Special Feature

AMA helps insurers improve claims payment accuracy

Thanks to AMA efforts, health insurers have cut in half the number of claims they pay inaccurately, saving $8 billion across the U.S. health care system.

That's according to the AMA's fifth annual National Health Insurer Report Card, the results of which were released last week during the Annual Meeting of the AMA House of Delegates. Measuring how major health insurance companies manage, process and pay medical claims, the report card has led to a number of improvements as the AMA has urged these insurers to better their performance.

Just last year, the number of claims insurers paid inaccurately was 19.3 percent, but that number dropped to 9.5 percent in 2012. This improvement saved physicians countless hours of work to reconcile errors and put billions of dollars previously wasted through insurers' administrative mistakes back into the health care system.

Since the AMA issued its first National Health Insurer Report Card in 2008, the private insurers it measures have shortened the time they take to respond to claims by 27 percent. Health Care Service Corporation and Humana had the fastest median response time of six days, while Aetna was the slowest with a median response time of 14 days.

Similarly, the rules the insurers use to edit claims have become 33 percent more transparent. When physicians know what these rules are, the time and cost to reconcile claims is reduced significantly.

But much improvement remains to be made. While better accuracy in claims payments saved time and money this year, physicians had to devote additional resources to prior authorization. The AMA found that the percentage of claims requiring prior authorization increased by 23 percent, adding $728 million in unnecessary administrative costs and countless hassles.

All but one of the private insurers also increased denials this year, reversing progress that had been made from 2008 to 2011. And insurers still need to work on their payment accuracy. The AMA estimates that an additional $7 billion could be saved if insurers consistently paid claims correctly.

The National Health Insurer Report Card is the cornerstone of the AMA's "Heal The Claims Process"™ campaign, which aims to reduce administrative waste through improving health care's billing and payment system. Physicians can access an array of resources to streamline the claims process in their own practices, including instructional webinars and toolkits.

Watch an archived webinar to learn more about this year's report card results.