Wednesday, May 27, 2009
Monday, May 25, 2009
Thursday, May 21, 2009
PHILHEALTH BENEFIT PACKAGES
A SEPARATE transmittal soon to be required to Health Care Providers (HCP) in filing PhilHealth Packages apart from the regular claims to hasten the turn around time of processing.
PhilHealth Regional Office (PhRO) VI issued an Advisory to take effect on June 1, 2009. It also directed that Professional Fee (PF) whether actual, deducted or net should be included in the Statement of Account or Billing Statement to ensure that reimbursements are provided to the rightful beneficiary for the PF. This shall be added prior to the signature of the member or the authorized representative confirming or concurring thereto.
PhilHealth Packages are derived from Maternity Care - Normal Spontaneous Delivery (MCP-NSD), Newborn Care (NCP), Voluntary Surgical Contraception Procedures, TB-DOTS, and Cataract claims. Other benefit packages are Outpatient Malaria, Severe Acute Respiratory Syndrome (SARS), Avian Influenza (Bird Flu) and Swine (H1N1) Flu.
Payments under the schemes are generally made to the accredited health care providers, facilities and professionals, for the supposed complete services to PhilHealth beneficiaries.
MCP covers 1st to 4th normal spontaneous deliveries both in hospital and non-hospital maternity facilities for a case rate of P4,500. (Non-hospital facility: P3250 for pre- natal, delivery & newborn care +P850 for post-natal and family planning. For hospital - P2,500 for room and board, drugs and medicines, diagnostic and OR fee; P2,000 for health care professional).
NCP rate is P1,000 which covers the newborn screening (P500), 1st dose of Hepa B (P250) and vaccination, BCG and others (P250).
TB-DOTS Package on the other hand, has a case payment of P4,000. Of which, P2,500 is paid after the intensive phase and P1,500 is given after the maintenance phase under eligibility criteria that the TB case is new or the patient neither had a treatment for TB nor has taken up TB drugs for less than one month; it has smear positive or negative pulmonary TB or extrapulmonary TB; and TB of children. Excluded to the package are cases of failure on previous treatment, relapse or return after default.
Cataract Package case rate is P16,000 - P8,000 for charges on room, drugs, meds, supplies including intraocular lens, x-ray, laboratory & ancillary procedures and use of OR complex and machines while the other P8,000 is paid to the doctor. Pre-operative tests done prior the confinement, consultation and physician standby service, PF for anesthesia service and complex cataract surgery (RVS code 66982) requiring techniques not generally used in routine cataract surgery or performed in amblyogenic developmental stage are excluded.
Voluntary Surgical Contraception Procedures, Bilateral Tubal Ligation (BTL) and Vasectomy has a case payment of P4,000. The component of which is P3,000 for the facility services and P1,000 for physician to cover family planning counseling and client assessment, intraoperative service services including provision of anesthesia and postoperative consultation procedures including management of complications.
PhilHealth Regional Office (PhRO) VI issued an Advisory to take effect on June 1, 2009. It also directed that Professional Fee (PF) whether actual, deducted or net should be included in the Statement of Account or Billing Statement to ensure that reimbursements are provided to the rightful beneficiary for the PF. This shall be added prior to the signature of the member or the authorized representative confirming or concurring thereto.
PhilHealth Packages are derived from Maternity Care - Normal Spontaneous Delivery (MCP-NSD), Newborn Care (NCP), Voluntary Surgical Contraception Procedures, TB-DOTS, and Cataract claims. Other benefit packages are Outpatient Malaria, Severe Acute Respiratory Syndrome (SARS), Avian Influenza (Bird Flu) and Swine (H1N1) Flu.
Payments under the schemes are generally made to the accredited health care providers, facilities and professionals, for the supposed complete services to PhilHealth beneficiaries.
MCP covers 1st to 4th normal spontaneous deliveries both in hospital and non-hospital maternity facilities for a case rate of P4,500. (Non-hospital facility: P3250 for pre- natal, delivery & newborn care +P850 for post-natal and family planning. For hospital - P2,500 for room and board, drugs and medicines, diagnostic and OR fee; P2,000 for health care professional).
NCP rate is P1,000 which covers the newborn screening (P500), 1st dose of Hepa B (P250) and vaccination, BCG and others (P250).
TB-DOTS Package on the other hand, has a case payment of P4,000. Of which, P2,500 is paid after the intensive phase and P1,500 is given after the maintenance phase under eligibility criteria that the TB case is new or the patient neither had a treatment for TB nor has taken up TB drugs for less than one month; it has smear positive or negative pulmonary TB or extrapulmonary TB; and TB of children. Excluded to the package are cases of failure on previous treatment, relapse or return after default.
Cataract Package case rate is P16,000 - P8,000 for charges on room, drugs, meds, supplies including intraocular lens, x-ray, laboratory & ancillary procedures and use of OR complex and machines while the other P8,000 is paid to the doctor. Pre-operative tests done prior the confinement, consultation and physician standby service, PF for anesthesia service and complex cataract surgery (RVS code 66982) requiring techniques not generally used in routine cataract surgery or performed in amblyogenic developmental stage are excluded.
Voluntary Surgical Contraception Procedures, Bilateral Tubal Ligation (BTL) and Vasectomy has a case payment of P4,000. The component of which is P3,000 for the facility services and P1,000 for physician to cover family planning counseling and client assessment, intraoperative service services including provision of anesthesia and postoperative consultation procedures including management of complications.
Thursday, May 7, 2009
Wednesday, May 6, 2009
Monday, May 4, 2009
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