Related Experiment Videos
Enforcing prompt-payment regulations: the Texas approach
Jim E McCoy1, Michael C Han, Michael S Malloy
1Ernst & Young, LLP, Dallas, Texas, USA. jim.mccoy@ey.com
Summary
Texas regulations aim for timely insurance payments to providers. While restitution has been made, challenges like clean claims and payment discrepancies persist.
Area of Science:
- Healthcare Administration
- Health Insurance Policy
- Provider Payment Systems
Background:
- Texas implemented strict regulations to ensure timely insurance payments for healthcare providers.
- Enforcement of these regulations has resulted in significant restitution payments for numerous providers.
- Despite regulatory efforts, persistent issues impact the payment process.
Purpose of the Study:
- To analyze the impact of Texas's payment regulations on healthcare providers.
- To identify ongoing challenges in the insurance payment process for providers.
- To evaluate the effectiveness of current regulations in ensuring timely and accurate payments.
Main Methods:
- Review of Texas insurance payment regulations.
- Analysis of restitution payment data.
- Identification and categorization of common provider payment issues.
Main Results:
- Regulatory enforcement has led to restitution for many providers.
- Key challenges include clean claims processing, underpayment, and payment date discrepancies.
- Self-funded claims present unique difficulties within the current system.
Conclusions:
- Texas regulations have improved payment timeliness for some providers through restitution.
- Addressing issues like clean claims, underpayment, and payment date discrepancies is crucial.
- Further refinements to regulations may be needed to fully resolve payment challenges, particularly for self-funded claims.