2013 Administrative Burden Index
The AMA Administrative Burden Index (ABI) will aid practices in identifying effeciences with the cost of doing business with participating payers in the National Health Insurer Report Card (NHIRC). To further apply the NHIRC results, the ABI was created to encourage increased physician and payer engagement in identifying and reducing current administrative hassles being experienced in the physician practice claims revenue cycle. Physician practices spend up to 14 percent of their revenue just to get paid. The AMA's goal is to decrease the 14 percent to just one percent of revenue. This will occur only through increased physician practice and health insurer efficiences.
View the results of the following six ABI scores:
- ABI Score 1: Administrative burden associated with delayed remittance response
- ABI Score 2: Administrative burden associated with inaccuracy of payment expectations
- ABI Score 3: Administrative burden associated with identifying prior authorization requirements and performing prior authorization
- ABI Score 4: Administrative burden associated with the application of payer-specific claim edits
- ABI Score 5: Administrative burden associated with undisclosed claim edits
- ABI Score 6: Administrative burden associated with claim denials
- 2013 ABI full results
Access the 2013 AMA National Health Insurer Report Card (NHIRC)
The NHIRC, which the ABI is a component of, documents the claims revenue cycle activities of the major commercial health insurers and Medicare. The NHIRC provides metrics on the timeliness, transparency and accuracy of claims processing of these payers in an effort to educate physicians and the public, and to reveal opportunities for improvement.
The Administrative Burden Index results are for informational purposes only. Physicians and payers are encouraged to review the results and support the AMA’s “Heal the Claims Process™” campaign, and commit to the goal of reducing the cost of claims administration to one percent of collections. Visit www.ama-assn.org/go/htc for details.
This index identifies the practice cost of performing rework with the NHIRC payers, including phone calls, investigative work and claim appeals associated with a specific payer—based on the NHIRC metric results for payment timeliness, accuracy, application of undisclosed and payer-specific edits, prior authorization and denials.
Physician practices will be able to consider this index when determining their practice automation priorities and in conjunction with contracting. It will also allow physician practices to:
- Score the payers with which they do business
- Review their internal workflows to identify areas to increase practice efficiency
- Engage with payers and vendors to identify ways to increase practice automation
- Identify the associated cost of rework with a payer prior to contracting and take advantage of automated options from payers to potentially lower claims processing costs
- Automate claims revenue cycle workflows through the use of electronic transactions.
To enable all physician practices to achieve results similar to those reported here, all health insurers must be fully transparent and compliant with the electronic data interchange standards.
This press release provides a high-level summary of 2013 NHIRC findings, and provides an explanation of how those numbers translate to spending across the health care industry.
View a webinar about the AMA's 2013 National Health Insurer Report Card (NHIRC) results and introduction of the Administrative Burden Index (ABI). Learn about payer improvements from the previous NHIRC results. To further apply the AMA’s NHIRC results, the first-ever ABI was created to encourage increased physician and payer engagement. Using this index, physicians can identify ways to reduce current administrative burdens being experienced in the physician practice claims revenue cycle. Watch this webinar to understand how this index can help your practice determine automation priorities, and how the index can also be used in conjunction with contracting.
Understand the method by which the Administrative Burden Index was developed. This document is an informative brief on the AMA's process for developing a report that is comprehensive, accurate and defensible.
The ABI score was created to assist physicians in identifying the cost of doing business with the participating payers in the NHIRC. For simplicity, a grading scale, similar to educational system grading scales which use 0-100 point scales, was utilized. An exception was made so that a score of 100 points was required to receive five stars, instead of the traditional 90-100 points for the top grade.
Therefore, an ABI score of:
- 100 is equal to five stars
- 90-99 is equal to four stars (95-99 is awarded an additional ½ star)*
- 80-89 is equal to three stars
- 70-79 is equal to two stars
- 60-69 is equal to one star
- 59 or lower is equal to zero stars
*Payer scores of 95-99 that fell in the 4 star category were given additional recognition of a ½ star to acknowledge their efforts to reach the AMA goals.