GOVERNMENT auditors have aired concern over the P54.47 million lost income of the National Kidney and Transplant Institute (NKTI) which represents denied and return to hospital (RTH) claims for reimbursements it filed with the Philippine Health Insurance Corporation (PhilHealth) in 2021.
The uncollected sum represented 381 claims that were denied outright amounting to P4.154 million, and 9,499 RTH claims totaling P50.317 million. These were filed from January to December 31, 2021.
Auditors said the state-owned tertiary hospital failed to comply with the requirement for documentary support when it filed the claims as provided under the Implementing Rules and Regulations (IRR) of RA 7874 or the National Health Insurance Act of 2013.
“Reimbursement claims from PhilHealth were denied due to the failure of the Institute to fully comply with the required documentation and conditions … thus resulting in the accumulation of uncollectible accounts from PhilHealth and loss of income (to NKTI),” the Commission on Audit said in a report released last June 1.
Among the top reasons cited by the PhilHealth for denying reimbursements were non-observance of the 60-day deadline for filing of claims, inconsistent data where members are erroneously listed as dependents, confinement of patient for less than 24-hours, the attending physician is not PhilHealth accredited, and the claim forms were improperly accomplished.
“The probability of non-collection of claims might mead to possible income loss thus depriving the NKTI of earnings,” the audit team said.
It recommended that the NKTI management remind its Billings and Claims Division to “strictly adhere to the guidelines,” including meeting submission deadlines and attaching all the required documentation.
The NKTI said it has re-filed the RTH claims and appealed to PhilHealth to reconsider withholding the reimbursements.
The hospital’s 2021 financial statements showed service and business income grew by P757 million year on year to P2.913 billion from P2.155 billion in 2020.
This was on the back of a P679 million increase in Net Hospital Fees and another P99.34 million from miscellaneous income.
However, the figure was still lower compared to the pre-pandemic service and business income of the NKTI of P3.093 billion posted as of yearend 2019.
