ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS OF
Transcription
ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS OF
* g b AHMOPI ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS OF THE PHILIPPINES, INC. WITNESSETH: WHEREAS, AHMOPI is the recognized trade organization of Health Maintenance Organizations (HMOs) in the Philippines WHEREAS, AHMOPI is currently composed of several HMOs which are business entities that arranges for pre-paid health care services for their members by contracting with hospitals, physicians, and other health professionals for their services AHMOPI members include, but are not limited to. the following: BLUE CROSS HEALTHCARE, INC. 800 Makati Avenue corner Burgos Strccl Makati City Tel. No. 899-8001 Fax; 899-5392 Website: \wvw bluccross.com.ph MEDICAL SERVICES MARKETING & DEVELOPMENT CORPORATION Penthouse. Seven East Capitol Building East Capitol Drive. Kapitolyo. Pasig City Tel. No. 746-5000 Fax: 632-0651 Website: wwvyjnedserve.com.ph CARITAS HEALTH SHIELD, INC 3' k Floor Kalipuiian Building 95 E. Rodrigue/ Boulevard. Que/on City Tel. No 7X1-6492 Fax- 732-5251 Wcdsiic: ww\\.cantashcajihshild.com.ph MEDICARD PHILIPPINES, INC. S/F The World Center 330 Sen Gil Puyal Avenue, Makati City Tel No. 867-2020 Fax: 810-3855 Website w\vw.mcdicardpli11Is coin COCOLIFE HEALTH CARE S/F Feliza Building. V A, Rufmo Strccl Lcgaspi Village. Makati /city Tel. No. SI3-3000 Fax: 812-3363 Website; \v\v\h MEDOCARE HEALTH SYSTEMS, INC 7/F EU State Tower #30 Quc/.on Avenue. Quc/on City Tel. No. 781-9682 Fax: 732-4415 Wcdsite: ww\v,cujj,roup net FORTUNE MEDICARE, INC. 3/F CityStalc Centre 709 Shaw Boulevard. Pasig City Tel. No. 706-4X47 Fax: 706-4231 Website. \vu\\.fortunccare.com.ph METROCARE HEALTH SYSTEMS, INC. 55 Don Bcnilo Hcniandc/ Street Jalandoui Compound. Pasay City Tel. No 551-7764 (or 67)'Fax: 551-0911 email: admprl'd.mctrocarchealth com HEALTH MAINTENANCE, INC. To\verGround. Makati Cinema Square Chino Roces Avenue. Makati Cit> Tel. No. 8 1 1 - 1 3 1 3 Fax; 817-1377 Website: wwu.hmi com.ph PH1LHEALTH CARE, INC. 7/F Philam Life Building U.N. Avenue, Malatc. Manila Tel. No. 523-6002 Fax: 528-3651 INSULAR LIFE HEALTH CARE, INC. 1-CARH Building. 167 Legaspi Street Lcgaspi Village. 1229 Makati Cit> Tel No 813-013! io36 Fax 813-7856 Website, \vw\v.icarccom ph PRUDENTIAL HEALTHCARE, INC. 3f Floor Prudentialife Building 843 Amai/ Avenue. Makati City Tel. No. 816-4976 Fax: 840-0692 email brrfl'prudentialife.com ph INTELLICARE 7'F Fell/a Building. V A. Rufmo Street Legaspi Village. Makati City Tel. No 894-2120 Fax: 894-2135 Wcdbistc: www.intcilicarc.com.ph STAR HEALTHCARE SYSTEMS, INC. 4/F Beneficial Lite Insurance Building 166 Salcedo Street. Legaspi Village. Makati Cit> Tel. No 819-0074 Fax: 819-0072 email; sales ajslarcarc.com ph MAXICARE HEALTHCARE CORP. I9/F Medical PI a/a Makati. Amorsolo cor dcla Rosa Streets. Lcgaspi Village, Makati Cit> Tel. No. 752-6294 Fax: 813-8713 Website: w\\w.niaxicare.com.ph VALUE CARE HEALTH SYSTEMS, INC. Una 607-613 6/F Philippine Slock Exchange Center Exchange Road. Ortigas Centre. 