Increased inaccuracy in claims payments by health insurers

Commercial health insurance has registered an increase of 2% over the existing average claims processing error rate of 19.3%. This 2% translates to an extra 3.6 million in erroneous claim payments, and costs an additional estimated $1.5 billion in highly avoidable administrative costs to the health system.

AMA (American Medical Association) has released its Fourth Annual National Health Insurer Report Card which underscores the 2% increase in inaccurate claim payments since last year among the leading commercial health insurers. Claims-processing errors by health insurance companies squander billions of hard-earned dollars, frustrating general public as well as physicians in the process. The AMA estimates that eliminating health insurer claim payment errors would save $ 17 Billion.

The key findings of this report are as follows:

Performance: United Healthcare emerged as the only commercial health insurers with an accuracy rating of 90.23% while Anthem Blue Cross Blue shield scored the worst with an accuracy rating of 61.05% according to the report.

Denials: A noticeable reduction in denial rates has occurred since last year at Aetna, Health Care Service Corporation and United Healthcare, which reduced its denial rate by half to 1.05%. CIGNA maintained its industry low denial rate of 0.68%. The common reason for denials continues to be the absence of patient eligibility for medical services.

Non-payment from Insurers: Nearly 23% of claims submitted by physicians in 2010 received no payment at all from the commercial health insurers. One of the most frequent reasons cited by insurers was deductible requirements that shift payment responsibility to patients until a dollar limit is exceeded.

Administrative requirements: The report has also mentioned how frequently claims included information on insurers requiring physicians to ask permission before performing a treatment or service. A recent AMA survey of physicians indicated that insurers’ requirements to preauthorize care delayed or interrupted medical services, consumed significant amounts of time and complicated medical decisions.

Analyzing the various facts highlighted in the report, it appears likely that physicians would continue to experience roadblocks in reimbursement for their payments. In order to streamline the process of reimbursement, they would have to rely on experts who are well versed and experienced enough to pre-empt the loopholes and grey areas in the payer system and avoid falling prey to those. Physicians and healthcare organizations facing obstinate rates of non-payment and/or denials do not have to take it lying down; they can take the help of qualified professionals from to experience error-free claims filing to ensure a healthy reimbursement rate.