HAGÅTÑA (The Guam Daily Post) — Questions posed by two health insurance companies over new fees proposed by the island’s only public hospital could not be answered during a public hearing held on Friday.
Yukari Hechanova, Guam Memorial Hospital’s chief financial officer presented 202 new fee items GMH would like to add to their fee schedule based on the needs of various department requests made from June to August.
“The summery of these new fee items are as follows: two intensive care unit supplies, four interventional radiology supplies, two laboratory test procedures, four OR (operating room) supplies, thirteen pharmacy medicine items, 95 special services supplies, 81 special services fees, one surgery professional fee, for a total of 202 new fee items,” Hechanova said.
The hospital also presented a total of 16 proposed fee adjustments of oxygen supplies needed by the respiratory department on June 21 and July 1.
While there was no testimony from the public, insurance companies did have questions pertaining to specific fee items the hospital wants to include.
“The last item on your updated list that was sent recently of the professional fee, is there a reason why we need to have that item there? The hospital already has a professional fee component … is there any reason why that needs to be there or can it be included in the current fee schedule of the professional fees,” Frank Campillo, health plan administrator of Calvo’s SelectCare asked.
The fee is specifically related to item 4407 a colonoscopy surgical procedure which would charge $1,642 for “professional services.”
Hechanova could not immediately respond and asked Campillo to put his question in writing for response at a later date.
Anthony Mendiola, the vice president of Medical Management for Staywell, had a similar concern but in relation to gastroenterologist services.
“We did ask the GMH team why is there a need to add these as new fees when there is already reference for professional fees,” Mendiola said. “We got a response … she stated it was a mistake and it was not a professional fee …but rather a facility fee. With that said these GI fees, if they are facility fees, will they be effective August? Because we also noted that these fees have been present on GMH’s website since April, in fact since 2022.”
Mendiola wanted clarification on whether the proposed fee was “really new fees” as he contended the fee already appears on the fee schedule since last year.
“Is GMH really implementing these facilities fees for these procedures because, though they have been in the fee schedule since April or since last year, when we looked at actually GMH claims for service dates of 2023 as recent as June this year we were billed for the same facility services using a different modem of billing,” Mendiola said.
As an example Mendiola shared that Staywell has been billed according to a fee schedule that reflects for minor OR charges of $900 for the first 30 minutes, and then a separate for an additional 15 minutes.
“When we looked at our colonoscopy claims this year … we have been billed using that approach, not based on the listed procedure codes. Does that mean that (these) fee rates would be … correct and (that) previously colonoscopy claims are incorrect which means we need to reconcile?” Mendiola asked.
GMH again could not provide an immediate answer and informed Mendiola that a written response would be provided.
Without any answers, Hechanova concluded the public hearing and noted that the next hearing would be held in the next quarter.
Guam Memorial Hospital in Tamuning on Thursday, Sept. 21, 2023. GMH proposes 202 new fees during public hearing on Friday.
