The failure of some consultants to fill in the forms required by private health insurers is being given as the reason why funding to the health service has been delayed
The Government has said that around €73 million in payments due to the health service from health insurers is outstanding because hospital consultants have delayed in signing the appropriate forms.
However the Government has argued that, as a result of new initiatives, the amounts due will fall significantly over the coming year.
Delays in public hospitals securing payment from insurance companies as a result of consultants not signing forms has been an issue of controversy for some time but it has been brought into sharper focus in recent weeks on foot of the cuts in front-line services introduced by the HSE.
Confidential figures produced by the HSE for the recent talks on work-practice reforms for senior doctors showed that in March there was over €11 million in outstanding claims at the Mid Western Regional Hospital in Limerick awaiting “consultant action”.
The management document, seen by The Irish Times, said this included the requirement for the consultant to sign the appropriate forms. It said over €1 million was outstanding while action was awaited from one consultant.
The report said that at Galway University Hospitals nearly €6 million was outstanding from insurance companies awaiting “consultant action”.
The figure for Cork University Hospital is €4.122 million and at Tallaght Hospital the amount outstanding is over €3.4 million.
In a topical issues debate in the Dáil last Thursday the Minister of State at the Department of Education Ciaran Cannon (speaking on behalf of the Minister for Health James Reilly) said that, as of the end of September, €204 million was due to the HSE from private health insurance companies in respect of treatment of private patients.
He said that of this €204 million, €100 million related to claims under preparation in hospitals, and €104 million related to claims submitted to insurers which were either being processed or are pending.
“Delays in consultants signing off on health insurance forms is one of the issues affecting the claims collation process in public hospitals. Of the €100 million under preparation in hospitals, €73 million relates to delays in consultant sign-off.”
Mr Cannon said that Dr Reilly had instructed the HSE “to address the issue as a matter of urgency”.
He said the HSE had directed hospitals to bring down the value of claims awaiting consultant action. He said hospitals were also targeting the highest value claims.
Mr Cannon also said that moves to deal with this issue had formed part of the proposed agreement between the Government and hospital consultants on work-practice reforms.
“An important feature of the proposals agreed between the parties was a commitment on the part of all consultants to expeditious processing and signing of claims for submission to private health insurers. Consultants will be required to complete and sign private insurance forms within 14 days of receipt of all the relevant documentation and to co-operate with the secondary consultant scheme, whereby a secondary consultant involved in a case can sign the claim form if the primary consultant has not signed it within a reasonable timeframe. “They will also be required to support the implementation of electronic claim preparation.
“Health service management is proceeding with implementation of this and other measures in the coming weeks, having regard to the relevant provisions in the public sector agreement.
“In addition to addressing delays in consultant sign-off, the HSE has also awarded a contract for the phased roll-out of an electronic claims management system in 11 HSE sites. The system will address the many deficiencies of the current paper-based process, will streamline the claims collection process and will ensure standardised work practices are implemented across hospitals. The system is live in six hospital sites with a further three to come on board by mid-November.”
Labour TD Kevin Humphreys, who raised the issue in the Dáil last week said: “Shame on the consultants that the Government had to go to such lengths to ensure the income stream and cashflow of our hospitals were guaranteed. These men and women walk the corridors of the hospitals and see the shortfall in income yet they delayed on signing off on significant sums that would make a substantial difference to the hospitals of the State.”
Mr Cannon said he agreed wholeheartedly that these were significant sums of money that could be expended on front-line services but were “held in abeyance because of a lack of will from certain ranks within the health sector and, perhaps, bureaucratic difficulties associated with the payment process”.
The delays on the part of consultants in signing insurance forms was also criticised by members of the Dáil Public Accounts Committee a fortnight ago.
At that meeting HSE national director of finance Liam Woods said that while most of the amounts outstanding were due for less than six months, the health service had been waiting for more than a year for between €5 million and €8 million.
HSE officials told the Public Accounts Committee that delays in signing the forms meant that consultants themselves did not receive payment from the insurance companies.
However the HSE declined to be drawn into speculating on the motivations on the part of senior doctors in delaying the signing of such forms.
Asked by Fine Gael TD Pascal Donohoe about what lay behind the failure to claim amounts of a significant magnitude, the HSE’s director general-designate Tony O’Brien said, “one could only speculate”.
“Either the individuals are not in need of the income or it suits them to defer that income for whatever reason.
“I am aware of a general provision in the tax code that once one is eligible to issue an invoice, one is also eligible for the tax that arises upon it, regardless of whether one has gained the income. I cannot speak to the individuals who all, no doubt, have different reasons.”
PAPER TRAIL
Midwestern Regional Hospital Dooradoyle has the single highest value of claims awaiting sign-off by primary consultants, with more than €11,125,000 outstanding.
The next four in order are:
* Galway University Hospital at €5,936,838
* Cork University Hospital at €4,122,930
* Waterford Regional Hospital at €3,741,323
* Adelaide Meath Hospital at Tallaght, €3,421,719.m
