The revised payment arrangement between the HSE and VHI relates to the statutory charge for patients who receive private services in a public hospital. It also reflects recommendations made in the 2013/2014 McLoughlin review of measures to reduce costs in the private health insurance market. As part of that review Mr. McLoughlin facilitated the establishment of a working group on claims processing comprising HSE and the Insurance Ireland Health Insurance Council, representing all health insurers. The agreement announced last week will facilitate timely claim processing for the benefit of HSE and insurers alike.
The following information was provided under Standing Order 40A
The Heads of Terms Agreement recently signed by the HSE and VHI commits both parties to work towards finalising, in January, terms under a memorandum of understanding on claiming and payment of private inpatient charges levied under section 55 of the Health Act 1970.
The Heads of Terms do not require the HSE to write off historic claims and the associated payments to the HSE and voluntary hospitals. The question of write-offs is subject to public financial procedures, relevant health legislation and agreed arrangements with private health insurers. As it stands, such write-offs do on occasion take place where errors arise, information is incomplete or there is little prospect of receiving payment, either directly from a former patient or from an insurer. It is envisaged that agreement between the parties, if concluded early next year, will bring much greater certainty and timeliness to the claims/payment process but with agreed periods for hospitals to lodge claims. These agreed periods will be reduced but still reasonable in providing hospitals with the opportunity to gather information and submit it to the VHI.
While the terms are obviously not final until agreed between the parties, the arrangement contemplated would see the insurer make an initial payment on account shortly after notification of the patient’s discharge, followed by a final balancing payment upon receipt, within a defined period, of the fully collated claim documentation. The period within which the HSE can receive payment for services will be shorter than that provided under the Statute of Limitations generally, and there is also a new deadline for submission of preliminary claims data after which the ability of the HSE to collect is restricted.
As requested by my Department, prior to entering into the memorandum of understanding, the HSE will be satisfying itself as to the detailed terms of the agreement having regard to the commercial value of the HSE and HSE’s statutory obligations.
Since the negotiations are not complete it is not possible to be definitive with regards to all of these matters at this stage, but I trust that the above information is off assistance.
