Professional fees (PF) paid by PhilHealth for salaried physicians in government or private training hospitals are pooled for hospital personnel. It has been a policy that the services of the accredited medical practitioners are paid even though they are employed by the government. PFs’ total amount are pooled to form as additional remuneration equally shared by every hospital staff so as in return will offer better services towards PhilHealth patients. Disposition of such is left to the discretion of hospital management or the hospital chief.
In claiming PhilHealth benefits, physician who actually rendered the service must be the signatory in the Claim Form 2 declaring therein that PF is payable to the director, administrator or hospital’s chief. However, the medical director, administrator (physician), chief of clinic or department heads can also sign for the government salaried physicians for as long as these are set aside for pooling, hence, maybe compensated.
Computation of benefits like daily visit shall be based on rate for non-specialists according to what is prescribed in the New Benefit Schedule. While the Peso Conversion Factor (PCF) of 40 shall be used in the computation of professional fee regardless of the accreditation category of the medical director, administrator, etc. except when the said medical director is also the provider of the service as reflected in the operative record, OB sheet or endoscopy report. With this, computation of professional fee is based on the accreditation category of the subject physician-signatory.
To this effect, PhilHealth has prescribed the list of procedures and services which are limited to the specified subclass of doctors. Preoperative Inpatient Consultations are either done by physician who is a diplomate or fellow of Philippine Academy of Family Physicians, College of Physicians, Pediatric Society or Neurological Association. Same is required to radiology services that need to be a fellow or diplomate member of Philippine College of Radiology and for procedures of flourescein angiography from the Philippine Academy of Ophthalmology.
Claims for PF of the above services provided by doctors who are not authorized to render such services are disallowed. Doctors providing surgery or anesthesia services who are classified as general practitioners based on maximum of 80 Relative Value Unit (RVU) for surgeries and RVU –linked services on secondary and tertiary classified hospitals, that is, 3,200 pesos for surgeries per RVU services and 1,280 pesos for anesthesia services and exempted from this rule are government salaried physicians and payment for PF is for pooling. (Larry T. Tabsing)
In government setting, since the philhealth pf is pooled and payable to the medical director, does the medical director has the right to deduct philhealth share of the government doctor as a form of punishment?
ReplyDeleteSame concern kapatid
Deleteremember that AO 42-2001 does not give the Chief of Hospital the discretion on how to distribute the PFs. instead,it states that distribution is left to the discretion of the health care institution. This was deliberately stated as so otherwise the chief of hospital may do as he wish and the said law will be subject for abuse.
ReplyDeleteIn our settings many of us are job orders.. But are personnels too.. That work with the patient.. The regular employees are having higher sharing than us.. That in a way that we nurses are the frontliners.. Too bad for regular employees.. Even utilities have 2x higher sharing than us job orders.. Even we wrote a letter to our chief.. To have equal share..
DeleteIn our settings many of us are job orders.. But are personnels too.. That work with the patient.. The regular employees are having higher sharing than us.. That in a way that we nurses are the frontliners.. Too bad for regular employees.. Even utilities have 2x higher sharing than us job orders.. Even we wrote a letter to our chief.. To have equal share..
DeleteAre the pooled fees taxable?
ReplyDeleteplease provide a very precise guidelines about this philhealth pooling. from philhealth institution to which account it would be deposited, to taxation, and to sharing..philhealth government Profesionals fee pooling has been long subjected for a debate and court appeals between local government and public health workers...... ps. DOH, PHIC
ReplyDeletein the last A.O. of then Sec. Garin dated June 30, 2016 are we not going to consider the workload, responsibilty, accountability to our admitted patients in the computation of sharing of philhealth pooled funds for doctors?
ReplyDeleteIs it legally right to deduct or remove the whole share to a gorvernment hospital personnel as a form of punishment or disciplinary action? Because the administrators of Quezon City General hospital are fond of doing this act.looking forward to your reply
ReplyDeleteang bata ko job hire nurse sa wvmc. ngaa wala sila ya gina tagaan philhealth share kay pareho man lang ukon kon kis-a mas damo pa ila obra sa mga plnatilyado nga nurses?? kagamay man lang sang ila allowance pero ang workload the same sa mga regular te, ngaa wala gid sila ya share maski gamay man lang to compensate for the services they render???
ReplyDeleteMay we suggest that PHIC share be in the form of incentives and not exceeding the basic monthly salary of personnel so that this will not be abused. ..some patients are not referred timely because of PHIC shares. Some diagnosis are changed because of PHIC shares...etc. among government facilities. This will also save the PHIC from unpaid claims.
ReplyDeleteThe primary intention of PHIC i think is improve easy access of poor to health services (100% NBB ang facility dapat), 2nd, to improve the health facilities & services (ratio of health worker to authorized or actual bed capacity is achieved e.g. MD is 1:20 bed (because others wont hire para less ang ka-share), & 3rd compensation of HW especially the overworked BHW some without honorarium. if a small spare from hospital and RHUs are save for BHW. Nag tatrabaho talaga sila ...some without honorarium.....PHO technical and DOH regional Office will have a role in validating the indicators.....
is it true po wala na makukuhang monthly philhealth shares ang government salaried physicians?
ReplyDeleteif a hospital employee is already separated from service during the granting of PF but the said coverage computation for PF the employee is still in service is he/she still qualified for it? Like for example,. The PF is for the period January to June (the employee still in service for that period Jan-June and he/she was separated form the service August)Is the employee qualified to receive?
ReplyDelete