AMA: Nearly one in five medical claims processed inaccurately
By Bruce Japsen
Chicago Tribune staff reporter
2:02 PM CDT, June 20, 2011
Health insurance companies are inaccurately processing nearly one in five medical claims, slowing payments to doctors and adding bureaucratic headaches to patients, the American Medical Association said this morning.
In its annual report card on the health insurance industry, released during the the group's annual House of Delegates meeting here, the AMA said commercial health insurance companies have an error rate of 19.3 percent, up 2 percentage points from last year's report.
Improving claims processing could save patients money and improve medical care by reducing hassles physicians have when they are forced to haggle with health plans over payments or other issues. The AMA said the report is designed to hold insurance companies accountable.
"A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes $17 billion annually," said Dr. Barbara McAneny, an AMA board member and medical oncologist from New Mexico. "Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care."
The AMA's report measured timeliness and accuracy of claims processing of the nation's seven largest health insurers, including Aetna Inc.; Humana Inc.; UnitedHealth Group; and Chicago-based Health Care Service Corp., parent of Blue Cross and Blue Shield of Illinois and Blues plans in Oklahoma, Texas and New Mexico.
UnitedHealth had the best rating at 90.23 percent followed by Regence Group Blue Cross Blue Shield at 88.41 percent and then Health Care Service at Service at 87.04 percent. Anthem Blue Cross Blue Shield was last among the nation's largest insurers with a 61.05 percent accuracy rating, the AMA said.
For its part, the insurance industry said health plans continue to reduce costs and improve efficiencies.
"Each year, (Health Care Service Corp.'s) Blue Cross and Blue Shield plans go through dozens of comprehensive, independent, third-party audits of the accuracy and timeliness of our claims administration," Health Care Service spokesman Ross Blackstone said. "These audits show that we process claims accurately more than 99 percent of the time. The quality and effectiveness of claims processing is an ongoing priority."
The AMA report pointed out areas where health plans have improved, such as reductions in "denial rates" and in "claims response time."
"Government data also show that the portion of health insurance premiums going to health plans' administrative costs has declined for six straight years," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans, which represents the nation's health insurance industry.
The AMA report's findings are based on a random sample of about 2.4 million electronic claims for about 4 million medical services submitted in February and March.
The problem is not just doctors, health plans say, but physicians who have yet to upgrade to electronic means of submitting their claims.
Nearly one in five claims to health insurance companies are not submitted to health plans electronically, AHIP said, citing its own survey of health insurance companies. In addition, America's Health Insurance Plans said "more than one in five claims are submitted by providers at least 30 days after the delivery of care."
The problem, health plans say, falls on both doctors and insurance companies to get it right for their patients and consumers.
"Health plans and providers share the responsibility of further improving the accuracy and efficiency of claims payment," Zirkelbach said. "Health plans are doing their part by collaborating with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly."
bjapsen@tribune.com
Twitter @brucejapsen
http://www.healthkey.com/chi-ama-nearly-one-in-five-medical-claims-processed-inaccurately--20110620,0,3471870.story?track=rss&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+latimes%2Ffeatures%2Fhealth+%28L.A.+Times+-+Health%29
Topic: AMA: Nearly one in five medical claims processed inaccurately (Read 2895 times)