AMA grades health insurers on physician reimbursements

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Physicians are spending up to 14 percent of their total collections to obtain accurate payment for their services, but health insurers and other third-party payors may still inappropriately delay, deny or significantly reduce payments. In response, the American Medical Association (AMA) has created a report card to grade health insurers on how quickly and accurately physicians receive payment.

The significant savings that could be realized from more efficient claims processing could be better spent on increasing the quality of patient care and reducing the burden of high premium costs to consumers, according to the AMA.

The National Health Insurer Report Card compared Medicare and seven U.S. commercial health insurers on the timeliness and accuracy of claims processing and is based on a random sample drawn from 3 million claims.

AMA’s report card was created to provide physicians and the public with an objective and reliable source of information on the timeliness, transparency and accuracy of claims processing by the health insurance companies that are responsible for paying medical bills.

The measures were selected because they are critical to the healthcare claims process, and provide actionable data that physicians and payors can use to improve the efficiency of billing and collections, thereby reducing overall healthcare costs to patients, physicians, employers, health insurers and other payors, according to the association.

The Associated Press (AP) reported that UnitedHealthcare had the lowest rate of contract compliance, according to the AMA report. About 62 percent of medical services billed were paid by UnitedHealthcare at the contracted rate, compared with 71 percent for Aetna and 98 percent for Medicare.

UnitedHealthcare spokesman Gregory Thompson told the AP that doctors and their billing services share responsibility for prompt payment. He said UnitedHealthcare has improved its electronic claims systems and noted the AMA gave the company higher ratings on other measures.

The report card is one resource supporting the AMA’s November Cure for Claims Month, part of an ongoing campaign that calls on both physicians and payers to do their part to eliminate waste in the claims process by getting it right the first time to improve claims processing efficiency and help reduce physician practices’ cost of submitting claims to the ultimate goal of 1 percent of collections.

In addition, AMA said the effort encourages physicians to understand the cost of a contract to their practices and to request and obtain the transparent, non-ambiguous electronic information they need from third-party payors to be paid accurately and efficiently.

Physicians can sign up or visit each payor/provider portal, as available, to access their contracted fee schedules, medical payment policies and claim edits that are applied to the physician’s frequently billed procedures and services.

Results from the National Health Insurer Report Card are posted for public viewing.