Thursday, May 7, 2009
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Monday, May 4, 2009
Wednesday, April 22, 2009
The New Cataract Payment Scheme
New cataract claim payment scheme
By: Larry Tabsing
PhilHealth payment of cataract extraction procedures shall now be on a case payment basis. The new policy has been laid down through PhilHealth Circular No. 16 2009 recently released by PhilHealth. This will be applicable to availment starting May 1, 2009.
By: Larry Tabsing
PhilHealth payment of cataract extraction procedures shall now be on a case payment basis. The new policy has been laid down through PhilHealth Circular No. 16 2009 recently released by PhilHealth. This will be applicable to availment starting May 1, 2009.
The new cataract package has a case payment scheme wherein claims arising from a cataract extraction procedures shall be paid P16,000 pesos regardless whether the procedure was done in one or both eyes in one operative session.
This payment scheme applies to all applicable health care providers for cataract surgery in an ambulatory surgical clinics, and in secondary or tertiary hospitals, whether done in outpatient or inpatient set up regardless of number of days of confinement. However, cataract procedures covered under this package are limited only for intracapsular cataract extraction with insertion of intraocular lens prosthesis; extracapsular cataract removal with insertion of intraocular lens prosthesis like irrigation and aspiration; and, phacoemulsification.
For this, P8,000 is payment for hospital charges for room and board, drugs and medicines used during confinement, x-ray, laboratory and ancillary procedures done during confinement and use of operating room complex and machines. While the other P8,000 goes to professional fee of doctor who performed the procedure.
For this, P8,000 is payment for hospital charges for room and board, drugs and medicines used during confinement, x-ray, laboratory and ancillary procedures done during confinement and use of operating room complex and machines. While the other P8,000 goes to professional fee of doctor who performed the procedure.
Excluded in the package are payment for preoperative tests done prior to confinement, professional fee for preoperative consultation and/or physician standby service as well as the anesthesia service, and complex cataract surgery requiring techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage.
In claims filing, in cases where members are required by hospitals to buy drugs, medicines and supplies or required to seek out other necessary services like laboratory procedures from other facilities, reimbursements to members is allowed if the facility cannot provide the necessary items and services covered by the benefit but these have been used during confinement. Members have to submit official documents and/or other purchased documents. Reimbursements however depend on the actual cost of the receipts submitted but not more than the difference between the maximum benefit and the facility reimbursement
In claims filing, in cases where members are required by hospitals to buy drugs, medicines and supplies or required to seek out other necessary services like laboratory procedures from other facilities, reimbursements to members is allowed if the facility cannot provide the necessary items and services covered by the benefit but these have been used during confinement. Members have to submit official documents and/or other purchased documents. Reimbursements however depend on the actual cost of the receipts submitted but not more than the difference between the maximum benefit and the facility reimbursement
The New Cataract Payment Scheme
New cataract claim payment scheme
By: Larry Tabsing
PhilHealth payment of cataract extraction procedures shall now be on a case payment basis. The new policy has been laid down through PhilHealth Circular No. 16 2009 recently released by PhilHealth. This will be applicable to availment starting May 1, 2009.
The new cataract package has a case payment scheme wherein claims arising from a cataract extraction procedures shall be paid P16,000 pesos regardless whether the procedure was done in one or both eyes in one operative session.
This payment scheme applies to all applicable health care providers for cataract surgery in an ambulatory surgical clinics, and in secondary or tertiary hospitals, whether done in outpatient or inpatient set up regardless of number of days of confinement. However, cataract procedures covered under this package are limited only for intracapsular cataract extraction with insertion of intraocular lens prosthesis; extracapsular cataract removal with insertion of intraocular lens prosthesis like irrigation and aspiration; and, phacoemulsification.
For this, P8,000 is payment for hospital charges for room and board, drugs and medicines used during confinement, x-ray, laboratory and ancillary procedures done during confinement and use of operating room complex and machines. While the other P8,000 goes to professional fee of doctor who performed the procedure.
Excluded in the package are payment for preoperative tests done prior to confinement, professional fee for preoperative consultation and/or physician standby service as well as the anesthesia service, and complex cataract surgery requiring techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage.
