14 September 2012
PHILIPPINE
HEALTH INSURANCE CORPORATION
17th
Flr., City State Centre Bldg.,
Shaw Blvd., Pasig
City
SUBJECT :
Performance Commitment
Sir/Madam:
To guarantee
our commitment to the National Health Insurance Program (“NHIP”), we
respectfully submit this Performance Commitment.
And for
the purposes of this Performance Commitment, we hereby warrant the following
representations:
1.
That we are a duly
registered/licensed/certified health care facility capable of delivering the
services expected from the type of healthcare provider that we are applying
for.
2.
That we are owned by __________________________________________________________
and managed by _______________________________________________________________
and doing business under the name of ______________________________________________
with License/Certificate No. _____________________ .
3.
That all professional health care
providers in our facility have proper credentials and given appropriate
privileges in accordance with our policies and procedures.
4.
That our officers, employees,
and other personnel are members in good standing of the NHIP.
Further,
we hereby commit ourselves to the following:
5.
That, as responsible owner(s) and/or manager(s) of
the institution, after being afforded the opportunity to be
heard in a full blown hearing, we shall be jointly and
severally liable for all violations committed against the provisions of Rep. Act
No. 7875 including its Implementing
Rules and Regulations (IRR) and PhilHealth policies issued pursuant thereto.
6.
That we shall promptly inform
PhilHealth prior to any change in the ownership and/or management of our
institution.
7.
That any change in ownership
and/or management of our institution shall not operate to exempt the previous and/or present
owner and/or manager from
liabilities for violations of Rep. Act No. 7875 and its IRR.
8.
That we shall maintain active
membership in the NHIP as an employer not only during the entire validity of
our participation in the NHIP as an
Institutional HealthCare Provider (“IHCP”) but also during the corporate
existence of our institution.
9.
That we shall abide with all fair and humane implementing rules and
regulations, memorandum circulars, office orders, special orders, and other
administrative issuances by PhilHealth affecting us.
10.
That we shall abide with all fair and humane administrative orders,
circulars and such other policies, rules and regulations issued by the
Department of Health and all other related government agencies and
instrumentalities governing the operations of IHCPs in participating in the NHIP.
11.
That, to that
extent that we are financially are capable, we shall adhere to pertinent statutory laws
affecting the operations of IHCPs including but not limited to the Expanded
Senior Citizens Act of 2003 (R.A. 9257), the Breastfeeding Act (R.A. 7600), the
Newborn Screening Act (R.A. 9288), the Cheaper Medicines Act (R.A. 9502), the
Pharmacy Law (R.A. 5921), the Magna Carta for Disabled Persons (R.A. 9442), and
all other laws, rules and regulations that may hereafter be passed by the
Congress of the Philippines or any other authorized instrumentalities of the government.
12.
That we shall promptly submit
reports as may be reasonably required
by PhilHealth, DOH and all other government agencies and instrumentalities
governing the operations of IHCPs.
13.
That we are duly capable of delivering
the following services for the duration of the validity of this commitment (please check appropriate boxes):
c Level 1 hospital services
c Level 2 hospital services
c Level 3 hospital services
c Level 4 hospital services
c Specialized services
o Radiotherapy
o Hemodialysis/Peritoneal Dialysis
o Others (please specify) ___________________________________
______________________________________________________
c Benefit package and other services
o Tuberculosis Directly Observed Treatment System (TB DOTS)
o Maternity Care Package
o Newborn Care Package
o Malaria Package
o Primary Care Benefit Package 1 (For government hospitals only)
o Outpatient HIV/AIDS Package (for DOH identified hospitals only)
o Animal Bite Package
o Others(please specify)____________________________________
______________________________________________________
14.
That, to the
extent that we are financially capable, and insofar as supplies are available, we shall provide and
charge to the PhilHealth benefit of the client the necessary services including
but not limited to drugs, medicines, supplies, devices, and diagnostic and
treatment procedures for our PhilHealth clients.
15.
That we, to the extent that we are financially capable, and insofar as
supplies are available, being engaged government/MCP
facility, shall provide the necessary drugs, supplies and services with no
out-of-pocket expenses on the part of the sponsored member in the NBB bed/all
types of members in the MCP provider as mandated by the PhilHealth’s ‘No
Balance Billing’ (NBB) Policy.
16.
That we shall maintain a high
level of service satisfaction among PhilHealth clients including all their
qualified dependents/beneficiaries.
