MANAGED CARE January 2010. ©MediMedia USA
National health insurers are paying physicians 5.3 percent faster and denying 9 percent fewer medical claims than last year, according to a survey from Athenahealth.
The survey measured payer performance in seven areas, including days in accounts receivable, first-pass resolution rate (the rate that the claim is adjudicated the first time it is submitted), percent patient liability (the percentage of billed charges deemed by the payer to be the patient’s responsibility, e.g., copayments and deductibles), denial rate, claim-denial transparency, and percentage of claims requiring medical documentation.
These metrics “measure the onus that’s on medical practices in having to deal with payers from a financial and administrative standpoint — not how much they’re getting paid, but the complexity and the challenge of getting paid,” says John Hallock, director of corporate communications.
Commercial insurers seem to be interested in the findings and make efforts to improve their rankings, he says. “Unfortunately, Medicaid plans are not doing so well in comparison,” he notes. The survey found that in states in which the pay was as high as in commercial plans, physicians would accept Medicaid patients if the hassle was much less.
“Medicaid may pay the doctor only $30, but add insult to injury by making him wait seven or eight months for payment. It makes the doctor less likely to want to participate,” Hallock says.
Survey findings were compiled from over 41 million medical charges, worth $7 billion in 47 states.
Who pays fastest?
Humana had claims for the fewest days (26.7) in accounts receivable, followed by Aetna (28.4), Cigna (30.0), UnitedHealth Group (33.2), Medicare (33.4), and WellPoint (35.9).
Source: Athenahealth Inc.