A consortium of five state and three national medical societies coordinated by the American Medical Association have issued a formal letter of complaint to claims clearinghouse WebMD, alleging poor service and noncompliance with HIPAA requirements.
Joining the AMA in the complaint were the American Academy of Family Physicians, the American College of Physicians, the Arkansas Medical Society, the Colorado Medical Society, the Iowa Medical Society, the Kentucky Medical Association and the Texas Medical Association.
Their letter, sent Jan. 8 to WebMD CEO Roger Holstein, said the associations "have received numerous complaints from individual physicians regarding lost claims, incomplete claims transmissions, and lack of connectivity between WebMD and health insurers' internal claims management systems as well as the practice management software systems employed by physician practices.
"These transaction problems have resulted in thousands, and in some cases, hundreds of thousands of dollars in delayed and denied claims payments to physicians by health plans and other third-party payers."
The letter continued: "While many types of concerns and numerous entities have been identified, physicians have identified WebMD most frequently as being non-compliant with HIPAA Transaction and Code Set standards. Information received by the AMA suggests that claims submitted to WebMD in a HIPAA compliant format for processing are sometimes never received by health plans, significantly delayed, or transmitted with missing or non-compliant information, often resulting in delayed or denied payments to physicians."
Problems as early as September
Steven Zinn, M.D., managing partner with the 53-year-old Austin (Texas) Anesthesiology Group, said his group started noticing problems with WebMD as early as September 2003 and by now, "basically, we're several hundred thousands of dollars behind in a practice of 60 M.D.s, and the problem's still not fixed."
Zinn said his group uses the Texas Health Information Network, or THIN, as its claims clearinghouse, because THIN has a contract with Blue Cross Blue Shield of Texas, the largest payer in the Austin area. But Zinn's group still does a large volume of business with patients covered by UnitedHealthcare, which uses WebMD, he said.
A large number of the problems they've experienced are with United claims handed off to WebMD by THIN, he said. They don't go through.
"We're being forced to submit our claims manually, either loading them onto a Web site or submitting them on paper," he said.
The worst part for medical groups, Zinn said, was no one told them there was a problem.
"They had to find out for themselves," he said. "The payers and the intermediaries have not been forthcoming, letting people know the problem has been there."
Jennifer Meyer, vice president of corporate communications for WebMD, said the Elmwood Park, N.J.-based claims clearinghouse is aware of technical difficulties it experienced that led to delayed claims payments affecting what she called a "tiny fraction" of the 2 billion claims it processes from 200,000 providers in a year.
"We fully appreciate the impact to providers," Meyer said. "We're working to rapidly resolve the issues as they occur."
Meyer said WebMD has been in contact with the AMA and the other groups and is trying to set up a meeting to address the concerns raised in the letter.
Rural practices having particular difficulties
Patrick Padgett, staff counsel for the Kentucky Medical Association, said its members' complaints also started coming in last fall. They weren't inundated, he said, but there were "specific problems from specific practices, and they weren't getting much satisfaction out of WebMD."
In particular, rural practices, which have special billing requirements, seemed to be having problems, he said.
"Two practices were having problems getting claims submitted to our Medicaid program. When they tried to get them resolved, they just ran into a brick wall. One of the practices I talked to, it was all of their claims . . . in a couple of cases to the tune of tens of thousands of dollars."
Padgett said he heard similar service complaints about WebMD from payers as well as physicians.
"It was the first we'd heard about problems from both ends," he said.
The letter said "several physician practices report having had to resort to printing out hard copies of their claims. This process of 'dropping' what otherwise would be an electronic claim to paper and submitting it manually has been initiated by physicians in order to comply with contractual obligations for timely submission of claims to health plans."
Padgett said the state association has been in touch with local representatives of WebMD in an effort to resolve the problems.
'An end to it'?
Zinn, the Texas anesthesiologist, said there have been phone calls between his group and WebMD as recently as yesterday, but he remains skeptical.
"It was sort of, the check's in the mail," Zinn said. "They said they're running test batches. They said they think they've got the problem fixed. The first time we heard they got the problem fixed was Nov. 1."
Meanwhile, Zinn said, "We're paying overtime, but it's bad for morale of our administrative staff."
One way or the other, Zinn said, he's going to "put an end to it" if the problem isn't fixed in two weeks. Zinn said he will contract with multiple clearinghouses to eliminate the handoff problem. Losing the bulk discount with THIN, he said, will probably cost the group "several thousands more a year."
"It gives you a really bad feeling," Zinn said. "But I'm trying to focus on getting what's owed to the group."
Both Zinn and Padgett credit the AMA for organizing the various societies to make an effective protest.
"I think the AMA did a good job coordinating everything just to get WebMD's attention," Padgett said.
AMA President Donald Palmisano. M.D., said, "The AMA is pleased that WebMD has responded by indicating a desire to meet with us to discuss this further. The outcome cannot be determined until we have had the meeting with WebMD."