AMA: Inaccuracy in claims payment is on the rise
Inaccurate claims payments have increased by 2 percent overall among commercial health insurers during the past year, according to the American Medical Association’s (AMA) fourth annual National Health Insurer Report Card.
Commercial health insurers now have an average claims-processing error rate of 19.3 percent, the AMA reported. That 2 percent increase represents $3.6 million more in erroneous claims payments compared to last year, and added an estimated $1.5 billion in unnecessary administrative costs to the health system. Eliminating health insurer claim payment errors would save approximately $17 billion, the Chicago-based organization stated.
Most of the health insurers measured by the AMA failed to improve their accuracy rating since last year. “UnitedHealthcare was the only commercial health insurer included in this year’s report card to demonstrate an improvement in claims-processing accuracy,” the association noted. “UnitedHealthcare came out on top of seven leading commercial health insurers with an accuracy rating of 90.23 percent. Anthem Blue Cross Blue Shield had scored the worst of those measured, with an accuracy rating of 61.05 percent."
The AMA's findings are based on a random sampling of approximately 2.4 million electronic claims for approximately 4 million medical services submitted in February and March to various insurers. Claims were accumulated from more than 400 physician practices in 80 medical specialties providing care in 42 states. Aetna, Anthem, CIGNA, Health Care Service Corporation, Humana, The Regence Group and UnitedHealthcare participated in the report.
“Physicians received no payment at all from commercial health insurers on nearly 23 percent of claims they submitted,” the AMA noted. “The most common reason insurers didn't issue a payment was due to deductible requirements that shift payment responsibility to patients until a dollar limit is exceeded.”
The report card for the first time measured how frequently claims included information on insurers requiring physicians to ask permission before performing a treatment or service. According to the report, CIGNA had the highest rate of claims requiring prior authorization, with more than 6 percent of claims indicating physician work associated with these requirements.
In addition to measuring overall claims-processing accuracy, the report card examined how accurately insurers reported the correct contract fees to physicians. UnitedHealthcare has shown consistent improvement during the last four years in reporting correct contract fees. CIGNA and Humana have cut their median claims response time in half during the last four years, the association noted.
The average response time for commercial health insurers varied from six to 15 median days, the AMA stated.
Commercial health insurers now have an average claims-processing error rate of 19.3 percent, the AMA reported. That 2 percent increase represents $3.6 million more in erroneous claims payments compared to last year, and added an estimated $1.5 billion in unnecessary administrative costs to the health system. Eliminating health insurer claim payment errors would save approximately $17 billion, the Chicago-based organization stated.
Most of the health insurers measured by the AMA failed to improve their accuracy rating since last year. “UnitedHealthcare was the only commercial health insurer included in this year’s report card to demonstrate an improvement in claims-processing accuracy,” the association noted. “UnitedHealthcare came out on top of seven leading commercial health insurers with an accuracy rating of 90.23 percent. Anthem Blue Cross Blue Shield had scored the worst of those measured, with an accuracy rating of 61.05 percent."
The AMA's findings are based on a random sampling of approximately 2.4 million electronic claims for approximately 4 million medical services submitted in February and March to various insurers. Claims were accumulated from more than 400 physician practices in 80 medical specialties providing care in 42 states. Aetna, Anthem, CIGNA, Health Care Service Corporation, Humana, The Regence Group and UnitedHealthcare participated in the report.
“Physicians received no payment at all from commercial health insurers on nearly 23 percent of claims they submitted,” the AMA noted. “The most common reason insurers didn't issue a payment was due to deductible requirements that shift payment responsibility to patients until a dollar limit is exceeded.”
The report card for the first time measured how frequently claims included information on insurers requiring physicians to ask permission before performing a treatment or service. According to the report, CIGNA had the highest rate of claims requiring prior authorization, with more than 6 percent of claims indicating physician work associated with these requirements.
In addition to measuring overall claims-processing accuracy, the report card examined how accurately insurers reported the correct contract fees to physicians. UnitedHealthcare has shown consistent improvement during the last four years in reporting correct contract fees. CIGNA and Humana have cut their median claims response time in half during the last four years, the association noted.
The average response time for commercial health insurers varied from six to 15 median days, the AMA stated.