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MGMA Survey Ranks Medicare as Top Payer

Elyas Bakhtiari, for HealthLeaders Media, October 13, 2009

Medical groups ranked Medicare Part B higher than any other payer in a satisfaction survey released by the Medical Group Management Association at its annual conference in Denver.

Members were asked to rate their satisfaction with payers on issues related to responsiveness, transparency, prompt payment, credentialing, overall satisfaction with administrative functions, and other metrics. More than 1,700 MGMA members participated in the poll.

Medicare topped the list with an average ranking of 3.59 on a five-point scale. Aetna came in second at 3.14, and was followed by CIGNA, Coventry, Humana, Anthem, and UnitedHealthcare.

William F. Jessee, MD, FACMPE, president and CEO of MGMA, suggested that medical groups like Medicare's predictability and the clearness of its rules. However, Medicare received low marks for its credentialing process, he noted. The CMS form physicians must fill out to become credentialed is nearly 30 pages long and much more cumbersome than private-payer equivalents.

Overall, respondents were most satisfied with payers' fee schedule disclosure and prompt payment of claims. They expressed frustration, however, with the amount of leverage they have during the contract negotiation process, as well as the transparency of ratings systems and the claims denial appeals process.

Jessee attributed the frustration about the payer negotiation process in part to the lack of competition between insurers in many markets. Medical groups often find it tough to negotiate when only three or four payers dominate an area and have the upper hand when setting rates. Medical groups often make their margin from smaller insurers, who have less leverage when crafting contracts, Jessee said. However, this makes it more difficult for new payers to enter a market.

The study only addressed the payment process, and did not ask respondents about their satisfaction with payment rates. That would have probably found much more dissatisfaction, Jessee joked.


Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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