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UHC Clinical Claims Consultancy, Davao City (2026)

10/07/2022

Did you know that hospitals claims are not paid due to inefficient claims blueprint?
What is a claims blueprint?
It is a high-level plan that guides hospital management and
staff to visualize the overall process flow to guide and identify gaps and problems.

So, it is a series of steps.
Please take note.
The output of a step is needed in the next process.
Each step has a specific task that is required in Philhealth claim forms.
Each step must do their part accurately to guarantee payment of claims.
Each step must be efficient.
There must be teamwork in the entire blueprint.

What is a claims blueprint? It is a high-level plan that guides hospital management and staff to visualize the overall process flow to guide and identify gap...

22/04/2022

Did you know that hospitals depend on Philhealth claims for their revenue and almost all of them do not have a Philhealth expert?

Hospital revenue is anchored in Philhealth claims reimbursement. We all know this.
For private hospitals, depending on their size at least 30% to 70% of their income is dependent on Philhealth.

For Public hospitals, at least 70 to 90% of their income is dependent on Philhealth reimbursement.

The tragic irony of all is this, almost all hospitals do not have a Philhealth expert or a Philhealth Champion.

Based on my experience hospitals repeatedly incur losses due to claims return and claims denied.

These are commonly due to misinterpretation of Philhealth polices or circulars.

These covers rules on benefits availment, membership, accreditation and even IT (Information Technology) related topics.

The wrong interpretation of Philhealth rules results in wrong ex*****on of policies and incorrect documentation.

This video is all about the tragic irony in hospital claims. No Philhealth expert.

Did you know that hospitals depend on Philhealth claims for their revenue and almost all of them do not have a Philhealth expert? Hospital revenue is anchore...

21/03/2022

Did you know that many health care providers are losing millions of pesos in claims due to poor documentation?

In my almost 2 decades in claims processing, I can confidently say that documentation is one of the major reasons why hospitals are losing million in Philhealth claims.

But what is documentation?

Documentation in claims processing is the process of providing proof or record that will support the services given to a Philhealth patient.

So common sense will tell us that documentation will lead to a document.

This can be a soft copy form or hard copy document.

I have said this a million times in our webinars and trainings.

Philhealth is not about money.

Philhealth is all about information.

Give Philhealth the right information and money will follow.

This video is a short guide on how to understand the problem of documentation.

Email us if you need our services support@coachdocben.com

Did you know that many health care providers are losing millions of pesos in claims due to poor documentation? In my almost 2 decades in claims processing, I...

16/02/2022

Did you know that a handful of hospitals and doctors want to earn multi-million revenue from Philhealth claims processing, but they do not have a Philhealth claims target?
After spending almost 2 decades in claims processing, many hospitals & doctors ask me how to make revenue from Philhealth claims processing.
But before I answer that questions, I ask them this question. “What is your Philhealth claims target?
Out of 10 hospitals, all of them cannot give a target.
As expected, all of them do not have a regular or sustainable revenue from Philhealth.
Everybody wants the money but not all wants to work for it.
Most health care providers can only wish but only a few of them hustle for it.
This video is all about having Philhealth claims target. Do you have one?

Did you know that a handful of hospitals and doctors want to earn multi-million revenue from Philhealth claims processing, but they do not have a Philhealth ...

04/02/2022

The Commission on Audit conducted a performance audit on Philhealth All Case Rate and other benefit packages last January 2020.

Based on the report the Commission on Audit (COA) identified the PhilHealth’s ACR Payment Scheme as one of its priority areas for performance audits.

The audit team reviewed the extent the ACR achieved its goals and objectives.

The audit team examined the existence of overpayments and whether the ACR facilitated such incidents.

The audit team reviewed the existing control mechanisms to prevent and detect improper payments.

Several findings were noted. Several recommendations were also given.

This video is about 3 major findings that may have great impact in hospital claims processing.

