One in five medical claims is processed incorrectly by health insurers, according to the American Medical Association in its third annual report on the topic. Health insurers had an accuracy rate for processing and paying claims of 80% overall.
Coventry Health Care rated first in accuracy, with 88.4% of claims processed and paid correctly, out of seven major insurers measured. About $777.6 million in administrative costs could be saved by improving claims payment accuracy by 1 percentage point, the AMA estimates.
Getting to 100% claims payment accuracy would save up to $15.5 billion, according to the AMA. “Creating a single transparent set of processing and payment rules for the health insurance industry would create systemwide savings and allow physicians to direct time and resources to patient care and away from excessive paperwork,” says Nancy Nielsen, M.D., former president of the AMA, in a written statement.
According to a statement from America's Health Insurance Plans, “Health plans and providers share the responsibility of making the innovations and investments needed to improve efficiency in our healthcare system.” A recent AHIP survey found that “nearly one-fifth of all provider claims are not submitted to health plans electronically, and more than 1 in 5 claims are submitted by providers at least 30 days after the delivery of care.”