More on Claims Processing

AMA: Patients pay 24 percent of bill

National insurer report card also finds insurers processing claims faster, more accurately

Patients are responsible for nearly one-quarter of their medical bill on average through the cost of co-pays, deductibles and co-insurance, according to the latest National Health Insurer Report Card from the American Medical Association (AMA).

The annual check-up of health insurers and their patterns for processing and paying medical claims examined for the first time the growing portions of healthcare expenses that patients must pay, AMA said in a news release Monday announcing the findings.

During February and March, patients paid an average 23.6 percent of the amount that health insurers set for paying physicians in a random sampling of 2.6 million electronic claims.

[See also: AMA launches health outcome effort]

But the report card also found that health insurers are processing claims faster, more accurately, with fewer denials and more explanations than previously.

In conjunction with the report card, the AMA also unveiled the Administrative Burden Index (ABI), which ranks commercial health insurers according to the level of unnecessary cost they contribute to the billing and payment of medical claims. “Physician practices spend up to 14 percent of their revenue just to get paid,” the index report said.

[See also: Proportion of families having difficulty paying medical bills declines]

Administrative tasks associated with avoidable errors, inefficiency and waste in the medical claims process resulted in an average ABI cost per claim of $2.36 for physicians and insurers, the release said. Cigna had the best ABI cost per claim of $1.25, or 47 percent below the commercial insurer average. HCSC had the worst ABI cost per claim of $3.32, or 41 percent above the commercial insurer average.

The AMA estimates that $12 billion a year could be saved if insurers eliminated unnecessary administrative tasks with automated systems for processing and paying medical claims, the release said. This savings represents 21 percent of total administrative costs that physicians spend to ensure accurate payments from insurers.

Health insurers countered the AMA’s findings. In a statement from America’s Health Insurance Plans, it pointed to the findings of a recent survey that nearly 20 percent of all provider claims are not submitted electronically to payers, and more than one in five claims are submitted by providers at least 30 days after the delivery of care.

“Health plans and providers share the responsibility of making the innovations and investments needed to improve efficiency in our healthcare system,” said AHIP spokesman Robert Zirkelbach in the statement.

Other findings that AMA gathered from the report card’s six years of data included:

• Error rates have dropped significantly for commercial health insurers on paid medical claims from nearly 20 percent in 2010 to 7.1 percent in 2013. UnitedHealthcare led commercial health insurers with an accuracy rating of 97.52 percent. Regence trailed all insurers with an accuracy rating of 85.03 percent. Medicare led all insurers with an accuracy rating of 98.10 percent.

• Medical claim denials have dropped 47 percent in 2013 after a sharp spike in 2012 among most commercial health insurers. The overall denial rate for commercial health insurers went from 3.48 percent in 2012 to 1.82 percent in 2013. This year, Cigna had the lowest denial rate at 0.54 percent, while Medicare had the highest denial rate at 4.92 percent.

• Health insurers have shortened response times to medical claims by 17 percent from 2008 to 2013. Humana had the fastest median response time of six days; Aetna the slowest at 14 days; and Medicare’s remained unchanged since 2008 at 14 days.

• Health insurers have increased the transparency of rules used to edit medical claims by 37 percent from 2008 to 2013.

[See also: Employers brace for cost increases]


Show All Comments