Regarding payment penalty, the calculations begin with “billed charges.” If I bill at the contracted rate, do I forfeit the opportunity for a penalty?
If there’s no difference between the contracted rate and your billed charges, there’s no difference upon which to compute a penalty. Q: A payer misses the statutory claims payment period deadline and is in the 1-45 day penalty period. According to 28 TAC ยง21.2815(a)(1), “if the claim is paid on or before the 45th day after the end of the applicable 21-, 30- or 45-day statutory claims payment period, pay to the preferred provider, in addition to the contracted rate owed on the claim, a penalty in the amount of the lesser of: …” Does the language “in addition to” require that the payer pay the penalty at the same time that the late claim is paid? What if the payer pays the contracted rate owed on the claim but does not pay the penalty at the same time? Does any additional penalty accrue until such time as the payer pays the penalty amount? Is there a violation if a payer elects to pay penalties periodically, say once a quarter for instance, rather that at the time the claims are paid?
