20131126 RIC October AR Report A

Download 20131126 RIC October AR Report A

Post on 25-Feb-2018




0 download

Embed Size (px)


<ul><li><p>7/25/2019 20131126 RIC October AR Report A</p><p> 1/4</p><p>Issues and Concerns Reported by CARESOctober, 2013</p><p>Below is an enumeration o important issues and concerns obser!ed by t"e</p><p>CARES deployed in accredited "ospitals durin# October o 2013$ %"is list isbased on submitted reports collated by t"e &amp;'%(CARES$</p><p>Membership</p><p>1$ Retirees w"o are able to complete 120 mont"s o contribution are notaware t"at t"ey can apply to &amp;"il)ealt" or *ietime members"ip</p><p>2$ +&amp;s members allow t"eir relati!es to use t"eir own &amp;"il)ealt" since t"eI- "as no picture$</p><p>3$ Sponsored 'embers complain o t"e wron# inormation encoded in t"eir&amp;.C I- t"ey recei!ed causin# problems durin# bene/t a!ailment</p><p>+$ Employers data, suc" as &amp;E and Employers ame, o some employees"a!e not yet been updated in our database$</p><p>$ I(roup 'embers are unaware t"at t"eir &amp;"il)ealt" members"ip "as a!alidity period$</p><p>$ 'ismatc" data on 'ember -ata Record and &amp;"il)ealt" I- o members4$ *)IOs are !ery strict in scrutini5in# t"e supportin# documents submitted</p><p>by members especially t"ose under t"e Sponsored6Indi#ent &amp;ro#ram$7$ E8pand t"e &amp;"il)ealt" E8press pro#ram not only in malls but to ot"er</p><p>cities and municipalities t"at "a!e "ealt" care acilities so t"at&amp;"il)ealt" is accessible to all9 especially in caterin# to t"e members"ip</p><p>concerns, enrolment and :ueries about bene/ts a!ailment$</p><p>Contributions</p><p>;$ 'embers under t"e Inormal Economy are "a!in# di umaca, ue5on Branc"+A, Bayawan</p><p>City Branc" &amp;RO4</p></li><li><p>7/25/2019 20131126 RIC October AR Report A</p><p> 2/4</p><p>12$ *ate postin# and o!er6under paid contributions in t"e remittancesmade t"ru ACAs$</p><p> SRI -asmarinas Ca!ite, Bayad Center Ca!ite Branc"es</p><p> 'B%C Edsa('a#allanes Branc"</p><p> Ban= o Commerce &gt; CR ort" Branc"</p><p> &amp;ostal Ban= &gt; &amp;RO 1</p><p>Claims/Benefts</p><p>13$ 'embers rom t"e ormal sector oten complain t"at t"ey are not#i!en t"e same priority w"en it comes to a!ailability o medicines in t"e"ospital compare to ot"er members$ 'ost o t"eir medicines andsupplies are bou#"t outside t"e acility$</p><p>1+$ 'embers oten complained o t"e len#t"y processin# o t"eirreimbursement or reunds$</p><p>1$ Increasin# number o Return to )ospital Claims due to e8"austedallowable days or con/nement</p><p>1$ 'ember(patients wit" dual members"ip were able to use bot" "iscate#ory types allowin# "im to "a!e a total o ;0 allowable days orbene/t a!ailment$</p><p>14$ %"e ewborn Screenin# %est is not a!ailed by members because oinsu</p></li><li><p>7/25/2019 20131126 RIC October AR Report A</p><p> 3/4</p><p>Obsere% Pra&amp;ti&amp;e/s Cir&amp;ular/s</p><p>not"in# to amend$</p><p>Re:uirin# t"e submission o certi/cate ocontribution6R1 despite submission o a properlyaccomplis"ed and si#ned C1</p><p>o$ 7, s 2004o$ 0, s(2012</p><p>on(acceptance o &amp;C1 as a substitute