5 Takeaways From athenahealth's 2014 PayerView Report

Watertown, Mass.-based athenahealth has released its 2014 PayerView report, a ranking of private and government payers garnered from the company's cloud-based databank of national network providers.

The data comes from more than 52,000 providers from 50 states and contains 108 million charge lines and $20 billion in billed healthcare services in 2013.

Here are five key takeaways from the PayerView report.

1. Medicaid lags in performance behind other payers and has demonstrated slower receivables, higher denials and lower transparency. The Medicaid average for days in accounts payable was 44 days, while the average payer was 26 days. Medicaid's average denial rate was 18.5 percent, compared to 6.8 percent for other payers. In terms of electronic remittance advice, or advising next steps and explaining denials, the Medicaid average was 89.4 percent, and the all-payer average was 95 percent.

Overall, Medicaid plans' performance did not result favorably, falling short of other payers in areas such as payment turnaround time, denial rate and ease of use. These trends don't bode too well for Medicaid, especially when enrollment is expected to hit 85 million by 2021, increasing nearly 50 percent from the 56 million in 2013.  

2. Blue Cross Blue Shield plans tended to have the lowest payment turnaround time — three days shorter than the average of all payers. Additionally, all of the top 15 and 30 of the top 50 performers on days in accounts receivable are BCBS plans.

3. Commercial payers tended to have more efficient enrollment processes, while Medicaid plans were the least efficient. While no commercial payers required enrollments for the Electronic Data Interchange, approximately half of Medicaid plans did. Additionally, no commercial payers required enrollment documents on paper form sent via mail, but 38 percent of Medicaid enrollments did.  

4. For the second year in a row, Humana claimed the top spot of overall payers. Humana ranked in the top 50 payers for all but two metrics — electronic remittance advice transparency and provider collection burden. However, it was in the top 10 for two metrics — enrollment efficiency and eligibility accuracy.

5. Here are the top 10 overall performers in the PayerView report.
•    Humana (Louisville, Ky.)
•    Healthpartners (Bloomington, Minn.)
•    BCBS-Massachusetts (Boston)
•    Cigna-Healthsource (Bloomfield, Conn.)
•    Group Health Cooperative (Seattle)
•    Medicare B-Missouri
•    BCBS-Pennsylvania Capital Blue Cross (Harrisburg)
•    BCBS-D.C. (Washington)
•    Medicare B-Indiana
•    Medicare B-Oregon

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