The amount of money outstanding in private insurance income at the 31st July 2012 is €216m, of which €125m is due to statutory hospitals and €91m to voluntary hospitals.
The HSE and Voluntary hospitals, recoup a considerable amount of income from private insurance companies in return for private and semi-private treatment services provided to patients with private health insurance cover. Lengthy delays can occur between the discharge of patients and the receipt of payment from the health insurance companies. I have emphasised to the HSE the importance of addressing this problem, in conjunction with the insurers, so that the maximum resources possible are available to the health system.
The HSE has introduced a number of initiatives to improve the claims collection process and facilitate faster submission of claims which will accelerate income collection within the public hospital system. In particular:
- The HSE has tasked hospitals with bringing down the value of claims awaiting Consultant action and hospitals will also target the highest-value claims.
- The proposals agreed by health service employers and the two consultant representative bodies at the Labour Relations Commission included 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 fully 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 within a reasonable timeframe. They will also be required to support the implementation of electronic claim preparation. Health service management is now proceeding with implementation of this and other measures, having regard to the relevant provisions in the Public Sector Agreement.
- The HSE has also awarded the contract for the roll-out of an electronic claims management system in eleven HSE sites. The system is currently operational in 6 HSE sites and a further 3 sites are expected to be operational by mid-November. This system will address the deficiencies of the current paper based process, will streamline the claims collection process and will also ensure that standardised work practices are implemented across hospitals.
Furthermore, my Department has agreed, in principle, a system of improved cash flow and accelerated payment with private health insurers. This will provide a once-off cash flow benefit in 2012 in the order of €125m. The accelerated payment arrangements are at an advanced stage with the detail of the legal agreements between the HSE and Insurers expected to be finalised very shortly.