Responses to a payment policy denying professional charges for diagnostic imaging by nonradiologist physicians.
- To assess the impact of a payment policy denying reimbursement for the imaging-related professional services of nonradiologist physicians by comparing the use of and expenditures for diagnostic imaging examinations before and after implementation of the policy.
- Retrospective economic evaluation of claims and expenditures for diagnostic imaging examinations filed by physicians practicing in the 20 US counties having the greatest number of United Mine Workers of America Health and Retirement Funds (hereafter referred to as Funds) beneficiaries.
- Insurance claims database of Funds beneficiaries, most of whom are elderly and live in rural communities and small towns.
- The January 1,1993, implementation of a reimbursement policy denying payment of professional claims for diagnostic imaging of nonradiologist physicians.
Main Outcome Measures
- Numbers and types of eligible claims and Funds payments for diagnostic imaging examinations during the year before and after the intervention, normalized for changes in the number of beneficiaries.
- Despite the rejection of $811 466 in claims disallowed by the policy, the Funds paid 12% more for diagnostic imaging performed in the 20 counties we studied during 1993 than during 1992.
- Despite a payment policy designed, in part, to reduce the Funds'imaging-related expenditures, the physicians we studied filed more claims, leading to greater expenditures.
Mots-clés Pascal : Assurance maladie, Imagerie médicale, Interprétation, Radiologue, Economie santé, Attitude, Homme, Amérique du Nord, Amérique
Mots-clés Pascal anglais : Health insurance, Medical imagery, Interpretation, Radiologist, Health economy, Attitude, Human, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0551754
Code Inist : 002B30A05. Création : 01/03/1996.