The National Kidney and Transplant Institute's (NKTI) claims for refund which had been rejected by the Philippine Health Insurance Corporation (PhilHealth) had increased from P50.32 million in 2021 to P242.92 million in 2022. Also, the Commission on Audit (COA) said in its report that there was an increase in claims which were denied with finality from P4.15 million in 2021 to P4.94 million in 2022. "These claims were returned to the hospital (RTH) and were denied reimbursement or payment by PhilHealth for various reasons," the COA said. It pointed out that the more common reasons are incomplete data provided about the patient or treatment; confinement of less than 24 hours; the attending physician was not accredited by PhilHealth; and cases that are not compensable under implementing rules and regulations of Republic Act No. 7875 or the National Health Insurance Act of 2013. "Management averred that despite their efforts, the reasons of RTH and denied claims are beyond their control and rest solely on the judgment of PhilHealth evaluators and the constant change of guidelines and requirements implemented by PhilHealth, thus affecting the validity and effectivity of the submitted claims," it said. Because of the RTH and denied claims, the COA questioned the "reliability and fair representation" of NKTI's asset accounts in the financial statements. While NKTI expressed hopes that its RTH and denied claims would be reconsidered by PhilHealth, COA stressed that the NKTI should exclude or deduct these RTH and denied claims from the total receivables from PhilHealth in order to establish "faithful representation in financial reporting." It also said that NKTI should require its Billing and Claims Division to strictly adhere to PhilHealth Circular No. 2019-0001 dated Jan. 10, 2019 for the proper recording of RTH and denied claims for recognition of accounting records. At the same time, the billing department should "thoroughly evaluate the RTH and denied claims for reimbursement of benefits and explore all possible remedies to have them reconsidered by PhilHealth,” it added.