Practice Management Alert

Plus, you received no payment at all on nearly 23 percent of claims submitted to commercial payers.

American Medical Association (AMA) released its fourth annual National Health Insurer Report Card (NHIRC) last month, and the findings don't paint a pretty picture. According to the AMA, commercial payers show an average claimsprocessing error rate of 19.3 percent. That represents a two percent increase over last year.

"A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually," said AMA Board Member Barbara L. McAneny, M.D., in the AMA press release. "Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care."

UnitedHealthcare was the only payer included in the 2011 report card that showed an improvement in claims-processing accuracy. UnitedHealthcare ranked first in the list of seven leading commercial payers with an accuracy rating of 90.23 percent. The worse score -- 61.05 percent -- went to Anthem Blue Cross Blue Shield.

Additionally: The report card also showed that you received no payment at all on nearly 23 percent of claims you submitted to commercial payers. "There are many reasons a legitimate claim may go unpaid by an insurer," the AMA press release indicates. "Claims may be denied, edited or deferred to patients. During Feb. and March of this year, the most common reason insurers didn't issue a payment was due to deductible requirements that shiftpayment responsibility to patients until a dollar limit is exceeded. Real-time claims processing would save time and money."

Good news: There were lower denial rates for many of the payers included in the report, including Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation and UnitedHealthcare. Cigna continues to have the lowest denial rate -- .68 percent this year.

Plus, the report card shows that two payers -- Cigna and Humana -- cut their median claims response time in half during the last four years.

To read the complete AMA report, visit www.ama-assn.org/go/reportcard.