AMA's Payer Report Card: No A's

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  • July 1, 2011
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The American Medical Association’s (AMA) fourth annual National Health Insurer Report Card has good news for some payers, but not for the industry as a whole.
Overall, the rate of inaccurate claims payments increased 2 percent since last year’s report card among leading commercial health insurers, the AMA said. The commercial claims processing error averages 19.3 percent, the latest study found. This results in $3.6 million in erroneous claims payments and $1.5 in unnecessary administrative costs in the health system, the AMA maintains.

That’s the bad news. The good news is that even though six of the seven measured health insurers failed to improve on last year’s performance, UnitedHealthcare improved to a claims-processing accuracy rate of 90.23 percent. Of the others, Anthem Blue Cross Blue Shield fared the worst with an accuracy rating of 61.05 percent.
Other tracked outcomes noted in the report:
Insurer Non-payment: Physicians received no payment at all from payers on nearly 23 percent of claims. This includes denials, edits, and deferral to patients. The most common reason in the early part of this year was shifting payment to patients until deductible limits were exceeded.
Denials: Denial rates have been reduced at Aetna, Anthem BCBS, Health Care Service Corporation, and UnitedHealthcare, which cut its denial rate to 1.05 percent. Cigna has the lowest rate at .68 percent. The report says patient ineligibility is the most frequent reason for denials.
Administrative Requirements: A new category, this tracks how frequently claims must be preauthorized. Cigna has the highest rate of claims (6 percent) requiring prior authorization.
Timeliness: The report card finds that CIGNA and Humana have cut their median claims response time in half during the last four years.  Response time varies from six to 15 days.
The National Health Insurer Report Card is the cornerstone of the AMA’s Heal the Claims Process campaign. Launched in June 2008, the campaign’s goal is to spur improvements in the industry’s billing process so physicians and patients are no longer at the mercy of a chaotic payment system.

Certified Professional Coder-Payer CPC-P

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