1600 Pasig Cit> Tel. No. (02)702-3388 / (02)687-0219 Fax. 637-9453/56 Website wvnv valucare.cQm \: \\-\\^v ph WHEREAS, AHMOPI has signed a Memorandum of Agreement (MOA) with the PHILIPPINE COLLEGE OF PHYSICIANS, a private corporation duly registered and existing in accordance with the laws of the Republic of the Philippines, with office address at Unit 2201-2203, 22nd Floor, One San Miguel Avenue Building, San Miguel Avenue corner Shaw Boulevard, Ortigas Centre, Pasig City, hereinafter referred to as "PCP". WHEREAS, the PCP-AHMOPI MOA took effect on May 04, 2009 and shall expire on May 03, 2011, after which both parties may jointly review, revise and/or modify the said MOA, if necessary, prior to its renewal for another two (2)-year term. WHEREAS, AHMOPI Members are desirous of entering into an arrangement with PCP Members (the Physician) in different localities/communities all over the Philippines for the purpose of providing medical services to its members. WHEREAS, the PHYSICIAN is a/an (specialization) .duly licensed to practice medicine in the Philippines, and is a member of the PCP, and has signed his conformity to the provisions of the MOA between the PCP and the AHMOPT dated 04 May 2009; NOW THEREFORE, for and in consideration of the foregoing premises the parties hereby mutually agree as follows I. The Physician agrees to render quality and cost - effective medical services to patients of AHMOPI members In consideration for the above services, the following professional fees (exclusive of Philippine Health Insurance Corporation fees) will be paid: 1 1 O u t - P a t i e n t Consultation Fees The out-patient consultation fees of the Physician shall be Php 300.00 regardless of their place of practice Other fees are as follows ~r 'f r For routine pre-procedure medical evaluation, in- patient and oul-patient - P 600 00 For pre-procedure medical evaluation, in-patient and out-patient but with medical indications - 800.00 Intra-operative monitoring - 1,200 00 In-Patient Daily Visits: All professional fees (PF) for both attending physicians and co-attending physicians shall be based on the following payment schemes: Ward Semi-Private Private Suite ICU/CCU 450.00 55000 65000 1,000.00 1,200.00 Other fees are as follows: For routine pre-procedure medical evaluation, in- patient and out-patient - P 600 00 For pre-procedure medical evaluation, in-patient^and out-patient but with medical indications 800.00 1.20000 Intra-operative monitoring The Physician shall not "balance-bill1' AHMOPi patients for coverable health conditions and availments. However, for non-coverable health conditions and availments, the Physician may bill AHMOPI patients for PFs based on the PF schedules of the AHMOPIMember concerned. All PFs are subject to the prevailing withholding tax rates and such other tax provisions. The prevailing Value Added Tax (VAT) currently at 12%) shall be shouldered by the AHMOPI-Member provided the Physician submits VAT registration certificates to the AHMOPI Member. On the other hand, withholding taxes will be deducted from the Physician's PFs, For medical procedures listed in the Philippine Health Insurance Corporation (PhilHealth) and Philippine College of Surgeons (PCS) handbook of 2001, as amended in 01 April 2009, AHMOPI Members agree to pay professional fees (PF) based on the 2009 PHIC Relative Value Scale (RVS) For those procedures not listed, the PCP-AHMOPI Liaison Committee, in collaboration with the PCP Subspecialties concerned, shall meet and decide on the most appropriate PF schedules Discounts for Senior Citizens will not apply to the negotiated rates ( I t e m l ) above. Similar PFs will apply to all specialists/physicians consulted to co-manage a particular patient 7 All bills presented by the Physician with complete documentation shall be fully paid by the .AHMOPI Member according to the negotiated rates (item 1 above) within forty-five (45) days from receipt of out-patient claims from the Physician, and within sixty (60) day.v from receipt of in-patient claims from the hospital 7.1, A penalty of 3% per month shail be imposed on delays from submission of outpatient and