Republic of the Philippines

Provincial Government of Palawan

ABORLAN MEDICARE HOSPITAL
Ramon Magsaysay, Aborlan, Palawan
email: [email protected] Admin 0947-440-4626

OFFICE MEMORANDUM NO. 2025- 035

DATE : January 23, 2025

TO : MEDICAL, NURSING AND ALLIED STAFF, HOSPITAL INFORMATION

MANAGEMENT/ MEDICAL RECORDS, PHILHEALTH, FINANCE AND BILLING
SERVICES

CC : ER, OPD, ALL WARDS, DEPARTMENTS

FROM : STENELY O. MANUEL, MD

Medical Officer V- OIC Chief of Hospital

SUBJECT : DISSEMINATION AND IMPLEMENTATION OF PC 2024-0033 OUTPATIENT

EMERGENCY CARE BENEFIT PACKAGE AND OTHER NEW PHILHEALTH
CIRCULARS/ TREATMENT GUIDELINES AND UPDATES

In support of the Universal Healthcare Act and Philhealth’s release of new circulars and benefit packages
to further improve healthcare service delivery specially in government hospitals, you are herewith directed
to fully read, understand, disseminate, implement and comply with the following Philhealth Circulars
specially PC 2024-033 or the Outpatient Emergency Care Benefit Package effective immediately.

The full text of the circulars can be accessed and downloaded from the Philhealth Website at
https://www.philhealth.gov.ph/circulars.

Please be guided by the important reminders in each circular to ensure our full compliance accordingly.

PhilHealth Content Summary/ Important Reminders

Circular
PC No.
2024-0037 50% Adjustment of Select - Defines the adjusted rate benefits package for select
Case Rates case rates ( increase of 50%)
- Means higher coverage for in-patients’
claims/benefits (also higher PF)

2024-0034 Philhealth Benefit for - Defines coverage for oral health services such as
Preventive Oral Health Mouth examination, oral screening, dental
Services in Primary Care prophylaxis, emergency tooth extraction and tooth
restoration;

- Reserved upon accreditation ( for application this

year)

2024-0033 Implementing Guidelines for - Outlines the policies for services rendered in the
PhilHealth Outpatient Emergency Room as Outpatient, allowing payment

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 Republic of the Philippines
Provincial Government of Palawan
ABORLAN MEDICARE HOSPITAL
Ramon Magsaysay, Aborlan, Palawan
email: [email protected] Admin 0947-440-4626

Emergency Care Benefit of diagnostics, treatment and procedures on a fixed

(OECB Package) Fee Schedule
- Allows PF payment through ED consultation
Package
- Need to Triage patient according to approved Scale
such as the Emergency Severity Index (ESI), the
Australasian Triage Scale ( ATS) and Canadian
Triage and Acuity Scale
Fixed Fee Schedule:
Php 707.00 ED Consultation (Emergent ER
Consultation Outpatient (Case Code 1 0004)

Php 260.00 ED Consultation (Urgent ER Consultation

Outpatient (Case Code 1 0005)

Php 300.00 Incentive – Referral to a Konsulta

Provider ( Downward) using attached Outpatient
Emergency Konsulta Referral Form

2024-0030 Quality Standards on the - Reiterates the Policy statements including making
Diagnosis and Management the correct diagnosis based on clinical presentation
of Acute Stroke as Reference of Acute Stroke which must be in the history of the
to the C orporation patients, the signs and symptoms, appropriate
treatment/management
- At least 1 CT Scan ( claim for old rate)
- 2 CT Scans (claim with Adjusted New Rate)
- Adjusted Case Rates:
I60.0-I60.7 Hemorrhage – Php 80,000.00
I63.0-I64 Infarction – P76,000.00

2024-0027 Quality Standards on the - Reiterates the Policy statements including making
Diagnosis, Management and the correct diagnosis of ACAP based on clinical
Prevention of Adult presentation which must be in the history of the
Community-Acquired patients, the signs and symptoms, appropriate
Pneumonia (ACAP) as treatment/management
Reference of the Corporation - Adopts the PSMID Risk Stratification for Community
Acquired-Pneumonia
- Need for Chest-xray for ALL suspected of
Pneumonia
- Only Moderate and High Risk CAP should be
admitted
- May repeat Chest Xray for those with “Normal” initial
Chest radiographic findings
- Other pertinent considerations in the diagnosis, risk
categorization and management essentials

