ADSE tightens rules on non-urgent transport of patients from June 1st – Public Service

Changes to the prices to be paid for births and services provided by IPSS are scheduled for tomorrow, but ADSE decided to send other changes to June 1st: the rules of non-urgent transport of patients will be changed with a view to combating “abuse and fraud to which ADSE cannot remain oblivious” and the price paid to those agreed by the intraoperative prostheses will also change.

In the case of transport, ADSE, which currently does not determine maximum values, says in a note that it has come across c“very large” costs It is “huge discrepancies” regarding “exit fee”, “waiting fee” and “value per kilometer”.

Two examples are given, paid 100% by ADSE. In one of them, the The same carrier based in Olhão “charged 6 times more for a trip within the city of Faro than for a trip to Coimbra“.

Situations that “indicate the practice of acts of abuse and fraud which ADSE cannot remain unaware of”, explains a note to beneficiaries contained in a statement from ADSE.

On June 1st, changes to two tables of the free regime came into effect, which were considered necessary to “clarify certain codes in the transport table, expand and densify the categories and limits of contributions, eliminate disparities and improve the coherence of the regime” .

Each type of transport now includes five components of paid services with a maximum reimbursement value, “and the contribution will, consequently, be awarded based on the kilometers travelled”.

ADSE emphasizes that it “continues to provide 100% coverage for situations in which transport is used by hemodialysis, cobalt therapy, paramyloidosis or hemophilia patients.”

Documents with detailed changes and invoice requirements were made available in advance and can be consulted here.

Price of prosthetics changes for providers

On the same date, June 1st, the table of intraoperative prosthetics of the agreed regime will also change, although with no impact on the beneficiary.

In a second note to beneficiaries, ADSE says that it initially had a fixed price list for intraoperative prostheses but that, considering the arguments presented by small providers, who have less negotiating capacity, “a rule was created that allowed the presentation of the acquisition invoice of these materials whenever the purchase price was higher than that set by ADSE.

“Surprisingly, it turned out that it was the large providers who, based on the established rule, took advantage of their flexibility to present a high number of acquisition invoices with prices much higher than those set in the table”.

ADSE says it found price variations “greater than 100% and up to 200% for the same intraoperative prostheses”, from the same supplier and with the same code, between different providers.

Therefore, new rules with maximum prices were established and new codes were introduced, which can be consulted here.

Despite this, ADSE estimates that the expenditure incurred will increase by 206.9 thousand euros, out of a total of 16.4 million euros (1.2%), which means that, overall, providers will receive more.

Births increase from tomorrow

As Negócios reported earlier this month, a significant increase in the prices charged to beneficiaries and ADSE for births was also in preparation – between 15% and 32%, according to official information provided at the time – as well as a review of background in the table applicable to IPSS.

Official source confirms that the tables that come into force this Wednesday, May 1st, have already been published for consultation on the ADSE website.