Guidelines for Nephrologists Before Signing the Philhealth Claim Forms (CSF) of Dialysis Patients

DATE: March 4, 2020

TO: ALL PSN MEMBERS

RE: GUIDELINES FOR NEPHROLOGISTS BEFORE SIGNING THE PHILHEALTH CLAIM SIGNATURE FORMS (CSF)

OF DIALYSIS PATIENTS

To ensure that the care of dialysis patients are adequately provided and coordinated by referring attending nephrologist and medical staff of dialysis centers and so that the data reflected in the Philhealth claim signature forms (CSF) being signed by attending nephrologists match with the data from the dialysis patient’s treatment log sheets and statement of account (SOA) submit through Philhealth e-claims, we are recommending the following guidelines:

1. Prior to or immediately after initiation of dialysis, the dialysis patient must be enrolled to Philhealth Dialysis Data Base (PDD).
2. Attending nephrologists must provide the dialysis center of choice with hemodialysis orders. Such dialysis orders must be updated regularly.
3. Medical Directors must see to it that attending nephrologists are informed and updated regularly on the names and schedule of treatments of their patients that are undergoing treatments in their dialysis centers
4. Medical Directors must see to it that attending nephrologists are updated on the status of their patients every dialysis treatment either by the dialysis nurse or physician on duty through calls or SMS.
5. Attending nephrologists must promptly acknowledge and/or answer referrals or updates made through calls or SMS by the dialysis nurse or POD.
6. Before signing the CSF, the attending should make sure that the following information are properly and accurately entered in the designated boxes for the following:
   1. Philhealth Identification Number (PIN) of Patients or Dependent
   2. Date of Birth of Member and Patient
   3. Confinement period
   4. Certification of Member- signed either by Member or Member’s representative
   5. Employer’s Certification
   6. Patient’s consent to access patient records
   7. Health Care Professional Information
   8. Provider Information and Certification
7. The attending nephrologist is the signatory of Part IV- Health Care Professional Information of the CSF and of Part VII-Certification of Health Care Professional of CF4, if ever the dialysis center keeps a hard copy of CF4 in their files.
8. The dialysis owner or his/her designated representative (Philhealth Officer, administrator, operations manager, etc) is the signatory of the Provider Information and Certification part of the CSF.
9. Attending nephrologists must ensure that there are no erasures in the CSF and other documents submitted thru e-claims.

10. Attending nephrologists should sign the CSF and/or CF4 after the treatment/s have been rendered. In no case should nephrologist sign CSFs in advance or pre-sign blank CSFs.
11. The following documents must be examined and evaluated by attending nephrologists, before signing the CSF of a particular patient, to ensure the correctness and accuracy of data written therein;
    1. Statement of Account (SOA)- must have been signed already by the patient and billing or Philhealth Officer
    2. Hemodialysis treatment log sheet
    3. PBEF- Philhealth Benefit Eligibility Form
12. Attending nephrologists must validate the treatment date/s being claimed in theStatement of account (SOA) with the actual treatment date/s as indicated in thehemodialysis treatment log sheets of the patients.
13. Attending nephrologists must ensure that the admission and discharge dates as writtenin the CSF correspond to the first and last treatments, respectively of the treatmentsession/s being claimed.

14. Attending nephrologists must also ensure that the dialysis centers deduct the

mandatory government discounts like VAT and senior citizen/PWD discounts from their

professional fees and must be properly reflected in the SOA.

15. Attending nephrologists must sign the CSF last; and after the patient and authorizedsignatory of the hospital or dialysis center have already signed and certified that thedialysis treatment services has been rendered.
16. The attending nephrologist may request for, or the dialysis centers keep a copy of, thedocument/s signed and submitted to Philhealth for his/her personal file or future reference, respectively.