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 Republic of the Philippines
Provincial Government of Palawan
ABORLAN MEDICARE HOSPITAL
Ramon Magsaysay, Aborlan, Palawan
email: [email protected] Admin 0947-440-4626

2024-0025 Implementing Guidelines on -Defines the adjusted rate benefits package for
the Adjusted Rates for Severe Severe Dengue and the necessary diagnostic tests,
Dengue history, presentation, signs and symptoms, and
management for claims to be valid and compensable:

2024-0021 Lifting the Single Period of Lifts the Single Period of Confinement Rule which
Confinement Rule (SPC Rule) denies claims for readmissions of the same condition
for All Case Rate Claims and surgical procedures within the 90-day period-
(ACR Claims) Effective for all second admissions starting October 1,
2024
Effect: Patient can be re-admitted for the same
condition regardless of time/period from a previous
admission for the same condition
Example- can be re-admitted for other cases and not
just Bronchial Asthma in Acute Exacerbation only

2024-0018 Outpatient Benefits Package - Reiterates the Policy statements to grant payment
for Mental Health Package for outpatient mental health benefits based on
clinical presentation which must be in the history of
the patients, the signs and symptoms, appropriate
treatment/management
- As much as Php 9,000 per case rate
- Defines the needed/ available medicines in the
Pharmacy and other necessary attachments to
claims
- Reserved upon accreditation ( for application this
year)

2024-0013 Enhancement of Philhealth -Increased from Php 500 to Php 1,700, with 40% or
Konsulta Benefit Package 680 pesos as PF according to AMH Internal Sharing
Guidelines
- Need to do FPE or First Patient encounter/ initial
consultation (1st tranche) and 2nd consultation for the
2nd payment)

2024-0012 Rules for Adjusted Case

Rates (Revision 1)
2024-0009 Implementing guidelines on - Outlines the adjusted rate benefits package for
the Case Rates for Bronchial Bronchial Asthma in Acute Exacerbation and the
Asthma in Acute Exacerbation necessary diagnostic tests, history, presentation,

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 Republic of the Philippines
Provincial Government of Palawan
ABORLAN MEDICARE HOSPITAL
Ramon Magsaysay, Aborlan, Palawan
email: [email protected] Admin 0947-440-4626

signs and symptoms, and management for claims to

be valid and compensable
- No “In Acute Exacerbation” in the Diagnosis-
automatically denied claims
- Requires Chest X-Ray as attachment though not
written in the policy because red flagged (one of the
commonly abused/ used diagnosis)

2024-0008 Implementing Guidelines on - Outlines the adjusted rate benefits package for
the Case Rates for Neonatal Neonatal Sepsis and the necessary diagnostic tests,
Sepsis history, presentation, signs and symptoms, and
management for claims to be valid and compensable
- Requires Blood Culture and Sensitivity result
- If no C/S – use the next case that used most
resources/ patient was treated for

2024-0005 Quality Policy on Diagnosis - Outlines the adjusted rate benefits package for
and Management of Pediatric Pediatric Community Acquired Pneumonia and the
Community Acquired necessary diagnostic tests, history, presentation,
Pneumonia as Reference by signs and symptoms, and management for claims to
the Corporation be valid and compensable
- Need for Chest-xray for ALL suspected of
Pneumonia
- Only Moderate and High Risk PCAP should be
admitted

2023-0025 Guiding Principles of the

Rationalized Inpatient Case
Rates
2023-0018 Outpatient Benefit for Mental
Health
2022-0007 Guidelines on the COVID-19
Community Isolation Unit
Benefit Package
2021-0012 Modification on Payment
Rules of benefit Under All
Case Rates Policy Increasing
COVID-19 Benefit Packages

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 Republic of the Philippines
Provincial Government of Palawan
ABORLAN MEDICARE HOSPITAL
Ramon Magsaysay, Aborlan, Palawan
email: [email protected] Admin 0947-440-4626

2016-0003 Policy Statements on the

Diagnosis, Empiric
Management and Prevention
of Community Acquired
Pneumonia (CAP) in
Immunocompetent Adults as
Reference by the Corporation
in Ensuring Quality of Care

Again, all physicians are directed to have valid PhilHealth Accreditation and submit/ update the same to
the PhilHealth Section every January of the current year and abide by their signed performance
commitment and ensure compliance with the existing National Guidelines in the diagnosis, treatment/
management of all our patients.

For your guidance and reference.