C&AG report: Billing delay means private carers owe State hospitals €290m

State-funded hospitals were owed some €290m by health insurers for private patient treatment at the end of last year.

The latest report by the Comptroller and Auditor General (C&AG) found that, due to serious delays in the collection of income from private health insurers, the exchequer “is effectively meeting the funding gap at hospitals until payment is made”.

The money owed to the HSE at the end of last year comprises €172m in relation to statutory hospitals and €118m for voluntary hospitals.

The C&AG noted that while the pace of debt collection improved in 2012 to 134 days, it was taking longer to generate invoices and collect the debts due from private health insurers.

It now takes an average of 186 days to collect the monies owed — some 212 days for HSE statutory hospitals and some 158 days for voluntary hospitals.

C&AG report: Billing delay means private carers owe State hospitals €290m

The report also notes that, despite a range of measures to improve the length of time it takes consultants signing off on claims to be submitted to insurance companies, the problem had worsened.

The times involved ranged from a low of 15 days to a high of 163 days at certain hospitals.

An examination of the top 10 highest value claims awaiting consultant sign- off found the majority were waiting to be signed off for more than two months.

Hospitals were found to be “not always aware of the reasons for the delay and no formal action had been taken where consultants were consistently late in submitting claims”.

At the end of 2014, claims had been with consultants for an average of 58 days — 68 days in HSE statutory hospitals and 47 days in voluntary hospitals.

“This is well above the target of 20 days agreed with consultants as part of the Labour Relations Commission agreement in September 2012, and the revised temporary target of 30 calendar days adopted by the HSE in November 2013,” it was stated in the report.

Just 29 of the 44 hospitals were found to have fully integrated Claimsure — the electronic management system for claims.

As a result of the system not being used as envisaged, a “significant level of manual intervention” is required. This was noted by the HSE which stressed that it still represents “a significant improvement” on the old manual system.

A total of €4.6m of private patients’ charges were written off by HSE hospitals.

The C&AG also found the value of claims queried by insurance companies increased by 69% over the course of 2014.

The HSE said it was partly due to the introduction of new changes to the payment system at the start of last year. The C&AG recommended the HSE agree more clearly defined terms of payment and payment processes with the insurance companies.

“This will ensure that the claims being submitted by the hospitals are complete and can be processed efficiently by the insurance companies with a minimum of queries arising post submission,” the C&AG report stated.

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