Medical Billing & Coding: AMA Report Shows 19.3 Percent Claims-Processing Error Rate

Here are some payer updates that will stand your medical coding & billing in good stead.

The findings of the American Medical Association’s (AMA) fourth annual National Health Insurer Report Card (NHIRC) do not paint a rosy picture. As per the association, commercial payers show an average claims processing error rate of 19.3 percent, notes an AMA press release. This is a two percent increase over last year.

Errors galore

According to the release, 20 percent error rate among health insurers talks of a great deal of incompetence that leads to a wastage of $17 billion annually.

Need of the hour

Keeping this huge inefficiency in mind, health insurers must put in more effort into paying claims correctly the first time to save money and bring down needless administrative tasks that take time and resources away from the patient, the release cites.

Payer rankings

As far as claims-processing accuracy is concerned, UnitedHealthcare was the only payer that showed a boost. The firm was ranked first in the list of seven leading commercial payers with an accuracy rate of 90.23 percent while Anthem Blue Cross Blue Shield figured in the bottom with an accuracy rate of 61.05 percent.

Legitimate pay may go unpaid by an insurer

What’s more, the report card also showed that you got no payment at all on around 23 percent of claims you submitted to commercial payers.

There are many reasons a rightful claim may go unpaid by an insurer, the release indicates. It may be denied, edited or deferred to patients. During February and March of this year, the most common reason insurers did not issue a payment was owing to deductible requirements that shift payment responsibility to patients until a dollar limit is surpassed.

Healthcare billing news: For many of the payers included in the report - Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation and UnitedHealthcare - there were lower denial rates.

In addition, the report card indicates that Cigna and Humana cut their medical claims response time in half during the last four years.

Resource: More information is available at http://www.ama-assn.org/ama/pub/advocacy/topics/administrative-simplification-initiatives/national-health-insurer-report-card.page.