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Study gives you insight about claims accuracy on seven top insurers
e-Reports, June 28, 2010
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No doubt, you and your staff spend a lot of time and money appealing medical claims that are incorrectly processed by health insurers. Now, a newly released study provides you a reliable and defensible snapshot of the timeliness and accuracy of claims processing and encourages insurers to improve their performance.

 claims accuracy chart

For the first time, the AMA’s third annual National Health Insurer Report Card benchmarked the overall claims processing accuracy of seven of the nation’s largest health insurers. The study estimates that the insurance industry is costing the nation’s health care system as much as $210 billion annually for processing inaccurate claims.

“The finding that one in five medical claims are processed by insurers with errors emphasizes the huge potential for reducing administrative costs for physicians and insurers,” said AMA Past President Nancy Nielsen, M.D. “Creating a single transparent set of processing and payment rules for the health insurance industry would create system-wide savings and allow physicians to direct time and resources to patient care and away from excessive paperwork.”

According to the study, Coventry Health Care Inc. had the best accuracy rating of 88.41 percent while Anthem Blue Cross Blue Shield had the lowest at 73.98 percent. Insurers were measured on accuracy, denials, timeliness and transparency.

One recent study projected that physicians spend the equivalent of five weeks annually on health insurer red tape. To keep up with the administrative tasks required by health plans, physicians divert as much as 14 percent of their revenue to ensure accurate payments from insurers.

However, another study released in June by athenahealth indicated insurers are improving their reimbursement time to physicians and denying fewer claims. (See the June 14, 2010 ISMA Reports)

Findings from the AMA’s 2010 National Health Insurer Report Card were based on a random sampling of approximately 2 million electronic claims for about 3.5 million medical services submitted in February and March of 2010. Claims were accumulated from more than 200 physician practices in 76 medical specialties providing care in 43 states.

Read more about the study here.

Also, the AMA’s Practice Management Center offers online resources to help you prepare claims, follow their progress and appeal them when necessary. Find the materials and tools on the AMA website.

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