The Commission on Audit conducted a performance audit on Philhealth All Case Rate and other benefit packages last January 2020.Based on the report the Commis...

20/01/2022

Philhealth legal sector has been very busy for the past few years.
Several hospitals and doctors have received several affidavit complaints.
It is like Philhealth legal sector has a quota or target on the number of affidavit complaints must be sent in a month or a year.

Due to the several numbers of complaints received, many health care providers scramble on how to resolve the complaints raised.

Many do not know what to do.
Many do not know how to reply.
Many do not even know how to make a good justification.

So, it is basically a recipe for disaster.

Doctors who are not accustomed to this suffer sleepless nights and are stressed.

All these unnecessary scrambling and sleepless nights can be prevented.

First, you need to know that Philhealth legal sector will send an affidavit complaint to you as a doctor or hospital once they have started a fact-finding investigation.

So, when does Philhealth fact-finding investigation occur?

This will happen when Philhealth regional office or central office will ask for several copies of clinical charts.

Take note the clinical charts need to be a certified true copy or CTC.

If they will ask for 5 or 6 sets of CTC of clinical charts that is when fact finding occurs.

You need to watch out for request of CTC charts.

This video all about the steps on how to act or manage the issues behind this problem.

Philhealth legal sector has been very busy for the past few years. Several hospitals and doctors have received several affidavit complaints. It is like Philh...

13/01/2022

Several hospitals are either under investigation or legal cases has been filed against them by Philhealth Legal Sector.
As such hospitals and doctors hire lawyers to handle these things.

This video is about the sad experiences of health care providers from their own lawyer or legal team.

Yes, you heard it right. They hire a law firm and somehow things get sour between themselves.

I know these things happen, but several health professionals do not know this.

When Philhealth files a case against a doctor or a hospital there is an exchange of legal documents.

These documents can be in a form of a declaration of facts, verified answer, summon, legal directives,

reports or legal justification, clinical charts, statement of accounts, and many more.

These are beyond the medical field.
Thus, doctors and hospitals need to hire lawyers to manage and go through the legal process.

Most doctors and hospitals are not accustomed to the nitty gritty of a legal process.

In fact, many health care providers are ignorant on this.

As a result, many legal processes and actions are poorly understood and even misunderstood by many health care providers.

Disclaimer:
The views and opinions expressed in this video are those of the author or based on the author’s experience.

Any content provided are not intended to malign any religion, group, organization, government office or personality.

Several hospitals are either under investigation or legal cases has been filed against them by Philhealth Legal Sector. As such hospitals and doctors hire la...

06/01/2022

After spending almost 15 years in Philhealth, I have noticed doubtful behavioral patterns in some hospitals.

As a former claims chief part of my task was to make sure hospital reimbursements must be accurate and on time.

After updating the payment of one private hospital with 2 million pesos or even 5 million pesos, the finance chief or hospital administrator of same hospital will ask for another 2 or 5 million pesos after 1 week. Take note everything is updated.

This is common in a handful of hospitals.

The same thing with government or public hospitals.
We updated the payment. No delay and no missed payment.
Claims are accounted for.

After paying 8 million pesos, the hospital chief or finance staff of the same hospital will ask for another 8 million pesos the following week.

I end up confused on why this occurs.

So, I went out to the 25 hospitals and did some research. These were infirmaries, level 1, 2 and 3.

I discovered that each hospital has its own unique problems.
However, they also share common problems.

This video is about specific reasons on why reimbursement is not enough.

After spending almost 15 years in Philhealth, I have noticed doubtful behavioral patterns in some hospitals. As a former claims chief part of my task was to ...

22/11/2021

A Medical Director is a clinician who oversees and guides the clinical care that is provided in the hospital.
The medical director is a leader that help define a vision of quality improvement, an operations consultant to address day-to-day aspects of organizational function, and a medical director is a direct supervisor of the medical practitioners who provide the direct patient care

It is an advantage if the medical director has personal resilience and integrity, communication skills, responsiveness,
and organizational skills.

