4 Key Insights Into Payer Efficiency, Transparency, Payment Speed and More

Cloud-based software services provider athenahealth has released its 2014 PayerView Report, which leverages the company's data to provide insight into provider-payer relationships.

Here are four key insights from the PayerView report.

1. Although some state Medicaid programs are high performers, many remain difficult to do business with and are among the slowest paying and least transparent payers, according to the report. Overall, Medicaid averages 44 days in accounts receivable, compared with 26 days on average for all payers. Additionally, Medicaid has an overall average denial rate of 18.5 percent, compared with 6.8 percent for all payers.

2. The provider collection burden (the percent of allowed amount transferred from the primary to the next  responsible party, excluding copays and time of service real-time adjudication) has been on the rise during the last two years, driven partly by the rise in health plans with higher co-pays, coinsurance and deductibles. According to the analysis, the provider collection burden for 2014 varies from 0.6 percent for Boston Medical Center's HealthNet Plan (unchanged since 2011) to 30.1 percent for Blue Cross Blue Shield of Texas (up from 29.7 percent in 2011).

3. National commercial payers have the best enrollment efficiency. As providers look to capture larger market shared by accepting new payers, they will likely find Medicaid enrollment the most difficult. For instance, 38 percent of Medicaid enrollments require paper forms that must be mailed in, while none of the national commercial payers require paper forms sent through the mail.

4. Humana beat all other payers with its overall score, making it the most efficient and transparent payer for providers to deal with, according to the report. For instance, Humana ranked second in enrollment efficiency and ninth in eligibility accuracy. Other highly ranked payers, based on metrics such as days in accounts receivable and denial rate, include HealthPartners, Blue Cross Blue Shield of Massachusetts and Cigna.

More Articles on Healthcare Payers:
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Tracking and Trending: How Hospitals Should Handle the Rise in Commercial Audits
Health Care Cost Institute, Health Insurers to Collaborate on Price Transparency Portal


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