. IATF supported some of the initiatives already,” Belgica said.
“We’re making headways and hopefully, sooner or later, we’ll get those payments going,” he added.
As the state insurer’s issues require a whole-of-government approach, Belgica said *ARTA formed* a “support group” comprised of members of various government agencies to help PhilHealth in disbursing payment for its unpaid hospital claims.
Officials from the Department of Health (DOH), Food and Drug Administration (FDA), Health Technology Assessment Council (HTAC), and Department of Information and Communications Technology (DICT) have agreed to become part of the support group. Belgica said the Office of the Presidential Adviser for Streamlining Government Processes (OPASGP) will also be invited to join the group while officials from the Commission on Audit (COA) will be invited as resource speakers.
In a meeting on Friday, PhilHealth Area Vice President Walter Bacareza said they formed their own group to mirror the one that ARTA is planning to create to help them receive more expert opinions from government officials and private stakeholders.
Bacareza shared that PhilHealth President and CEO Dante Gierran ordered them to study the possibility of conducting their Medical Prepayment Review (MPR) post-audit for a limited time to tide over hospitals during the health crisis.
In their previous meetings, ARTA suggested that PhilHealth conduct a more extensive MPR post-audit to fast track the release of claims. This, as estimates presented to the Authority showed that only a fraction of the claims that the state insurer receives contain wrong diagnoses.
Belgica told Bacareza that the DICT can provide them with additional cloud storage to partially resolve their ICT issues. Earlier, PhilHealth complained of its slow internet connection and low cloud storage space.
The Authority and the other agencies present during the meeting will continue discussions to craft a clear policy on which medicines used to treat COVID-19 patients can PhilHealth cover.
The ARTA chief signified his willingness to participate in PhilHealth’s board meetings to discuss the agency’s policy and streamlining recommendations to further improve the state insurer’s services.
However, Belgica reiterated his strong reminder to PhilHealth to release the payment for the COVID-19 reimbursement claims of hospitals within 60 days in accordance with its special law.
Non-compliance may lead to further investigations and possible filing of cases for violation of Republic Act No. 11032 or the Ease of Doing Business and Efficient Government Service Delivery Act of 2018 by ARTA.
“We are really hopeful with the pace that we’re going and the significant headways that we’re having. We’re optimistic that the issues of PhilHealth will be settled sooner rather than later,” Belgica said.