The Rwanda Social Security Board (RSSB) is taking proactive measures to address the escalating number of rejected hospital claims by medical insurers and tackle issues related to overbilling.
In an effort to combat these challenges, RSSB has announced the introduction of a digital system for verifying invoices from hospitals.
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The recently released Auditor General (AG)&039;s report for 2022 highlighted the persistent problem of rejected hospital claims by medical insurers, which has resulted in the loss of billions of Rwandan Francs.
According to the report, the rejection of billed amounts was primarily attributed to incomplete documentation supporting the claims, utilization of expired insurance cards and transfers, billing errors, inclusion of medical services not covered by insurance providers, and discrepancies in interpreting medical invoices or tariff disagreements among insurance staff.
"The rejection of invoices deprives hospitals of funds that could have been utilized for essential operational activities. Hospital management should exercise due diligence in billing medical insurers. Furthermore, they should engage the Ministry of Health (MINISANTE) to resolve tariff disagreements," the report recommended.
Speaking to The New Times, Regis Rugemanshuro, the Director General of RSSB, attributed the rejections to health facilities overbilling insurers or charging for items not covered by insurance. The identification of overbilled items prompts a verification process conducted by medical facilities and insurers, during which the agreed-upon items are removed from the final invoices.
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To expedite this process and curb overbilling, RSSB is digitizing the verification process. This initiative aims not only to reduce instances of overbilling but also to accelerate the verification and payment process, shortening the current contractual period of 60 days to just 15 days.
"RSSB has already onboarded over 1,026 health facilities, and we aim to include all partner health facilities and pharmacies by the end of 2023," Rugemanshuro stated.
Meanwhile, the AG's report also highlighted instances of hospitals experiencing delays of up to 317 days to bill private insurance companies for invoices totaling Rwf8.38 billion in 20 public hospitals.
Such delays negatively impact hospitals' liquidity, necessitating district hospitals to prioritize timely invoicing to maintain smooth cash flows and operational efficiency.