6 takeaways from athenahealth's 2016 PayerView report

Watertown, Mass.-based athenahealth has released its 2016 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 75,000 providers from 50 states and contains more than 202 million charge lines and $40.2 billion in billed healthcare services in 2015.

Here are six key takeaways from the PayerView report.

1. National commercial payers are leading the pack on electronic remittance advice transparency and enrollment efficiency. Specifically, the payers score 90.9 percent on the enrollment efficiency metric. athenahealth said the robust experience and processes of the biggest commercial payers may be what drives their strong performance on administrative metrics. It also noted these payers continue to adapt by engaging in mergers, acquisitions and the vertical integration of technology capabilities.

2. Blue Cross Blue Shield plans have shown great performance on administrative and transactional metrics, such as days in accounts receivable, denial rate and enrollment efficiency. The average days in accounts receivable is 25.9 for Blues payers.

3. Medicare Part B payers benefit from strong, standardized claims adjudication systems and clear payment rules, resulting in the highest rate of claims successfully paid on the initial attempt. Medicare Part B payers score 96.6 percent on the first-pass resolve rate metric.

4. Medicaid payers, which include both state Medicaid programs and Medicaid managed care organizations, perform well on the eligibility accuracy and provider collection burden metrics, but have room for improvement on most others. Medicaid payers score 3.8 percent on the provider collection burden metric.

5. For the first time, Cigna claimed the top spot of overall payers. Cigna particularly excelled at athenahealth's three most heavily weighted metrics: days in accounts receivable, first-pass resolve rate and denial rate. Cigna's 2015-2016 year-over-year performance on these metrics improved.

6. Here are the top 10 overall performers in the PayerView report.

  • Cigna (Bloomfield, Conn.)
  • Capital Blue Cross Pennsylvania (Harrisburg)
  • Anthem BCBS in Maine (South Portland) 
  • Health New England (Springfield, Mass.)
  • Medicare Part B-Washington State
  • BCBS of North Carolina Blue Medicare (Winston-Salem)
  • BCBS of Massachusetts (Boston)
  • UniCare (Indianapolis)
  • Medicare Part B-Indiana
  • CareFirst BCBS-Washington, D.C.
 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Top 40 articles from the past 6 months