BUSINESSCleaning your claims: How to improve your chances for prompt paymentExperts offer tips on getting your reimbursement forms complete and correct the first time, which should speed insurance payments.By Jonathan G. Bethely, amednews staff. Aug. 21, 2006. For the last decade or so, just about every state legislature has adopted or refined laws that mandate insurers pay promptly for "clean claims" -- ones that contain all the necessary information when the physician sends it to the health plan. And yet, physicians complain that health plans still find ways to delay payment past the 15- to 60-day windows set by most state laws. Physicians say plans haggle over typographical errors, demand extra information after submission, or otherwise find petty ways of delaying payment. A survey by Athenahealth, a Watertown, Mass.-based claims-processing company shows that, indeed, not all plans process claims at the same speed. Health plans, however, maintain they pay clean claims on time, and that any payment problems stem from physicians filling out forms incorrectly or sending claims in late. According to a study conducted this year by America's Health Insurance Plans, 29% of physician claims were submitted more than 30 days after the point of service, and 15% were submitted more than 60 days after service. One point both sides can agree on is that even when laws state a deadline for paying "clean claims," they don't define what a "clean claim" is. The AMA is among many medical organizations calling for, and working for, changes in laws to close the loopholes that let insurers define it at will. Meanwhile, consultants suggest practices submit claims as soon as possible after the patient visit, and they note that the longer the delay, the more likely an error will be included. [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2006 American Medical Association. All rights reserved.
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