PhilHealth defends IRM to hospitals

CEBU, Philippines —  The Philippine Health Insurance Corporation (PhilHealth) has dispelled allegations of corruption in the grant of interim reimbursement mechanism (IRM) to help health facilities with the financial requirements in the fight against coronavirus disease (COVID-19).

 The IRM is an emergency cash advance measure applied by PhilHealth to provide hospitals with an emergency fund to respond to unanticipated events like natural disaster and calamities.

“Extraordinary times need extraordinary measures,” said PhilHealth President and CEO Ricardo C. Morales.

 PhilHealth earlier announced that it is in the process of evaluating a second wave of IRM to high Covid-19 concentration areas, including Central Visayas, where bed capacity has either reached full or in critical levels resulting from the easing of quarantine levels.

PhilHealth clarified that IRM releases are based on the historical claims of hospitals, and undergo a process of application, evaluation, validation and recommendation at the level of the PhilHealth Regional Offices, and approval at its head office.

“All transactions on IRM are aboveboard and within the guidelines set by the Corporation,” Philhealth said in a statement released by its Visayas office.

  Philhealth said that the IRM is strictly subject to the usual stringent government accounting and auditing rules, and requires reconciliation and liquidation contrary to reports that hospitals are not required to liquidate their advances.

 “Liquidation is definitely a must but since we are in unusual times, we made the timing of liquidation flexible with such options left to the good judgment of the regions given the situations that hospitals are in,” Morales said.

 Philhealth also belied reports that its Senior Vice President for Fund Management Sector Renato Limsiaco Jr. favored certain hospitals or has quickly released the IRM in record time, clarifying that Limsiaco’s authority is limited to vetting the release of funds only in terms of completeness of documents, and not in determining which hospitals will be given the fund.

  Having been able to release some P15 billion to 711 facilities of late also disproves unfounded claims that he abandoned his post during the Enhanced Community Quarantine where he was stranded by the lockdown in his hometown in Region VIII.

 PhilHealth reiterated that early in the pandemic with no pattern of geographical distribution of cases still identified, the IRM funds was offered to all healthcare facilities including lying in centers and dialysis clinics to ensure unhampered health services to all Filipinos. It necessitated funds even in facilities with pending cases as long as they were licensed by the DOH.

“This is not to say that they will no longer be penalized once proven guilty of any infraction of rules and policies. The whole point here is to ensure that we are able to help in making sure that as many facilities are open and able to serve patients,” Morales added.

 In late May 2020, PhilHealth revised its strategy in IRM releases by scaling down releases only to areas with high concentration of COVID-19 and the presence of government facilities directly handling patients.

 The pivot was to ensure that sufficient funds are available for all citizens needing healthcare as well as provide sufficient support to the country’s expanded targeted testing strategy against the pandemic.

Morales explained that the pandemic is not yet over and it is premature to conclude that these hospitals will not be treating infected patients in the weeks or months to come.

 “Remember that we have to contain yet the transmission. With LSIs returning home en masse, a spike in cases is still a very real possibility,” Morales said.

 Philhealth also explained that its partnership with the Philippine Red Cross is pursuant to the Bayanihan We Heal As One Act, and in compliance to the call of the Office of the Executive Secretary addressed to government heads in late March to partner with PRC “as the primary humanitarian agency that is auxiliary to the government in giving aid to the people, subject to reimbursement, in the distribution of goods and services incidental in the fight against COVID-19.”

 Under the partnership, PhilHealth will prospectively pay PRC for its testing services only for this occasion.

 Philhealth said that the advance financing arrangement with PRC is consistent with the Universal Health Care Act that authorizes PhilHealth to paying providers using performance-driven, close-end, prospective payments.

 The engagement is but one of the many activities being pursued by the state health insurer to mitigate, if not contain, the transmission of Covid-19, to prevent the overburdening of the healthcare system, and to ensure that there is sufficient, adequate and readily available funding for these initiatives.

“We are always on the lookout for developments in the field. We do not have a complete picture yet of the true behavior of this contagion so it is incumbent upon PhilHealth to be agile and swift in decisions to be more responsive to population areas needing support,” Morales further said. FPL (FREEMAN)