The Ministry of Health has referred to as for a overview of the National Health Insurance Act that has scheduled the funds of excellent claims to service suppliers from inside three months to 4 weeks.
This is to allow the ministry to have the ability to have a extra handy cost schedule because the 4 weeks required now was quick and liable to challenges.
The Minister of Health, Kwaku Agyeman-Manu, made the decision when he appeared earlier than the Public Accounts Committee (PAC) of Parliament to reply questions with regard to his ministry raised within the 2020 Report of the Auditor-General on Public Accounts of Ghana: Ministries, Departments and Agencies (MDAs) for the Year Ended December 31, 2020.
He was answering questions on the cost of NHIS claims.
“Statutorily we have been working on the three months basis for a very long time and the Health Insurance Act says three months. After the amendment of the Act, the time has changed to four weeks’’.
“Practically, maybe we have to revisit the regulation. From submission of claims to processing and payment can’t be done within four weeks. So we would go and get our work done and come back to you to support us on how the regulation could be amended,” he instructed the committee.
Mr Agyeman-Manu was answering questions from a member of the PAC and Member of Parliament (MP) for Buem, Kofi Adams, who wished to know the present standing of reimbursement of cost to accredited well being establishments, particularly for the 2019 and 2020 interval.
The minister mentioned as of now, the federal government had cleared arrears as much as April 2022 and had seven extra months in arrears for final 12 months however was working to settle the arrears as quickly as doable.
However, his consideration was drawn to the truth that the federal government had 4 weeks to obtain claims, course of and make cost and never three months in accordance with the amended NHI Act.
Responding additional to the grace interval correction, he mentioned the Act earlier than it was amended indicated that cost must be accomplished in three months after receipt and processing.
“Honourable Chair, reimbursement has been done up to April last year and this month we are reimbursing for May last year. So we still have about seven months outstanding.
“And statutorily we have three months for submission of claims, processing and payment and so what will be outstanding as debt effectively will be about four months and we are working on trying to clear it as soon as possible,” he mentioned.
Regulation 38 of the National Health Insurance Regulations requires a declare of cost of well being service submitted to the scheme shall be paid inside 4 weeks after receipt of the claims from the healthcare facility except there may be authorized obstacle.
According to the report, opposite to the above provision, the auditors famous that as of August 31, 2020, the NHIS owed 46 Budget Management Centres (BMCs) GH¢ 20,999,551.10 for companies rendered between June 2019 and August 2020.
The auditors really helpful that the Heads of the BMCs ought to have interaction the CEO, NHIA for reimbursement of the excellent quantity.
With the delay in funds of claims, some well being services final 12 months resorted to co-payment, compelling individuals searching for medical consideration at these services to pay money for some companies, regardless of being on the NHIS.
This prompted the Chief Executive Officer (CEO) of the National Health Insurance Authority (NHIA), Dr Bernard Okoe-Boye, to warning that services engaged in that co-payment association risked dropping their accreditation.
“I am announcing confidently that very soon the accreditation of health facilities which additionally charge active NHIS patients with impunity will be revoked,” he added.
He mentioned it was worrying that some sufferers nonetheless complained about making funds after visiting hospitals, though they have been energetic members of the scheme.
“The NHIA yearly injects GH¢120 million into the well being sector, a median of GH¢1.5 million is paid to every well being facility each month throughout the nation.
“So we are pumping so much into the health sector on a monthly basis and, therefore, we demand that patients who visit the hospitals should be taken care of and not be made to pay for services covered by the NHIS,” he mentioned.
Admitting that there have been typically delays within the cost of claims, Dr Okoe Boye, nonetheless, attributed the delay within the cost of claims partly to the truth that “some of the tariffs are high and unrealistic.”
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