Doctor surveys put teeth in prompt-payment laws

Asking physicians to track how fast they are paid by health plans is an effective tool to gain prompt-payment laws and tough enforcement.

Editorial. July 23, 2001.

A recent AMA poll of state medical societies reported that the No. 1 private-sector concern of their members was prompt payment.

The good news is that state lawmakers also have made prompt payment a priority. All told, 44 states have laws -- Oregon, this month, is the latest -- that require health plans, in varying degrees, to pay their claims in a timely manner.

Significantly, many states have revisited the problem and have passed second-generation laws to toughen the weak standards that plagued early legislation.

Enacting legislation is one thing; enforcing it is another. Officials in some states are setting a commendable standard for holding health plans to their obligations and the letter of the law. We profiled one last month -- Georgia Insurance Commissioner John W. Oxendine. State officials in Ohio, New York and Connecticut also have demonstrated that they take prompt payment seriously.

Yet for all the progress, it still remains too early to tell if prompt-payment laws will live up to their potential. Laws differ state to state. For any given law, expect health plans to find and exploit any loophole.

Physician-payment surveys have been an important strategy in developing and enforcing strong laws. The surveys report actual physician experience with getting paid -- hard evidence, not easily dismissed as physician griping. The AMA has been a leading advocate for the surveys. Its system has been used directly by 35 state and county medical societies, and the Association has advised many more on how to do them. [...]