Brong Ahafo NHIA recoups GH¢150,000 after claims verification exercise

A claims payment verification and compliance audit exercise conducted by the National Health Insurance Authority (NHIA) in the Brong Ahafo Region in 2016 resulted in the authority recouping GHC150,000 from claims submitted by some health providers for payment.

The acting Brong Ahafo Regional Director of the NHIA, Mr Emmanuel Baah-Danquah, who disclosed this in Sunyani yesterday, said it was found out during the exercise that some health facilities had prescribed drugs above their levels of operation (credential level), while others duplicated some of their claims.

Mr Baah-Danquah, who was speaking at the 2016 annual regional review conference of the NHIA in Sunyani, indicated that claims payment remained a major challenge to the National Health Insurance Scheme (NHIS).

Findings

He explained that the exercise further revealed that some health providers billed clients twice for service delivery within nine months.

According to him, the exercise also detected that even though some patients were transferred from the out-patient departments, some facilities were found using full in-patient tariffs, instead of “transferred out tariffs”.

He appealed to the NHIA’s partners and providers to study and apply NHIA tariffs and operations manual appropriately and also adhere to the standard treatment guidelines and other protocols.

Indebtedness

Regarding the payment of claims to healthcare providers, Mr Baah-Danquah said GH¢24,778,453.18 had been paid to the providers to cover January to March 2016 claims, while another GH¢7,076,615 was ready for the payment of April 2016 claims.

He explained that the NHIA owed health providers GH¢44,698,810.22, covering the period from May 2016 to date.

Registration

Even though the NHIA targeted to register 1,285,978 people in the region during the year under review, the actual number registered was 1,169,158.

According to him, the NHIA collaborated with the Ghana Education Service (GES) to register 367,841 students and pupils, out of the targeted 607,968.

“We teamed up with the Ministry of Gender, Children and Social Protection to register 118,346 indigents and LEAP beneficiaries,” he added.

He expressed concern over the issue of co-payment, by which some health service providers collected money from insured patients, and cautioned health staff against “hiding behind the delayed payment of claims to collect money that they do not have to”.

Mr Baah-Danquah said in spite of the challenges, the Brong Ahafo Region mobilised GH¢10,420,454.20 as premium and processing fees in 2016.

Capitation

He stated that the region started capitation in October 2016 and by December of the same year 35 per cent of active members in the region had enrolled to indicate their preferred health facilities.

That, according to him, enabled the region to top a number of regions, including Northern, Central and Western, which started the exercise at the same period.

An official of the Ghana Health Service (GHS), Mr George Asare, who chaired the function, called for measures to ensure that claims submitted by service providers were paid promptly, since the delays were hampering the efficient operation of the providers.