Claims Processing Performance Improves, Report Shows
June 19—Accuracy is up, denials are down, and claims payment is more timely according to the American Medical Association (AMA)’s sixth annual National Health Insurer Report Card (NHIRC), which provides metrics on the timeliness, transparency, and accuracy of claims processing of the nation’s largest insurers, including Medicare and seven commercial payers.
According to the NHIRC, error rates on paid medical claims for commercial insurers have dropped from nearly 20 percent in 2010 to 7.1 percent in 2013. The report also states that medical claim denials dropped 47 percent in 2013 with the overall denial rate for commercial health insurers resting at 1.82 percent. In addition, health insurers have improved response times to medical claims by 17 percent from 2008 to 2013.
As part of the NHIRC, the AMA created an Administrative Burden Index, which ranks commercial health insurers according to the level of unnecessary cost they contribute to the billing and payment of medical claims. The AMA estimates that $12 billion a year could be saved if insurers eliminated unnecessary administrative tasks.
Also, the NHIRC looks at patient responsibility for healthcare expenses, including copays, deductibles, and coinsurance. According to the report, patients are typically responsible for approximately one-quarter of their medical bill.
Publication Date: Wednesday, June 19, 2013