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AMA: 1 in 5 Insurance Claims Bungled

Margaret Dick Tocknell, for HealthLeaders Media, June 21, 2011

Among the other findings:

  • Physicians received no payment at all on about 23% of the claims they submitted. In 2011 the most common reason insurers didn't issue a payment was due to deductible requirements that shift payment responsibility to patients until a dollar limit is exceeded.
  • There have been significant reductions in denial rates, which ranged from .68% (CIGNA) to 3.6% (Anthem). UnitedHealthcare cut its denial rate by half to 1.05%. Lack of patient eligibility for medical services continued to be the most frequent reason for a payment denial.

The report card is part of the AMA's "Heal the Claims Process" campaign, which was launched in June 2008 with the goal of reducing the cost of submitting claims for the physician practice from as much as 14% of physician practice revenue to just 1%.

See Also:
AMA Ranks Payers' Claims Processes, Which are Often a 'Murky Mess'
Seven Largest Insurers Incorrectly Pay One in Five Claims, Says AMA

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.

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