PF of Government Salaried Physicians

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)