Nearly one in five of your private payer payments were inaccurate in 2011, according to the AMA's latest "National Heatlh Insurer Report Card," released June 20. The average rate of inaccurate payments is 19.3% in 2011, up from 17.3% in 2010, the AMA says.
That 2% jump comes out to a $1.5 billion increase in administrative costs to the health system, the AMA estimates. "A 20% error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually," AMA Board Member Barbara McAneny, MD, said in a prepared statement. "Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care."
NOTE: The AMA figures are based on its analysis of claims data from seven major private payers, with Medicare data also included for comparison. The government makes far fewer errors than the private sector, according to the AMA.
Here's the breakdown (percentages represent what percent of first electronica remittance advices were fully accurate):
-
Aetna: 81.08%
-
Anthem: 61.05%
-
CIGNA: 83.02%
-
HCSC: 87.04%
-
Humana: 81.99%
-
Regence: 88.41%
-
UHC: 90.23%
-
Medicare: 96.19%
While UHC (United Healthcare) scores the best of all the private payers, none comes within striking distance of Medicare. TIP: In cases where the payers were correct, the most common reason for denials was lack of patient eligibility, the AMA found. During February and March of 2011, the most common reason was patients failing to meet deductibles.