The AMA is urging physicians to take action against inaccurate payments from private health insurers. As part of the launch of its “Heal That Claim” campaign, the AMA is supplying physicians with tools to fight flawed and inefficient claims processing by health insurers.
One out of five medical claims is processed inaccurately by commercial health insurers, according to the AMA’s National Health Insurer Report Card.
A 20% error rate represents an intolerable level of inefficiency that wastes an estimated $15.5 billion annually.
The administrative costs of ensuring proper insurance payments takes a heavy financial toll on physicians and can consume up to 14% of their earned revenue, says AMA president Cecil Wilson, MD.
“The AMA’s goal is to significantly reduce the administrative costs of processing claims from 14% to 1% and allow doctors to focus on caring for patients instead of battling health insurers over delayed, denied, or shortchanged medical claims,” Wilson says.
Because health insurers often increase their rate of claim denials during the last quarter of the year, many more physicians may have just experienced such activity and will appreciate the reason for the campaign, Wilson says. He urges physician practices to take the initiative in improving the accuracy of claims, rather than waiting for insurers to do it.
The AMA is helping physicians overcome claims obstacles by offering online resources to help prepare, track, and appeal claims. These resources include template appeal letters, printable checklists, and logs that help physicians simplify their claims management system.
To learn more about how the AMA is helping physicians get paid accurately by health insurers, please visit the “Heal That Claim” campaign site.
At the site, physicians can pledge support for the campaign, report any unfair health insurer practices, share successes, or sign up for the AMA’s free e-mail alerts to help stay up to date on unfair payer practices.
As part of its “Heal That Claim” initiative, the AMA suggests using the following checklist to determine whether your practice is submitting claims efficiently and accurately:
- Does your practice prepare and submit claims in a timely manner? Do you update and verify patient insurance coverage and eligibility information prior to each visit to make sure that you submit eligible claims to the correct health insurer?
- Do you have a practice staff member specifically responsible for reviewing health insurer payments for accuracy? When you receive EOBs and electronic remittance advice (ERA), do you address delays, denials, and reductions?
- Do you keep copies of your contracted fee schedules in order to verify accurate payment from health insurers? Does your practice management software allow you to store contracted fee schedules? Do you maintain all health insurer contracts in a central and easy-to-locate file cabinet or drive?
- Does your practice run a monthly collection report and review EOBs and ERAs for each claim?
- Do you identify the basis for health insurer payment adjustments? Do you understand the claims adjustment reason and remark codes reported on EOBs and ERAs to explain adjustments to payments and address them quickly and appropriately?
- Do you gather supporting documentation to respond to health insurers’ claims adjustments and routinely submit appeal letters using easily accessible templates to streamline and standardize appeals for common denials?
- Does your practice maintain a follow-up log to monitor its communications with insurers regarding claims?
- Does your practice hold internal claims processing and review meetings to periodically evaluate your work flow for ways to improve efficiency?
- Do you persist in appealing your delayed, denied, or reduced payments until they are paid accurately?
- Do you have a plan for complying with the 5010 and ICD-10 mandated updates? The deadline for upgrading electronic transactions to the HIPAA-mandated 5010 version is January 1, 2012, and the deadline for reporting ICD-10 codes is October 1, 2013.
The AMA offers an interactive library of resources and tools for improving claims submission and efficiency here. The tools are available free of charge.