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Despite legislation, prompt payment for radiology services 'elusive goal' in New Jersey

Medical providers in New Jersey are continuing to experience payment delays even after the state has implemented prompt payment laws, a situation that could have relevance across the U.S., says a new study published in the July 2004 issue of the American Journal of Roentgenology (AJR).

The study is a follow-up to a prior publication of delayed paid claims that also appeared in the AJR. In the current work, the authors focused on unpaid claims, analyzing 48,217 claims submitted in February, June and October of 2000 to six major payers for 93 radiologists in New Jersey. The percentage of completely unpaid claims after the legal 40-day limit was 28%; after 170 days, the percentage was 6%. The study shows that lost revenue from unpaid claims was 28 times greater than the lost interest associated with delayed payments.

According to lead author on the study Lawrence C. Swayne, MD, of Morristown Memorial Hospital and Morris Imaging Associates in Morristown, NJ, the issue of prompt payment has become prominent in managed care reform. "Payment abuses have become so widespread that prompt payment laws have been enacted in 47 states. Despite these efforts, our study suggests that managed care companies may pocket close to $20 billion per year for unpaid claims at the expense of U.S. physicians," said Dr. Swayne.

And it is not just the physicians who are affected, according to Dr. Swayne. "Ultimately, the general public bears the final burden. Patients without insurance or with insufficient insurance experience decreased access. Even patients with insurance coverage frequently discover their choices are limited as physicians are forced to cease participating with a tardy payer," he said.

In addition, the study found a clean claims filing rate of 97% that, according to the researchers, contradicts the managed care organizations' assertion that about 50% of provider submitted claims are flawed. Furthermore, they said, the majority of late payme
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1-Jul-2004


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