PhilHealth coverage for room is only up to discharge order

CEBU, Philippines – PhilHealth reminds accredited hospitals and doctors that coverage for room and board extends only up to the date the attending physician issues the order of discharge.

Under Circular 14, series of 2010, the order of discharge may be in the form of "May go home," "For discharge," or any other similar order written in the doctor's order sheet. In any case, PhilHealth will only reimburse claims for confinement up to the date the patient is ordered discharged. For instance, if the patient is admitted on August 3, 2010 and a "May go home" order is issued on August 6, 2010, the total compensable days of confinement are only three days.

PhilHealth chief for Health Care Delivery Management, Dr. Francis Javier explained that this clarifies matters for health care providers when filing for reimbursement with PhilHealth.

"We pay for the care of sick patients," Dr. Javier said, emphasizing a key aspect of the insurance program of PhilHealth-that of insuring members for illness or injury requiring hospitalization. With the issuance of a discharge order, the attending physician deems that the patient's continued confinement is no longer necessary.

However, onset of complications requiring further management by the health care provider is a valid ground for deferment of a previously issued order of discharge. The patient's clinical chart must substantiate the deferment.

Atty. Gerardo Ortiz, then in his capacity as PhilHealth Legal Office head, said this also clarifies the confusion regarding interpretation of a "May go home" order. This had been interpreted as merely permissive such that hospitals or doctors would seem justified in extending the period of confinement to include the days after the issuance of the discharge order.

The circular now directs health care providers to ensure that the appropriate confinement period is indicated in the claim forms and other supporting documents for reimbursement. Violation of this policy constitutes the offense of extending the period of confinement which is punishable under the implementing rules and regulations of the PhilHealth law.

The legal office of PhilHealth has been closely and regularly monitoring health care providers. Those found to have unnecessarily extended a patient's confinement period will be referred to the legal sector for appropriate action. - /WAB (THE FREEMAN)