17.
That we shall be guided by PhilHealth-approved
clinical practice guidelines or if not available, other established and accepted
standards of practice.
18.
That we shall provide a
PhilHealth Bulletin Board for the posting of updated information of the NHIP
(circulars, memoranda, IEC materials, price reference index, etc.) in
conspicuous places accessible to patients, members and dependents of the NHIP
within our healthcare facility.
19.
That we shall always make
available the necessary forms for PhilHealth member-patient’s use.
20.
That we shall treat PhilHealth
member-patient with utmost courtesy and respect, assist them in availing PhilHealth
benefits and provide them with accurate information on PhilHealth policies and
guidelines.
21.
That we shall ensure that
PhilHealth member-patient with needs beyond our service capability are referred
to appropriate PhilHealth-accredited health care facilities.
22.
That we shall maintain a registry of all
our PhilHealth members-patients (including newborns) and a database of all
claims filed containing actual charges (board, drugs, labs, auxiliary, services
and professional fees), actual amount deducted by the facility as PhilHealth reimbursement
and actual PhilHealth reimbursement, which shall be made available, upon request and within a reasonable time, to
PhilHealth or any of its authorized personnel.
23.
That we shall maintain and submit to
PhilHealth an electronic registry, if the system is
accessible and affordable, of physicians including their fields of
practice, official e-mail and mobile phone numbers.
24.
That we shall, if connected with
e-claims and if
the system is accessible and affordable,, electronically encode the drugs and supplies
used in the care of the patient in our information system which shall be made
available for PhilHealth use.
25.
That we shall ensure that true
and accurate data are encoded in all patients’ records.
26.
That we shall only file true
and legitimate claims recognizing the period of filing the same after the
patient’s discharge as prescribed in PhilHealth circulars.
27.
That we shall submit claims in
the format required by PhilHealth for our facility.
28.
That we shall regularly submit
PhilHealth monitoring reports as required in PhilHealth circulars and the
PhilHealth Benchbook.
29.
That we shall annually submit
to PhilHealth a copy of our audited financial statement/report, Provided, that the financial statement or report shall not be used
by Philhealth for any other purpose/s other than for purpose/s of the NHIP ;
30.
That we shall extend full
cooperation with duly recognized authorities of PhilHealth and any other
authorized personnel and instrumentalities to provide access to patient records
and submit to any orderly assessment conducted by PhilHealth relative to any
findings, adverse reports, pattern of utilization and/or any other acts
indicative of any illegal, irregular and/or unethical practices in our
operations as an accredited IHCP of the NHIP that may be prejudicial or tends
to undermine the NHIP and make available, when properly requested, all pertinent official records
and documents including the provision of copies thereof; Provided that our rights to private ownership, respect and privacy are observed at all times.
31.
That we shall ensure that our
officers, employees and personnel extend full cooperation and due courtesy to
all PhilHealth officers, employees and staff during the conduct of assessment/visitation/investigation/monitoring
of our operations as an accredited IHCP of the NHIP.
32.
That at any time during the
period of our participation in the NHIP, upon request of PhilHealth, we shall, insofar as the contents are fair and acceptable, voluntarily and unconditionally sign and execute a new
‘Performance Commitment’ to cover the remaining portion of our engagement or to
renew our participation with the NHIP as the case may be, as a sign of our good
faith and continuous commitment to support the NHIP.
33.
That, except for
obviously unintentional error/s in the entries, we shall take full responsibility for any palpable
glaring inaccuracies and/or falsities entered
into and/or reflected in our patients’ records as well as any intentional and malicious omission, addition,
inaccuracies and/or falsities entered into and/or reflected in the claims
submitted to PhilHealth by our institution.
34.
That, insofar
as consistent with fair play, we shall comply with PhilHealth’s summons, subpoena,
subpoena ‘duces tecum’ and other legal or quality assurance processes and
requirements.
35.
That we shall recognize the
authority of PhilHealth, its Officers and personnel and/or its duly authorized
representatives to conduct regular surveys, domiciliary visits, and/or conduct
administrative assessments at any
reasonable time relative to the exercise of our privilege and conduct of our
operations as an accredited IHCP of the NHIP, Provided
that the Philhealth’s visits, assessments and surveys shall not result to undue
disruption nor interfere with the regular operation of the hospital, and
Provided further that the Philhealth’s personnel shall always observe our right
to privacy, respect and right of ownership.
