Four of the nation’s largest health insurers had “dramatic reductions” in their claims payment denial rates since last year, according to new American Medical Association research.
The doctors’ group cited improvement in denial rates at Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corp. and UnitedHealthcare, which cut its denial rate by half to 1.05%. Cigna maintained its industry leading low denial rate of 0.68%, the AMA said.
The group, which tracks claims payment trends by insurers each year, said lack of patient eligibility for medical services continues to be the most frequent reason for denials.
Claims payments less accurate
Meanwhile, health insurers’ overall claims payments were more inaccurate last year than in the prior year, the AMA found.
Claims-processing errors from health insurance companies, noted in its fourth annual National Health Insurer Report Card, “waste billions of dollars and frustrate patients and physicians,” the AMA said in a statement.
Commercial health insurers have an average claims-processing error rate of 19.3%, an increase of 2% compared last year.
The increase in overall inaccuracy represents an extra 3.6 million in erroneous claims payments compared to last year, and added an estimated $1.5 billion in unnecessary administrative costs to the health system, according to the AMA.
Inefficiency costing everyone
“A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually,” said AMA Board Member Barbara L. McAneny. “Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care.”
Most of the health insurers measured by the AMA failed to improved their accuracy rating since last year. UnitedHealthcare was the only commercial health insurer included in this year’s report card to demonstrate an improvement in claims-processing accuracy. UnitedHealthcare came out on top of seven largest commercial health insurers with a accuracy rating of 90.23%. Anthem Blue Cross Blue Shield had scored the worst of those measured with an accuracy rating of 61.05%.
The research found other trends. Physicians received no payment at all from commercial health insurers on nearly 23% of claims they submitted.
Mixed contract fee reporting
UnitedHealthcare has shown consistent improvement during the last four years in reporting correct contract fees. Other commercial health insurers showed progressive improvement over four years, but had slight declines this year. The exception was Anthem Blue Cross Blue Shield, which scored 14 percent lower on this measure than it did four years ago.
The report card found that CIGNA and Humana have cut their median claims response time in half during the last fours years. Response time varied for commercial health insurers from six to 15 median days.
The report card is based on a random sampling of about 2.4 million electronic claims for about 4 million medical services submitted in February and March to Aetna, Anthem Blue Cross Blue Shield, CIGNA, Health Care Service Corp., Humana, The Regence Group, UnitedHealthcare and Medicare. Claims were accumulated from more than 400 physician practices in 80 medical specialties providing care in 42 states, according to the AMA.
Health insurers denying fewer claims, but payment errors increasing via IFAwebnews .
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