TMA Supports Medicaid HMOs Paying Claims in 15 Days

TMA Testimony by Doug Curran, MD

House Human Services Committee
House Bill 2647
April 16, 2013

Good afternoon. I am Doug Curran, MD, a family physician from Athens, Texas, and member of the Texas Medical Association’s Board of Trustees. Thank you for the opportunity to testify. I am here to speak strongly in favor of House Bill 2647 by Representative Munoz, which would expedite and simplify Medicaid HMO payments by requiring the plans to pay clean claims within 15 days and to accept documents relating to the claim in an electronic format.

A clean claim is one submitted with all the necessary and correct information for a health plan to process it. Currently, the Medicaid HMOs are statutorily required to pay clean claims with 45 days. The Texas Health and Human Services Commission (HHSC) contractually establishes a limit of 30 days.

However, several of the Medicaid HMOs have cut this timeframe even further, paying clean claims in 15 days, establishing a best practice for the industry. Their ability and willingness to pay more quickly financially benefits physicians tremendously, particularly high-volume rural Medicaid practices such as mine, but also those along the border and in inner city Texas, which operate on very tight margins.

Medicaid is the lowest payer in my practice. On average, Medicaid pays less than half of what I receive from a commercial insurer for the same service. Last session, lawmakers cut Medicaid payments by 20 percent for some of the sickest and poorest patients who qualify for both Medicare and Medicaid. To stay in Medicaid, physicians must operate ever more efficiently. While it is imperative that the legislature also improve Medicaid payments, tightening claims payment timelines also will benefit us by providing payment stability and improved cash flow.

Additionally, the ability to submit documents electronically — such as clinical records — is more efficient and will streamline our claims submission processes, thus minimizing office overhead.

While the changes in the bill may seem minimal, if enacted, they will enormously benefit Medicaid physicians across the state, bolstering TMA’s efforts to strengthen the Medicaid physician network. I urge your support for this legislation.

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