in-patient claims (using the same 45-day and 60-day turn-around time after providing services to the patient) to payment of claims 72 It is the responsibility of the AHMOPI-Member to remit the payments for PFs directly to the Physician, including the certificate of tax withheld at source (Form \ 2307), for both in-patient and out-patient services. All billings pertinent to professional fees of the Physician for out-patient services afforded Planholders of AHMOPI Members must be submitted to the individual AHMOPI Member concerned within 60 days from date of service All claims submitted for processing beyond this 60-day prescription period shall be considered void and non-payable 9. The Physician shall extend utmost cooperation and shall coordinate with the AHMOPI Member on all matters pertaining to the effective and efficient delivery of health care and other support services. 10 The Physician shall comply with the policies and guidelines governing the servicing of Planholders of AHMOPI Members such as, but not limited to, providing medical records, operative reports, discharge summaries, etc., whenever these shall be needed The Physician is an independent contractor, hence he is not considered an employee or an agent of the AHMOPI Member As such, the AHMOPI Member shall not assume any statutory employer obligations such as, but not limited to, Social Security, PhilHealth, and Employee's Compensation premiums The Physician agrees to hold AHMOPI Members and its Planholders free and harmless from any claim or liability to any third party arising out of, or related to, any act, omission or negligence of the part of the Physician ji 13. This Agreement shall be valid and effective on the date of execution hereof and is automatically renewable every year thereafter, unless earlier terminated/revoked by either party by giving a thirty-day prior notice to the other party 14 Any modification/s to this Agreement shall be embodied in an Addendum to be attached herein and considered an integral part hereof IN WITNESS WHEREOF, the parties have set their hands on this PHYSIC IA IS ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS OF THE PHILIPPINES, INC. CARLOS D. DA SILVA President Printed Name & Signature AHMOPI MEMBERS: I Blue Cross HealthCare, Inc Noel L. Rosas, MD 2. Caritas Health Shield, Inc Geoffrey M. Martinez 3 Cocolife Health Care Atty Alfredo C. Tumacder, Jr 4 Fortune Medicare, Inc. Dorothea J. Sibal 5 Health Maintenance, Inc. Pilar A. Adrias, MD 6. Insular Life Health Care, Inc Seralme L Manguni 7. IntelliCare Mario M Silos 8. Maxicare Healthcare Corp Jose Pastor Z. Puno 9 Medical Services Marketing & Development Corporation Vir?,ilio A. Del ValLe 10 Medicard Philippines, Inc Nicanor S. Montoya, Jr., MD II Eugene L. Sagcal, MD. Medocare Health Systems, Inc day of 12. Metrocare Health Systems, Inc. Jo Eileen Suzanne R Pama, MD 13 Philhealth Care. Inc Marites L. Nepomuceno 14 Prudentialife Healthcare, Inc Benito R. Reverente, Jr., MD 15 Star Healthcare Systems, Inc. Jaime C Fernandez 16 Value Care Health Systems, Inc Rosemarie U. Yu ' AHMOPl v i / I N F O R M A T I O N SHFF-T ON F H F P H Y S I C I A N : N-\\U- RlRTUDATl: Surname hist Name Middle Name HUSPH Al \\-\\\N sciu-.m i 1 ; R(K)M\ _ " I L L NO MOBIL t PHONI 7 . NO PROKFSSIONAI, UTIMTIF.S 1 icid ill" Specialization Specialty Buaid of Alilliations (DipUimaie l-eikn-.ships) 1MU' S.ic No TIN PM-\r Hospital -MlHiation; i! affiliations j 1 Yes 1 1 N L' 3 accredit sou m those hospitals1' { ] V e s I |No Dav 1 i m i- Km fel IXn 1 ime Km Tel Dav 1'um' Km I el Dav lime Rni lei _ I imc Rm Tel Rm lei Oav l);i\e