or '-R$ o$ 22, s(2012</p><p>on(compliance wit" Senior Citi5en discounts and.A% e8emption</p><p>o$ , s(2012</p><p>ot allowin# outri#"t deduction o ewborn Care&amp;ac=a#e, )emodialysis, C"emot"erapy, andRadiot"erapy and subse:uently re:uirin# direct/llin# o claims$</p><p>o$ 11, s(2011o$ 11B, s(2011</p><p>ot compliance wit" t"e BB &amp;olicy o$ 11, s(2011</p><p>o$ 22, s(2012</p><p>&amp;rescribin# o on(&amp;- medicines o$ 2, s(200;</p><p>on(acceptance o &amp;"il)ealt" I- as a solere:uirement or t"e members bene/t a!ailment</p><p>o$ 0, s(2012</p><p>)ospital as=in# payment or claim orms o$ 12 s$2010</p><p>Imposin# a ceilin# amount6 limit on t"e bene/ts omembers in a!ailin# t"e case rate pac=a#es</p><p>includin# t"e sponsored pro#ram members</p><p>o$ 20, s(2011</p><p>&amp;"il)ealt" Bene/ts deducted are not re@ected in t"e</p><p>Statement o Account #i!en to members upon</p><p>disc"ar#e$</p><p>o$ 22, s(</p><p>2004</p><p>Re:uirin# 'ember -ata Record to +&amp;s member(</p><p>patient e!en i t"e +&amp;s I- is on "and</p><p>o$ 2+, s(</p><p>2012</p><p>Health Care Proi%er #elationsSome standards set ort" by t"e Corporation are not ollowed by "ealt" care</p><p>pro!iders$ %"e ollowin# are obser!ed or e8perienced by CARES on t"isre#ard$</p><p>2+$ )ospitals are still uncertain wit" t"e new IRR, t"ey want us CARES toully e8plain to t"em t"e #uidelines and s"ow circulars beore appro!in#t"e members bene/t a!ailment$</p><p>2$ )ospital re:uirin# ot"er documentary re:uirements to member(patient e!en i &amp;"il)ealt" I- is on "and$</p></li><li><p>7/25/2019 20131126 RIC October AR Report A</p><p> 4/4</p><p>2$ A sur#eon is as=in# indi#ent patients to deposit beore any operationis done$</p><p>24$ I)C&amp; &amp;ortal in some "ospitals are not unctionin# and appears to "a!ein!alid account$WHICH HOSPITALS Siruma Muni&amp;ipal Hospital</p><p>27$ Cler=s are not aware t"at ewborn Care &amp;ac=a#e can still be a!ailed</p><p>to newborns born as t"</p><p>c"ild$2;$ Some doctors are not cooperati!e wit" t"e "ospital claims processor9t"ey do not accomplis" t"e C3 properly and on time</p><p>30$ %"e "ospital does not "a!e its own p"armacy$ Clients are orced tobuy medicines outside t"e "ospital$</p><p>31$ )ospitals as= payment or t"e second Claim orm 1 once t"eycommitted error on t"e /rst /ll up$</p><p>32$ )ospitals do not reimbursed receipts rom t"e out o t"e pac=a#ee8penses o members e!en t"ou#" t"e ull case rate amount is not yete8"austed$</p><p>33$ -urin# t"e days were t"e CARES is not present in t"e )ospital</p><p>Sundays, "ospital are not acceptin# supportin# documentaryre:uirements or a!ailment and ad!ise members to directly /le t"eirclaims$</p><p>3+$ )ospital cler=s assi#ned in t"e &amp;"il)ealt" Section do not #i!e uniorminormation to clients and most o t"e time t"is lead to clientFs conusion$%"ose w"o attended t"e trainin# or seminars do not disseminate t"e newpolicies to t"eir collea#ues$</p><p>3$ %"e "ospitalFs &amp;"il)ealt" sta&lt; lac= o coordination wit" one anot"er$%"eir speci/c tas=s arenFt well de/ned$ %"eses predicaments resulted inR%)6R%S claims and ine</p></li></ul>