independent

Sunday 20 April 2014

Hospitals being forced to take photos of patients in bed for insurers

Doctor and nurse examining patient in hospital room
File photo

HOSPITALS are being forced to take photographs of patients to prove they are being treated in a bed in order to get paid by health insurance companies.

Insurers are increasingly looking for hard evidence to show if a patient was left on a chair or a bed when waiting to see a doctor.

The payments to a hospital can differ by hundreds of euro depending on where the sick person is treated.

Thomas Byrne, chief financial officer of the Health Service Executive (HSE), said insurers were increasingly testing bills.

He revealed that insurance companies -- which owe public hospitals €146m -- were calling patients individually to double-check if they were given a bed.

Mr Byrne -- who was recruited from the private sector to overhaul the finances of the HSE -- said he had made debt collection a major priority and had a team of staff working on obtaining the money faster.

Mr Byrne had been told by a certain hospital that they "must take a photo of a patient being treated in a bed rather than on a chair" in order to back up their claim for a higher payment.

The insurance companies -- which have lost thousands of customers in recent years -- are increasingly dragging their heels on paying bills to the public hospitals unless they are supplied with a significant paper trail to detail exactly what treatment the patient received.

OVERSPENT

News of the €146m owed to hospitals comes at a time when Health Minister James Reilly has had to return with the begging bowl to the Committee on Health to get a €199m bailout for the HSE, which overspent again in 2013.

Insurance companies are also refusing to pay for orthopaedic procedures unless there are accompanying medical report.

Although busy consultants were previously the main culprits for hospital delays in getting paid, they have now improved their performance and it is increasingly insurers that are slowing up the process.

In some cases, hospital staff have no direct point of contact with the insurance companies.

Mr Byrne told the committee he had been told by hospital staff that they are confined to asking questions on three claims per phone call and have to ring again in order to submit more queries, a practice that was described as "preposterous and bizarre" by committee chairman Jerry Buttimer.

Asked to comment, a spokesman for the VHI, the country's largest health insurer, said: "We would also like to clarify that in the interests of cost-management, it is absolutely essential that we ascertain the medical necessity of a patient's admission to and ongoing detention in an acute hospital setting.

"This includes the setting in which the patient was treated to ensure that the charges raised by hospitals are appropriate."

Irish Independent

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