Major health plans slow down payments
Medical providers may face delays in collecting billing claims from some major health plans. Some managed care organizations just can’t seem to manage their budgets, citing industry expansion and computer automation, a recent Wall Street Journal article reports.
For example, Aetna says that its payment lag to doctors and hospitals is a result of trying to absorb its $8.9 billion acquisition of U.S. Healthcare. Similarly, because it has been an "active acquirer of health plans," the Minneapolis-based United Healthcare Corporation admits to falling behind on claims.
These delays can also result from computer-based glitches, including a frequent area of controversy insufficient documentation. Trying to prove these claims are "clean" and ready for payment can take months at time, according to The Wall Street Journal. Typically, an HMO carries an average of 66 days of unpaid claims, which can range anywhere from 27 days to 120 days.
One such case is how New Jersey state insurance and health regulators have voluntarily agreed with 10 major HMO companies to pay clean claims within 60 days. If delinquencies occur, a 10% penalty must be paid and possibly late fines up to $1000 per violation.
The following sources were used in this month’s issue of Managed Care Strategies:
Randy Killian, MBA, MS, Executive Vice President, National Association of Managed Care Physicians and American Association of Integrated Healthcare Delivery Systems, 4435 Waterfront Drive, Suite 101, Glen Allen, VA 23060. Telephone: (804) 747-5823. Fax: (804) 747-5316.
Anne Ladd, Director of Statistical Publications, The Business Word, 5350 S. Roslyn St., Suite 400, Englewood, CO 80111. Telephone: (303) 967-0131.
Marjorie A. Satinsky, MBA, FACHE, Executive Director, ReXMed, 2709 Blue Ridge Road, Suite 301, Raleigh, NC 27607. Telephone: (919) 785-4799.
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