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AMA: Health Insurers Slash Claims Mistakes in Half

Margaret Dick Tocknell, for HealthLeaders Media, June 20, 2012

In an all-too-rare bit of good news from the realm of provider reimbursements, commercial health insurers posted a significant reduction in bungled medical claims in 2012, says the American Medical Association.

Only 9.5% of claims were improperly denied or paid physicians the wrong amount. That compares to 19.3% in 2011, the physicians organization says.

The AMA says the improvement helped physicians reduce unnecessary administrative work to reconcile mistakes, which saved the health system a whopping $8 billion.

"Paying medical claims accurately the first time is good business practice for insurance companies that saves precious healthcare dollars and frees physicians from needless administrative tasks that take time away from patient care," AMA board chair Robert M. Wah, M.D., said in a press statement.

On the health plan side it looks like the improvement can be attributed to a couple of things. Robert Zirkelbach, the spokesperson for American's Health Insurance Plans noted in an e-mail exchange that streamlining healthcare administration to reduce paperwork and improve efficiency is a priority for health plans. Collaborating with providers and investing in new technologies to improve the claims submission process have also produced results.

The 2012 National Insurer Report Card, which was released on Monday during the AMA's annual meeting in Chicago, looks at the timeliness and accuracy of claims processing for Medicare and seven of the largest health insurers: Aetna, Anthem Blue Cross, CIGNA, Humana, Regence (Blue Cross Blue Shield-affiliated healthcare plans in Idaho, Oregon, Utah, and Washington), UnitedHealthcare, and Health Care Service Corp. (parent of Blues plans in Illinois, New Mexico, Oklahoma and Texas).

While there was across-the-board improvement in claims accuracy, most of the improvement was recorded by Anthem, which processed 88.6% of its claims accurately. That's up from 61% in 2011. For the second year in a row UnitedHealthcare scored the highest accuracy rating?98%? up from 90% in 2011. Humana rounded out the list with an accuracy rating of 87.4%.

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1 comments on "AMA: Health Insurers Slash Claims Mistakes in Half"


Michele Bartko (6/21/2012 at 11:01 AM)
Paying claims too quickly is the reason CMS has so much fraud and it is not caught until the dollar amounts are staggering. Consumers have the right to make sure their claims are coded properly, come from a legitimate provider and that the services were actually rendered and were appropriate.