Missouri to Survey Health Providers Over Untimely Reimbursements

Thursday, Sep 17,2009, 2:13:31 PM Click:

Missouri insurance regulators are investigating complaints from health care providers that health insurers are withholding reimbursement payments for improper and extreme lengths of time.

Gov. Jay Nixon issued an executive order for the Department of Insurance, Financial Institutions and Professional Registration to determine the timeliness of payments to doctors and hospitals. The order launched a "Prompt Pay for a Healthy Missouri Project" to examine issues relating to the timely reimbursement of Missouri hospitals and health care providers by health insurance companies.

Officials are distributing a survey to physicians, hospitals and other health care providers asking for information on outstanding and overdue claims and the reasons health insurers have provided for any delay in payment, DIFP spokesman Travis Ford said.

"We have hundreds of complaints comprising thousands of claims," Ford said.

DIFP Director John Huff will issue a report, potentially with recommendations for future regulation or legislation, to the governor by Dec. 31, 2009. The 2010 legislative session will begin in early January.

Complaint volume for 2009 is already six times as high as it was for all of 2006, according to the DIFP. Under Missouri's prompt-pay statutes, health insurers are required to respond to and pay claims within specific time frames, under threat of penalties and interest payments. According to the executive order, a lack of timely claims payments "may significantly compromise" the functions of health care providers.

"This problem hits small and rural providers hardest, straining their cash flow and requiring them to dedicate staff time to paperwork and collections," Huff said in a statement.

Examples cited by the insurance department include a rural hospital in eastern Missouri waiting more than two years for reimbursement of $300,000; a central Missouri anesthesia practice with $120,000 in outstanding claims; and a St. Louis-area hospital citing more than 3,000 unpaid claims.