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Administrative Burden Index - Score 1

Administrative burden associated with delayed remittance response

Data for these scores are taken from the NHIRC "Metric 2A": Cash flow anaylsis.  The percent of claims paid after 30 days was used to calculate the ABI score.[1]

The AMA's goal is 0% of claims paid after 30 days to reduce the most administrative burden and to move the health care system to real-time adjudication or estimation at the time of service.  This eliminates the need for patient invoicing and related follow-up communications, as it allows practices to reconcile patient accounts prior to the patient leaving the office.

ABI 1

 

 

[1] All scores in the Administrative Burden Index refer to metrics outlined in the National Health Insurer Report Card. Visit www.ama-assn.org/go/reportcard for a full metric description and methodology.


What can physicians do after reviewing ABI scores?

Scoring and five-star ratings

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.