In my previous video I have stated that one of the problems in claims processing are doctors.
Primarily because many of them were not trained in Phil health concept and claims processing.

In my webinars I emphasize that 80% of the errors are clinical information.
Naturally, the source are clinicians.

If that is the case, you need to inspire and train clinicians on how to be Philhealth compliant.

This video is all about the role of Medical Directors in relation to claims processing. These are observations and concrete examples on how a Medical Director should act.

A Medical Director is a clinician who oversees and guides the clinical care that is provided in the hospital. The medical director is a leader that help defi...

13/11/2021

After spending almost 2 decades in claims processing, I can say that at least 80% of the problems in claims is Physician induced.
Yes, it is mostly doctor induced.

So, if my premise is correct the clinical information provided by doctors be it interns, residents, and consultants may be incomplete, incorrect, and inconsistent.

Now many of these are innocently done. This happens because doctors were not trained in the concept of Philhealth.
Our health industry trains our doctors to be 99% healer and 1% manager.

Next, the pandemic has made it more difficult for the doctors to meet and communicate accurately.

As a result, your claim forms will be inaccurate.
This is what I tell my clients “If you want to decrease claims problems, if you want to avoid Philhealth legal problems invest in a claims medical evaluator”.

But what is a claims medical evaluator?

Claims medical evaluator is a doctor who will review the compensability of your hospital claim based on clinical standards and Philhealth rules.

In this video you will discover the advantages of having a claims medical evaluator in your hospital. You will discover that this investment will not only give you peace of mind but sustainable revenue.

After spending almost 2 decades in claims processing, I can say that at least 80% of the problems in claims is Physician induced. Yes, it is mostly doctor i...

25/10/2021

Most health care providers see Philhealth as nothing more than just payment. It is like an ATM machine that dispenses money for as long as they send claims on time.

Philhealth claims processing is not an ATM machine wherein you only need your PIN code to get money.

This is a flawed mindset. In fact, this is the most common reason why health care providers end up having so many RTH, denied claims, and claims to end up in Philhealth legal.

In this video, we will talk about types of information. We will talk about the inaccuracies and inconsistencies of information as one of the main causes that why claims end up as RTH and Denied for almost a decade.

Most health care providers see Philhealth as nothing more than just payment. It is like an ATM machine that dispenses money for as long as they send claims o...

14/10/2021

This video is all about the top reasons for return to hospital claims and the top reasons for denied claims for the years 2011, 2019, and 2021.
You will discover that health care providers have been repeating the same mistakes for almost 10 years or one decade.

There is a recurring pattern for the reason of denial and RTH of claims.
From 2011 to 2021 the pattern is obvious.

As a health care provider, can you relate to this?
Are you doing something to solve this?
Or you just turn a blind eye to this issue.

The real question that needs to be asked now is why does this happen?
How can an organization of professionals allow this to happen for a decade?
There is a saying "Repeating the same mistake is mediocrity".
When will this stop?

Are health care providers capable of putting an end to this?
After spending almost 2 decades in claims processing the mistakes are recurring because

Hospital leaders see claims processing as a stand-alone task-specific for one office alone which is the hospital claims office. This is incorrect.

More than half of the hospital staff are involved in claims processing.
Next, among officers and hospital staff involved in claims processing there is a lack of awareness of Philhealth concepts and rules.

There is no training for them. Everybody assumes that what they do daily is correct.
Unfortunately, this is incorrect.

This video is all about the top reasons for return to hospital claims and the top reasons for denied claims for the years 2011, 2019, and 2021. You will dis...

UHC Clinical Claims Consultancy

10/07/2022

22/04/2022

21/03/2022

16/02/2022

04/02/2022

20/01/2022

13/01/2022

06/01/2022

22/11/2021

13/11/2021

25/10/2021

14/10/2021

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