In claims filing, in cases where members are required by hospitals to buy drugs, medicines and supplies or required to seek out other necessary services like laboratory procedures from other facilities, reimbursements to members is allowed if the facility cannot provide the necessary items and services covered by the benefit but these have been used during confinement. Members have to submit official documents and/or other purchased documents. Reimbursements however depend on the actual cost of the receipts submitted but not more than the difference between the maximum benefit and the facility reimbursement
By: Larry Tabsing
PhilHealth payment of cataract extraction procedures shall now be on a case payment basis. The new policy has been laid down through PhilHealth Circular No. 16 2009 recently released by PhilHealth. This will be applicable to availment starting May 1, 2009.
The new cataract package has a case payment scheme wherein claims arising from a cataract extraction procedures shall be paid P16,000 pesos regardless whether the procedure was done in one or both eyes in one operative session.
This payment scheme applies to all applicable health care providers for cataract surgery in an ambulatory surgical clinics, and in secondary or tertiary hospitals, whether done in outpatient or inpatient set up regardless of number of days of confinement. However, cataract procedures covered under this package are limited only for intracapsular cataract extraction with insertion of intraocular lens prosthesis; extracapsular cataract removal with insertion of intraocular lens prosthesis like irrigation and aspiration; and, phacoemulsification.
For this, P8,000 is payment for hospital charges for room and board, drugs and medicines used during confinement, x-ray, laboratory and ancillary procedures done during confinement and use of operating room complex and machines. While the other P8,000 goes to professional fee of doctor who performed the procedure.
Excluded in the package are payment for preoperative tests done prior to confinement, professional fee for preoperative consultation and/or physician standby service as well as the anesthesia service, and complex cataract surgery requiring techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage.
In claims filing, in cases where members are required by hospitals to buy drugs, medicines and supplies or required to seek out other necessary services like laboratory procedures from other facilities, reimbursements to members is allowed if the facility cannot provide the necessary items and services covered by the benefit but these have been used during confinement. Members have to submit official documents and/or other purchased documents. Reimbursements however depend on the actual cost of the receipts submitted but not more than the difference between the maximum benefit and the facility reimbursement
PhilHealth cites 8 Iloilo LGUs for universal coverage
PhilHealth cites 8 Iloilo LGUs for universal coverage
By: Larry T. Tabsing
PhilHealth recognized 8 local government units in the province of Iloilo for enrolling more than the targeted poor families for universal coverage to the National Health Insurance program.
The Municipality of Bingawan topped as the most number of sponsored indigent households of 274% followed by San Enrique (208%) and Mina (203%).Then Concepcion, Barotac Viejo, Banate, Batad and Badiangan. All of their mayors personally received the recognition except for Concepcion and Batad.
There are about 18 LGUs that have enrolled more than the targeted poor families but PhilHealth on this focused on LGU initiated universal enrollments less the provincial and legislative sponsorship.
There are about 90,859 poor families in the Province (based on the 2006 NSCB data net of the 21,204 poor families in Iloilo City). As of December 2008 there were already 70,982 poor families enrolled into the Program (inclusive of the provincial, municipal and legislative enrollment). About 19,877 poor families needs to be enrolled into the program, which is now the target to cover before October 2009.
Regional Vice President Alberto C. Manduriao said that the intention of the Program is to ensure that the poor will have free access to quality health service and make the members and theirs dependents feel they are secured. “In times that someone in the family get sick they are assured that they can get quality health care services in any of the PhilHealth accredited health care facilities and confident that their hospital bill will be taken cared of”, he noted..
Addressing the Local Chief Executives RVP Manduriao stresses, “Through you, their local official, you have given them back their sense of dignity as a human being for they will no longer be afraid or ashamed of entering a hospital if they need medical service”.
Manduriao challenged the health workers asking why PhilHealth member has to go to the hospital when the illness can be prevented and treated in the RHU. “Baka walang tiwala mga tao magpagamot sa RHU dahil siguro, wala lagi si Doc? Wala o kulang ang gamut at mga gamit sa RHU, masungit ang nurse? O baka naman walang health program sa RHU kaya ganun!, he surmised. “We still believe that Health is Good Governance; Health Good Investment and Health is Good Politics”, he stressed.
