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Reports indicate insurer claim errors and complaints are down
e-Reports, Nov. 5, 2012
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The ISMA checked out those claims with member practices Untitled document

If you look forward to a day when commercial insurers pay all your claims accurately the first time, you may be encouraged by a couple reports. The AMA’s National Health Insurer Report Card indicated error rates for private health insurers on paid medical claims dropped from 19.3 percent in 2011 to 9.5 percent in 2012.

And the Indiana Department of Insurance (IDOI) Complaint Index, using last year’s data, shows two of the state’s largest insurers had significant drops in number of complaints filed.

The encouraging news
In the AMA report, UnitedHealthcare came out on top of seven large commercial health insurers for the second year in a row with an accuracy rating of 98.3 percent. Anthem Blue Cross Blue Shield, with the previous year's worst accuracy rating, made the most improvement with an accuracy rating of 88.6 percent. Humana rounded out the list with an accuracy rating of 87.4 percent.

Find the AMA Report Card here.

The IDOI index showed UnitedHealthcare making great strides. Complaints went from 128 in 2009, to 108 in 2010, to just six in 2011.

"As the industry becomes more complicated, we recognize the importance of supporting physician practices, striving for administrative ease and providing personal touch,” said Joseph Baraber, UnitedHealthcare’s director of Provider Relations.

Contact UnitedHealthcare’s Provider Relations via email.

See the IDOI Complaint Index here.

Cathy Yoder M.D. and assistants
Michele East (standing, left) and Valerie Haywood (seated) handle billing for Cathy Yoder, M.D., (standing, right); Eric Wallisa, M.D., Rhonda Goul, M.D., and David Williams, M.D., of Southside Family Medical Group in Indianapolis.

Real world experience
The ISMA sought to validate these reports with member medical practices. Here’s what we discovered about claim errors being cut in half.

“I would say from a 50,000 foot perspective that statement is true,” said Linda Wilgus, C.P.A., C.M.P.E., executive director and CFO of Northwest Radiology in Indianapolis. “Our overall denial rate for what we would call insurance company errors is down 8 percent.

Yet, Wilgus says filing claims has become more difficult. “Digging deeper, we still see a significant level of denials because the insurance companies have more claim edits and/or denial reasons than in the past.”

“That’s more burden placed on the provider, making us expend more resources to file a ‘clean claim’ with all the correct modifiers, etc.,” said Wilgus.

Team Leader Sandra Thompson in the billing department at Wagoner Medical Center (WMC) in Burlington reported most problems with commercial insurers are in the past. “Since 2009, working accounts receivable on a monthly basis, we have had fewer problem and denials,” she said. “WMC is paid in a timely manner at this time.”

Michael Yoder handles billing and finances for Southside Family Medical Group where his wife, Cathy Yoder, M.D., and three other physicians have an active independent practice. Yoder has experienced a decrease in denials in the last four months.

“Claims are paid timely for the most part – in just under 30 days for commercial insurers,” he said. “However, I don’t know if that can be attributed to actions of the insurance companies. I give my staff credit for doing a great job.”

ISMA’s practice advisors can assist you with denials, and each summer’s Commercial Payer Forum brings insurers to one location for updates and issue resolution. Call the ISMA for information.

Have an insurer complaint?
If you’re surprised that insurer complaints are lower, perhaps it’s because fewer practices take the time to complain. You can file a complaint with the IDOI any time by completing a form online at in.gov.

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