A BILL extending the filing period for hospital reimbursement claims with the Philippine Health Insurance Corp. (PhilHealth) was filed at the House of Representatives last week.
Filed by Cagayan de Oro Rep. Rufus B. Rodriguez on Feb. 4, House Bill (HB) No. 11410 seeks to extend the deadline of the filing period for hospitals to 120 days from the current 60 days to reduce the amount of denied reimbursement claims.
It also allows PhilHealth to extend the claiming period for “reasonable causes.”
“This bill seeks to address the issue of the 60-day filing period of claims with PhilHealth, which proves to be unreasonable and debilitating to the healthcare industry,” Mr. Rodriguez said in the bill’s explanatory note.
“The intent behind this flexibility is to ensure that health facilities are fairly compensated for the services they render, even when delays in claim submission occur due to circumstances beyond their control,” he added.
Philippine hospitals file reimbursement claims to PhilHealth for the accrued costs of medical services provided to Filipinos, which is then deliberated by the state health insurer to determine its validity for compensation.
Processed claims which PhilHealth finds worthy of repayment are tagged as a “good claim,” according to a 2021 PhilHealth memorandum; while reimbursement requests seen as “deficient” are categorized into return-to-hospital (RTH) and denied claims.
Most denied PhilHealth claims are due to the 60-day deadline limit for the filing of reimbursement requests, Health department spokesman Albert Francis E. Domingo told lawmakers in a House hearing in January. — Kenneth Christiane L. Basilio
