NHIA moves to reduce delays in claims payment (Graphic Business)

THE issue of prompt reimbursement of claims to health care providers has remained a major challenge facing the National Health Insurance Authority (NHIA).
That challenge has of late created some form of misunderstanding between officials of the NHIA and members of the Ghana Medical Association (GMA) with each accusing the other for not doing enough to ensure the sustenance of the National Health Insurance Scheme (NHIS).
It is widely believed in medical circles that the undue delays in payment of claims is capable of collapsing the scheme. But the NHIA argued that it needed time to effectively audit claims made by the providers to prevent fraud.
In a statement issued at the end of its third National Executive Council meeting at Tegbi in Keta in the Volta Region, the GMA contended that most facilities owed substantial amounts in medicines and consumable procured on credit.
It pointed out that as a result, suppliers were no longer willing to supply on credit to the providers.
But the Deputy Director of Corporate Affairs of the NHIA, Mr Eric Ametor-Quarmyne in an interview with the Graphic Business denied the GMA’s assertion and claimed that the debt service schedule of the authority was on course.
In the statement, the GMA said the Korle-bu Teaching Hospital, for instance, was owed GH¢2.7 million; the Central Regional Hospital, GH¢694,000; the Eastern Regional Hospital, GH¢1,090,000, with similar examples from other health facilities.
That situation, according to the association, had enormously affected the ability of those facilities to provide quality service to their clients.
In his reaction, Mr Ametor-Quarmyne said the arrangement made with the health facilities would always leave some debts unpaid and called on the service providers to exercise restraint.
He explained that the NHIA was using what he termed the fee-for-service method, which meant that the health facilities would provide services for the NHIS subscribers before payments were made. According to Mr Ametor-Quarmyne, in 2009 alone, GH¢372 million was paid to service providers, adding that NHIA would continue to make payments.
As the debate rages on the NHIA issued a statement that the authority would establish a Consolidated Claims Management Centre in Accra which would be a pilot project to manage claims from the teaching hospitals and the 10 regional hospitals in the country.
In the statement, the Communications Manager of the NHIA, Nii Anang Adjetey, indicated that the claims management centre, which would be managed by competent scheme managers, would provide a greater capacity for the vetting of claims and the efficient payment of service providers adding that it would be rolled out across the country.
With regard to the requirement for payment plans before disbursement, he said, “Scheme managers will henceforth be required to produce and forward payment plans in advance to the authority for endorsement before funds are released for disbursement to service providers in order to combat irregularities in payment arrangements.”
To check systemic abuse and fraudulent practices in the dispensing of medicines, he said a standardised NHIS prescription form, which would require the personal identification numbers (PINs) of the prescriber and the dispenser and also identify the scheme involved, would be introduced.
He said with regard to free maternal care, pregnant women would, from July next year, be required to register for free first before they would be allowed to access free maternal care, noting that that would help check abuse in the system.
Nii Adjetey said in order to eradicate double billing by service providers, all private health care facilities run by full-time operatives in public health facilities had been discredited to eliminate conflict of interest.
The NHIA, he said, would also introduce capitation for out-patient department services in primary health care facilities following a pilot programme to be carried out in a selected region scheduled to start by the end of 2010.
He said to ensure uniformity, apex bodies such as the Ghana Health Service (GHS), the NHIS, the Christian Health Association of Ghana, among others, would be involved in reviewing the current system to ensure a unitary system of contracting service providers.
In addition, the authority had also directed all scheme managers to close all scheme accounts by July this year and channel all premiums into the Consolidated Premium Account.
The consolidated account, which will be opened with the Ghana Commercial Bank (GCB) and the Agricultural Development Bank (ADB), is aimed at addressing the current situation where more than 70 per cent of premiums collected is not properly accounted for.
The statement pointed out the authority had decided to overhaul the NHIS, after its Chief Executive Officer, Mr Sylvester Mensah, had undertaken a two-week nation-wide tour of all the 145 district mutual health insurance schemes (DMHISs) in the country.
To ensure a smooth review process, staff from all the 145 DMHISs in the country had been trained in the use of a new financial and operational reporting tool developed by the authority.
The new tool was designed to streamline and standardise electronic recording and the timely transmission of accurate data by the schemes to the NHIA for efficient planning.