AMA Rates Health Insurers on Timeliness, Accuracy

The American Medical Association's latest National Health Insurer Report Card, which evaluates payers on characteristics such as timeliness and accuracy, has for the first time measured patients' portion of medical bills, finding their contribution to be 23.6 percent of the cost, on average.


The physician lobbying group studied 2.6 million electronic claims for 4.7 million medical services between February and March 2013, gathered from more than 450 physician practices.


Administrative burden. As part of a larger campaign, the AMA launched its administrative burden index, which will rate insurers according to the overhead cost needed to bill and collect payment from each major payer, according to a news release. The physician lobbying group claims 21 percent of total administrative costs, or $12 billion, could be saved each year from healthcare payments through eliminating errors, waste and other factors that add to the overhead cost of billing and collections.


Cigna had the most favorable average administrative burden index, costing 47 percent less per claim in erroneous administrative costs. Health Care Service Corporation had the highest administrative burden, with an index 41 percent higher than the average commercial insurer.


Accuracy. Commercial payers' error rates have improved dramatically since 2010, although AMA says billions can still be saved with greater accuracy in billing.


Medicare had the highest accuracy rating of 98.1 percent, followed by United Healthcare at 97.52 percent. Regency had the lowest rating of 85.03 percent.


Denials. Denials of claims fell 47 percent this year after they jumped last year. Medicare denied the most claims at a rate of 4.92 percent, while Cigna had the fewest denials at 0.54 percent.


Timeliness. Response times for medical claims dropped 17 percent from 2008 to 2013, with Humana leading the pack at a six-day median response time and Aetna trailing behind at 14 days. Medicare's median response time remained unmoved at 14 days since 2008.


Transparency. Overall transparency on payer-specific rules for editing medical claims increased by 37 percent between 2008 and 2013, according to the AMA.


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