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Administrative Burden Index - Score 6

Administrative burden associated with claim denials

Data for these scores are taken from the NHIRC "Metric 11": Percentages of claim lines denied.[1]

The AMA's goal is to move the health care system to fully automate the denials process.  Denials, while not always unavoidable and whether the fault of the provider or the payer, still contribute heavily to the overall administrative cost through waste and redundancy.  Many denials can be prevented through the use of automation, such as electronic eligibility verification, which can maximize communication between physicians and payers.

ABI 6

 

[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 full metric descriptions 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.