Under the Sponsored - Indigent Program, in every family a LGU enrolled, PhilHealth pays back P300 as Capitation payment to augment their budget or fund for health services; ensure that indigents are given quality out-patient service in the RHU. The 80% of the Capitation fund to purchase drugs, medicines, medical, laboratory and dental supplies, equipment and even for the repair and renovate your health facility if necessary.
RHU can be accredited under the 3 in 1 scheme - the OPB, MCP and TB-DOTs. PhilHealth is paying an additional P4,500.00 for every normal delivery (member can claim up to 4 normal spontaneous delivery), P1,000.00 for the new-born care package and P4,000 for every treated TB patient.
Infact, the amount due to the different LGUs in Iloilo as Capitation payment is P15.5M , but paid only P1.76M not because it does not have the money but simply because certain Municipal Health Officers and Municipal accountants are not submitting the required monthly Reports and the Capitation utilization report which are pre-requisite to support the release of the remaining P13.8M.
The recognition was done during the Semana sa Iloilo at the Provincial Health sponsored Hospital Operations and Services awards.
By: Larry T. Tabsing
PhilHealth recognized 8 local government units in the province of Iloilo for enrolling more than the targeted poor families for universal coverage to the National Health Insurance program.
The Municipality of Bingawan topped as the most number of sponsored indigent households of 274% followed by San Enrique (208%) and Mina (203%).Then Concepcion, Barotac Viejo, Banate, Batad and Badiangan. All of their mayors personally received the recognition except for Concepcion and Batad.
There are about 18 LGUs that have enrolled more than the targeted poor families but PhilHealth on this focused on LGU initiated universal enrollments less the provincial and legislative sponsorship.
There are about 90,859 poor families in the Province (based on the 2006 NSCB data net of the 21,204 poor families in Iloilo City). As of December 2008 there were already 70,982 poor families enrolled into the Program (inclusive of the provincial, municipal and legislative enrollment). About 19,877 poor families needs to be enrolled into the program, which is now the target to cover before October 2009.
Regional Vice President Alberto C. Manduriao said that the intention of the Program is to ensure that the poor will have free access to quality health service and make the members and theirs dependents feel they are secured. “In times that someone in the family get sick they are assured that they can get quality health care services in any of the PhilHealth accredited health care facilities and confident that their hospital bill will be taken cared of”, he noted..
Addressing the Local Chief Executives RVP Manduriao stresses, “Through you, their local official, you have given them back their sense of dignity as a human being for they will no longer be afraid or ashamed of entering a hospital if they need medical service”.
Manduriao challenged the health workers asking why PhilHealth member has to go to the hospital when the illness can be prevented and treated in the RHU. “Baka walang tiwala mga tao magpagamot sa RHU dahil siguro, wala lagi si Doc? Wala o kulang ang gamut at mga gamit sa RHU, masungit ang nurse? O baka naman walang health program sa RHU kaya ganun!, he surmised. “We still believe that Health is Good Governance; Health Good Investment and Health is Good Politics”, he stressed.
Under the Sponsored - Indigent Program, in every family a LGU enrolled, PhilHealth pays back P300 as Capitation payment to augment their budget or fund for health services; ensure that indigents are given quality out-patient service in the RHU. The 80% of the Capitation fund to purchase drugs, medicines, medical, laboratory and dental supplies, equipment and even for the repair and renovate your health facility if necessary.
RHU can be accredited under the 3 in 1 scheme - the OPB, MCP and TB-DOTs. PhilHealth is paying an additional P4,500.00 for every normal delivery (member can claim up to 4 normal spontaneous delivery), P1,000.00 for the new-born care package and P4,000 for every treated TB patient.
Infact, the amount due to the different LGUs in Iloilo as Capitation payment is P15.5M , but paid only P1.76M not because it does not have the money but simply because certain Municipal Health Officers and Municipal accountants are not submitting the required monthly Reports and the Capitation utilization report which are pre-requisite to support the release of the remaining P13.8M.
The recognition was done during the Semana sa Iloilo at the Provincial Health sponsored Hospital Operations and Services awards.
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