Effect of state legislation prohibiting denial of emergency department patient claims

Study objective: On July 1, 1996, two Florida state laws were implemented to prevent denial of legitimate patient claims. Our objective was to determine whether the laws have been effective in reducing inappropriate denials as measured by the proportion of claims and charges denied. Methods: A compr...

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Bibliographic Details
Published in:Annals of emergency medicine 2000-03, Vol.35 (3), p.267-271
Main Authors: Seaberg, David C., Stimler, John E., Wears, Robert L.
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Emergency and intensive care: techniques, logistics
Emergency Service, Hospital - economics
Emergency Service, Hospital - legislation & jurisprudence
Emergency Service, Hospital - statistics & numerical data
Florida
Humans
Insurance Claim Review - economics
Insurance Claim Review - legislation & jurisprudence
Insurance Claim Review - statistics & numerical data
Insurance, Health, Reimbursement - economics
Intensive care medicine
Intensive care unit. Emergency transport systems. Emergency, hospital ward
Medical sciences
Statistics, Nonparametric
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Summary:Study objective: On July 1, 1996, two Florida state laws were implemented to prevent denial of legitimate patient claims. Our objective was to determine whether the laws have been effective in reducing inappropriate denials as measured by the proportion of claims and charges denied. Methods: A comprehensive set of claims for in-state emergency physician services from a physician billing company were analyzed for the period January 1996 through June 1997, covering 6 months before and 12 months after the effective date of state legislation. The number of facilities included in the data varied from 55 to 67 (mean 63). Denials were classified into 6 categories by payer type. Gross denials were those claims that were completely not paid by the payer, net denials represented the amount denied after patient payments. Downcoding was not examined in this study. Main outcome measures were the proportion of claims and charges denied before and after July 1, 1996. Results: The classification of relative proportions of primary payers did not change appreciably over the study period. The proportion of denied claims decreased significantly (Kruskal-Wallis P
ISSN:0196-0644
1097-6760
DOI:10.1016/S0196-0644(00)70078-3