Consultants' failure to sign off on claims is costing HSE €76 million

THE HEALTH Service Executive (HSE) has not been able to recoup more than €770,000 due from health insurance companies in respect of private patients treated because of delays by one consultant in signing off claims forms.

Under current rules, health insurance companies will not reimburse hospitals for the accommodation costs of private patients treated in their facilities until consultants sign the overall claims, including the provision of clinical data on the treatment.

The HSE has told the Department of Health it is owed about €160 million in private charges by health insurance companies. In a report submitted to the department, it says the payment of about €76 million from health insurance companies is awaiting action by hospital consultants. The payment of just under €12 million is awaiting the completion of claims by hospitals.

The report says that full claims worth a total of over €40 million have been submitted to insurers. Separately, claims to the value of €19 million are being queried by the companies.

The HSE report given to the Department of Health in recent weeks says that in the HSE West, over €4.5 million due to hospitals in the region is outstanding as a result of delays in action by 10 hospital consultants. It says the bulk of this sum – over €3 million – is outstanding, while action in respect of the claims is awaited by consultants at the regional hospital in Limerick. It says payment of €705,367 from health insurance companies is awaiting sign-off by one consultant while payments of €617,859, €553,116, €451,607 and €438,802 respectively are awaiting action by other senior doctors.

The highest amount outstanding in payments due from insurance companies is €774,620 at the Mercy Hospital in Cork which is awaiting sign-off from one consultant. Overall in the HSE South the payment of €2.8 million from health insurance companies is awaiting action from 10 hospital consultants.

The HSE report reveals that it is asking the Government to change the rules to allow it to recoup money owed more quickly following the discharge of private patients from its facilities.

It told the Department of Health that its plans to collect private health insurance income could be achieved in two ways: “Redesign the claims’ process to allow the hospital to immediately send its accommodation bill to the insurer without clinical data and consultant sign-off. HSE has requested insurers to accept billing direct by the hospital of the accommodation charge independently of the need for consultant sign-off of the overall claim. Each of the three insurers has refused to comply with this approach. This matter is being taken up with the Department of Health and Children. HSE is requesting a change in the regulatory environment to ensure prompt payment of monies owed to it post discharge.

“Hospitals are putting increased focus and effort on the collection of debt through the current process. While it is accepted that the process of completing the total claim including the sign-off by consultant is onerous, we cannot stand over current practice and must improve.”

The Irish Hospital Consultants Association said the administration in many hospitals could do more to streamline the process of making claims using a system similar to that in operation at St James’s Hospital in Dublin.