36.
That we shall comply with
PhilHealth corrective actions given after monitoring activities within the
prescribed period.
37.
That we shall protect the NHIP
against abuse, violation and/or over-utilization of its funds and we shall not
allow our institution to be a party to any act, scheme, plan, or contract that
may directly or indirectly be prejudicial or detrimental to the NHIP.
38.
That we shall not directly or
indirectly engage in any form of unethical or improper practices as an
accredited health care provider such as but not limited to solicitation of
patients for purposes of compensability under the NHIP, the purpose and/or the
end consideration of which tends unnecessary financial gain rather than
promotion of the NHIP.
39.
That we shall immediately
report to PhilHealth, its Officers and/or to any of its personnel, any act of
illegal, improper and/or unethical practices of IHCP and any
Philhealth representative in the implementation of the
NHIP that may have come to our knowledge directly or indirectly.
40.
That we shall allow PhilHealth
to deduct from our future claims, all reimbursements paid to our institution
during the period of its non-accredited status as a result of a gap in validity
of our DOH license, suspension of accreditation, etc; downgrading of level,
loss of license for certain services including any and all other fees due to be
paid to PhilHealth, Provided that deductions shall not be
made in cases of suspensions that are
still under appeal to appropriate tribunals until the finality of decision.
Furthermore, recognizing and respecting its indispensable role in
the NHIP, we hereby acknowledge the power and authority of PhilHealth to do the
following:
41.
After being
afforded due process and after due a full blown hearing and in accordance with
the pertinent provisions of R.A. 7875 and its IRR, to suspend, shorten,
pre-terminate and/or revoke our privilege of participating in the NHIP
including the appurtenant benefits and opportunities at any time during the
validity of the commitment for any violation of any provision of this Performance
Commitment and of R.A. 7875 and its IRR.
42.
After being
afforded due process and after due a full blown hearing and in accordance with
the pertinent provisions of R.A. 7875 and its IRR, to suspend, shorten,
pre-terminate and/or revoke our accreditation including the appurtenant
benefits and opportunities incident thereto at any time during the term of the
commitment due to verified, adverse complaint or reports/findings of pattern or any other similar incidents which
may be indicative of any illegal, irregular or improper and/or unethical
conduct of our operations.
We
commit to extend our full support in sharing PhilHealth’s vision in achieving
this noble objective of providing accessible quality health insurance coverage
for all Filipinos.
Very truly
yours,
Local Chief Executive
(If LGU owned/Owner)
|
Head of Facility/Medical Director/Manager
|
From the desk of the President
PHA
Memorandum Circular No. 2012-03-B
Issued
Augusts 1, 2012
TO:
ALL PHA PROVINCIAL & CITY CHAPTERS
PHA
AND PHAPi MEMBERS
RE:
Phihealth Circular No. 13 (Performance Commitment):
Extension
of Deadline For Compliance By Hospitals
G
R E E T I N G S :
Please
be informed that yesterday, July 31, 2012, Dr. Eduardo Banzon (through Dr.
Francisco Soria) has sent advisory to all PHIC Regional Vice-Presidents
extending the deadline for compliance by hospitals with PHIC Circular No. 13
(Performance Commitment) to September 30, 2012 pending resolution of issues and
serious concerns by hospitals.
Likewise,
in anticipation of other circulars by Philhealth, kindly send by email to the
PHA and PHAPi secretariat the complete name and address, name of officers and
bank signatories of your respective provincial and city chapters for purposes
of opening a “bank account in trust” for your respective provincial chapter or
city chapter. This is for certification purposes by the Philippine Hospital
Association that your respective chapters indeed are under the Philippine
Hospital Association (PHA) and the Private Hospitals Association of the
Philippines (PHAPi). This is to anticipate a move by Philhealth to implement a
“pre-payment” scheme/s for the case rate/case mix and NBB cases. Please email
us to:
(1) secretariat@pha.ph
(for PHA) (cc: legalmed@yahoo.com)
(2)
eulama@yahoo.com
(for PHAPi) (cc:
legalmed@yahoo.com)
All
PHA Regional Councils and Provincial & City Chapters are hereby directed to
disseminate this circular to all PHA members under their respective area of
responsibilities.
For
your guidance. Thank you.
DR.
BU C. CASTRO
P
r e s i d e n t
Philippine
Hospital Association
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