Leptospirosis Benefit Package
||admin · 572 · · 10-September-2012|
A. General Rules
1. PhilHealth reimbursement for cases of moderate leptospirosis requiring admission shall now be paid through the case payment system at the following rate:
|ICD 10 Code||Description||Per Case Payment|
|A27.8||Other forms of leptospirosis (canicola, pomona)||PhP11,000|
2. The Payment shall cover all medically-necessary services, as may be regtrired, such as room and board, drugs, laboratory/diagnostic procedures, supplies and professional fees of doctors, subject to the following rules:
- Payment shall be made directly to accredited facilities.
- Professional fee shall account for 30% of the case payment rate (Php 3,300); and
- All other rules on case rate shall still apply.
3. All sponsored members and dependents availing of this benefit at accredited government facilities shall be covered by the No Balance Billing (NBB) policy stated in PhilHealth Circular Nos. 11 and 20, s-2011. Hence, in such cases:
- No other fees or expenses shall be charged or paid for by the member beyond the package rates.
- For items not available in the facility, the facility shall purchase necessary drugs and supplies in behalf of the member.
4. The following cases are excluded from this package:
- Mild leptospirosis managed on an outpatient basis shall not be reimbursed.
- Severe leptospirosis, which shall be reimbursed via fee-for-service scheme, in die following forms:
- Leptospirosis icterohaemorrhagica, Leptospirosis clue to Leptospira interrogans serovar icterohacinurrhagica, Wed's disease (ICD 10 Code A27.0)
- Leptospirosis-associated acute kidney injury requiting emergency dialysis (e.g., ICD 10 Code A27.- N17.9)
- Meningitis in leptospirosis (e.g., ICD 10 Code A27.-+ G01*)
- Pulmonary hemorrhage (e.g., ICD 10 Code R04.8) and acute respiratory distress syndrome (e.g., ICD 10 Code J80) in leptospirosis (A27.-)
- Death, as per PhilHealth Circular No. 15, s-2011, shall be reimbursed via fee-for-service scheme
- Non-definitive final diagnosis such as suspected, to consider; probable or role out leptospirosis may be denied or paid as fee-for-service.
5. Pre- or post-exposure antibiotic prophylaxis for leptospirosis shall not be covered by PhilHealth.
6. PhilHealth's policy recommendations on the diagnosis, management and prevention of leptospirosis is published at www.philhealth.gov.ph.
1. The following documents must be submitted:
- PhilHealth Claim Form 1 to be filled out by the member and/or employer
- PhilHealth Claim Form 2 to be filled out by the providers
- PhilHealth Claim Form 3 to be filled out by the providers
2. In addition to the above, the PhilHealth Member Registration Form (PMRF) to be filled out by the member, shall be required for newly-enrolled Sponsored members referred to in Circular No. 39 s-2012.
3. All claims must be filed within 60 days from date of discharge.
1. All accredited government-owned and private hospitals may file for reimbursement for the leptospirosis package.
2. Complicated cases of leptospirosis enumerated in Section A.3 of this Circular shall only be reimbursed as Case type B in Level 1 facilities.
3. All non-accredited hospitals as provided for by Sec. 47 (e) of the Implementing Rules and Regulation of Republic Act 7875.
All provisions of previous issuances, circulars, and directives that are inconsistent with any of the provisions of this Circular are hereby amended, modified, or repealed accordingly.
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