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Claims report reveals payer trends you can expect
e-Reports, Aug. 5, 2013
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If you thought claims payments from health insurers were slow last year, expect more of the same in the coming year, according to a new report.

The eighth annual PayerView® report, a project of anthenahealth, revealed the ANSI 5010 conversion from 4010, a federally required electronic transaction standards update, contributed to claims payment problems. The ANSI 5010 is needed for the ICD-10-CM medical coding transition.

“Practices may be in for significant practice disruption for the first three to six months of ICD-10 adoption and sustainably endure at least 15 percent increase in documentation time. The slowdown in claims resolution in 2012 may be minor compared with what’s ahead with ICD-10,” said the report.

The ranking, which reviews payers’ performance based on actual claims data of athenahealth providers, indicated only modest improvements in payments were made in 2012. The report found:

  • About 65 percent of payers continue to make enrollment difficult for physicians by requiring transactions be conducted by fax or mail.
  • Medicaid programs continue to underperform.
  • Only 17 percent of payers scored high in communicating information about their quality incentive programs.
  • The burden on physicians to collect more from their patients increased. The study’s authors advised that with rising co-pays, it is important for physicians to get accurate information from payers to collect the right amounts.

This year, Humana ranked first in overall performance in both National and Midwest rankings, even though its claims denial rate was slightly higher at 4.7 percent than second-ranked UnitedHealthcare at 3.4 percent. Blue Cross Blue Shield of Indiana placed 10th in the Midwest rankings with a 4.9 percent denial rate.

“With changing reimbursement models entering the scene and the influx of millions of new Medicare patients looking for care, there’s no slowing of challenges for both providers and payers,” said Todd Rothenhaus, M.D., athenahealth chief medical officer. “Because of these changing dynamics in health care, we explored a few new metrics in this year’s PayerView report. We are sharing the results and calling on payers to step up in areas like electronic enrollment and benefit accuracy to ensure providers get paid faster and more efficiently.”

Find the report here.

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