Hospitals due €10m as consultants delay claim forms

DELAYS BY 20 hospital consultants in signing claim forms for insurance companies are responsible for holding up the payment of €10 million to public hospitals, new official figures state.

The Health Service Executive (HSE) told the Dáil Public Accounts Committee in a letter published last week that on average there was €485,000 outstanding in relation to each of these 20 senior doctors.

Before they will make such payments in respect of subscribers treated in public hospital facilities, health insurance companies require consultants to submit signed claim forms for processing. For some time now there has been controversy over delays in some consultants signing these claims forms, leading to public hospitals experiencing lengthy delays in receiving payment.

The HSE told the committee that while there had been some improvement last year, more than €70 million was still due for payment from insurance companies in respect of members treated in public hospital facilities as a result of delays in signing claim forms. It said the amount due from insurance companies had stood at €89.1 million at the end of 2010, but there had been an improvement of 21 per cent as a result of a number of initiatives undertaken last year.

Among the measures introduced by the HSE was the linking of approval for new or replacement consultant posts to moves by hospitals to improve their collection of income due from health insurers.

It said applications by hospitals for new or replacement consultant posts which have private practice rights (type B contracts) “must be backed up by a comprehensive plan outlining the hospital’s current income position and a comprehensive plan to achieve the national target of 30 days [in having consultants sign claim forms for insurance companies] if the hospital in question is currently in excess of 30 days”.

The HSE said it had extended to 30 public hospitals a pilot scheme with the VHI allowing a secondary consultant involved in a case to sign a claim form after a defined period of time.

Minister for Health James Reilly has said he is to introduce measures which would allow the HSE to collect bills from insurance companies without having to wait on consultants to sign claim forms – a process known as “decoupling”. However, The Irish Times reported last month the VHI had expressed concern at the proposals to allow for decoupling.

In a letter to the Minister, VHI chairman Bernard Collins said decoupling would not deal with the root cause of the HSE’s cash-flow problems.

He warned decoupling would expose the VHI and, by extension, its customers “to significantly increased costs due to the additional resources that would be required to manage multiple separate claims submissions and to collate invoices in advance of consideration of same”.