The American Medical Association has issued a report card highly critical of the claims-processing performance of seven top insurers compared with Medicare. The influential medical group said that the report card, and a new campaign on billing practices, aims to highlight inefficiencies that add an estimated $210 billion a year to the U.S. healthcare system.
For the National Health Insurer Report Card, the AMA randomly sampled claims from 5 million electronically billed services processed by leading commercial health insurers. The insurers included were Aetna, Anthem Blue Cross and Blue Shield, Cigna, Coventry Health Care, Health Net, Humana and United Healthcare. The AMA found that variation in denial of claims ranged from 3% to 7%, and there was no consistency for explaining reasons for denied claims. Correct contracted-rate payments were made just 62% to 87% of the time, and more than half of the insurers dont provide physicians with the transparency needed for efficient claims processing, according to the report. Timeliness in payment and compliance with widely accepted pricing rules varied greatly as well.
Karen Ignagni, president and chief executive officer of Americas Health Insurance Plans, said in a statement that administrative simplification is a top priority for the group, adding that our view is that discussions of efficiency are important, but that they should be broad discussions of opportunities for improvement by all the responsible stakeholders. -- by Rebecca Vesely