FEU-NRMF disengages from PhilHealth
The Far Eastern University – Dr. Nicanor Reyes Medical Foundation (FEU-NRMF) Center in a statement announced that they will no longer renew the accreditation of its hospital with the Philippine Health Insurance Corporation.
Republic Act 7875, or the National Health Insurance Act, states that PhilHealth must process, review, and pay the claims of providers within a period not exceeding sixty (60) days. According to FEU-NRMF, this has not been the case.
At the start of this year, the receivables of the non-stock non-profit institution has already reached P114 million and their exposure has grown by roughly P8 million month on month due to PhilHealth non-payments. And as of November 30, 2021, the amount has ballooned to P200 million.
This means that the claims paid by PhilHealth are far less than the claims submitted by FEU-NRMF, despite the Interim Reimbursement Mechanism (IRM) and Debit Credit Payment Mechanism (DCPM) liquidations.
Juan Enrique Reyes, FEU-NRMF Chief Operating Officer said, “We must take action before we are forced to close due to financial difficulties. We will continue to serve PhilHealth members, but we can no longer deduct their PhilHealth benefits from their hospital bills. We will, however, provide the patients with all the necessary forms so they can apply for reimbursement on their own.”
As a non-stock non-profit institution, the FEU-NRMF medical center has allocated two-thirds of their authorized beds to pay patients, and one-third of their beds to the less fortunate.
“Today, we remain steadfast in our commitment to provide world class medical services to all Filipinos. However, in these difficult times, altruism must give way to pragmatism. We simply cannot treat our patients if we are not financially viable.“
He further said that In the meantime, they will continue to work with PhilHealth with the hopes of reaching an amicable settlement. More importantly, he mentioned that it is the fervent wish of the institution that these dialogues with PhilHealth can lead to reforms to minimize the burden shouldered by hospitals in financial distress.
In addition, the FEU-NRMF COO mentioned that in the dialogue with PhilHealth, they will put forward two recommendations.
First would be that before any medical treatment is given to a Health Maintenance Organization (HMO) patient, there must first be a Letter of Authorization (LOA). The LOA essentially preapproves the treatment before any service is rendered.
Under the current practice, hospitals often learn that patient benefits have been exhausted only after the claim has been submitted, leaving them no chance of getting reimbursed. Reyes said that PhilHealth should adopt a LOA mechanism like HMOs so healthcare providers will know if patient benefits have been exhausted before providing medical services.
Secondly, PhilHealth needs to revamp its claim filing system, specifically the Eurolink Easy Claims software. Aside from the frequent down time, Reyes further said that it is very difficult to upload attachments. These unreadable attachments typically result in denied claims.
“As a result of the Eurolink issues, there is a difference of P83 million between our claims submitted versus our PhilHealth claims on file. Hence, even assuming that PhilHealth is sincere about their intention to settle our unpaid claims, we can never get caught up if we cannot even agree on the outstanding balance.”
Quoting TS Eliot, Reyes said, “This is how the world ends, not with a bang but a whimper. This implies that democracy dies quietly, and our silence regarding these PhilHealth issues signifies our acceptance of the status quo. Thus, we are making it known that we do not accept.”
He stressed that there must be changes or hospitals will close.
“Only time will tell if we have chosen the best path for our institution. But for FEU-NRMF Medical Center, the cost of remaining silent is greater than the cost of speaking out. We have far more to lose by allowing this to continue,” ended Reyes.