The nation's largest healthcare plans are improving the accuracy, timeliness and transparency of their claims, but there is still wide variation in how often companies deny claims and the reasons given for those denials, according to the second annual National Health Insurer Report Card released by the American Medical Association.
AMA's report card on health insurers finds gains
Calling current practices "a real murky mess" that bogs physicians down in paperwork, AMA Trustee William Dolan said current estimates put billing expenses at 14% of physician gross revenue and called for reducing that to 1%.
Mark Rieger, CEO of Sacramento, Calif.-based National Healthcare Exchange Services, which helped develop the report card with the AMA, said prompt-pay laws appear to be helping, as five of eight insurers studied showed slight improvements in reducing response times to physician claims.
Although the document is described as a "report card," no grades are given nor are the individual companies ranked. Its findings were based on a random sample of about 1.6 million electronic claims for some 2.5 million medical services submitted in February and March to Aetna, Anthem Blue Cross Blue Shield, Cigna Corp., Coventry Health Care, Health Net, Humana, Medicare and UnitedHealth Group, according to a news release.
Reiger added that the existence of the AMA's report cards has also helped. “I think the AMA would say that, as a result of the first report card in 2008, we got the payers' attention,” Rieger said, adding that the report cards' focus on denials, timeliness, accuracy and transparency identified what was meaningful to physicians, used valid data, and showed that there was “plenty of room for improvement.”
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