According to a study, the conventional deadlines are not respected in more than 50% of the bills of patients in third party payment. The situation is most critical for the patient benefiting from State Medical Aid.
The Health Insurance today pays the liberal doctor directly, without advance of costs for the patient, when the latter is covered by CMU or AME (State medical aid): this is the third-party payment mechanism. This mechanism is based on the doctor sending a paper (FSP) or electronic (FSE) treatment sheet as part of the teletransmission. A device that guarantees the doctor’s payment within the agreed time limits? Not really, according to a recent study conducted in France. This reveals that the contractual deadlines for third-party payment would not be respected in more than 50% of cases. This is worrying news for doctors, while the next health bill provides for the extension of third-party payment to the entire population.
2 months for the payment of a paper invoice
To reach this conclusion, Drs Bertrand Legrand and Thomas Rémy, first installed in Tourcoing for seven years and replacing for the second, studied the 65,169 third-party payment invoices between January 2009 and December 2013 in their group practice of general practitioners. The objective for these doctors was to study the payment terms in real life and those estimated in the report on the third-party payment for town medicine consultations submitted by IGAS to the Minister in July 2013. And the results are final.
All invoices combined (FSE and FSP), the difference is quite simply from the simple to the double between the findings of the doctors of Tourcoing and those of the IGAS. The study finds an average payment deadline of 10.7 days, while IGAS announces an average deadline of 5 days.
For the FSP only, the study finds an average delay of 58 days, while the IGAS announces an average delay of 15 days. Finally, for FSEs, the study finds an average payment deadline of 6.15 days, while IGAS variably announces a deadline of 4 days, 2 days, or 5 days.
Conclusion, the contractual deadlines do not seem to be respected, so all of the FSEs should be settled within 5 working days (art. 48 of the agreement), and all of the FSPs should be settled within 20 days (art. 52 of the agreement). ).
AME: a discriminating factor
In addition, the payment period increases significantly (average at 64 days) in the event of coverage of the insured by the AME (illegal aliens whose care is covered by the State for health reasons) or if the care sheet is issued before / during the first semester of the year or between the 4the day and 7e day of the week.
A study to be carried out on the whole of the territory
In conclusion, the authors of the study want the IGAS methodology to be made public in order to objectively discuss these contradictory results. And for them, these preliminary results raise questions about the current operation of third-party payment. “Very sincerely, I fear the generalization of third-party payment, which risks threatening the cash flow of doctors’ offices. In the event of late payment by health insurance for an entire patient population, the effect can be disastrous, ”says Dr. Bertrand Legrand, main author of the study, contacted by why actor.
Finally, the latter appeals to the Health Insurance or, failing that, to representative groups in order to launch an independent control study on a larger sample of invoices.
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