AMA Health Insurer Report Indicates Increased Inaccuracy in Claims Payment

The overall rate of inaccurate claims payments increased since last year
among leading commercial health insurers, according to the American Medical
Association’s (AMA) fourth annual National Health Insurer Report Card.

According to the AMA’s latest findings, commercial health insurers
have an average claims-processing error rate of 19.3%, an increase of 2%
compared with last year. The increase in overall inaccuracy represents an extra
3.6 million in erroneous claims payments compared with last year and an
additional estimated $1.5 billion in unnecessary administrative costs to the
health system. The AMA estimates that eliminating health insurer claim payment
errors would save $17 billion.

“A 20% error rate among health insurers represents an intolerable
level of inefficiency that wastes an estimated $17 billion annually,”
Barbara L. McAneny, MD, AMA board member, stated in a press release.
“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.”

Most of the health insurers measured by the AMA failed to improve their
accuracy rating since last year. UnitedHealthcare was the only commercial
health insurer included in this year’s report card to demonstrate an
improvement in claims-processing accuracy. UnitedHealthcare came out on top of
seven leading commercial health insurers with an accuracy rating of 90.23%.
Anthem Blue Cross Blue Shield had scored the worst among those measured, with
an accuracy rating of 61.05%.

To encourage a more efficient claims payment system, the AMA’s
National Health Insurer Report Card provides an annual check-up for the
nation’s largest health insurers and benchmarks the systems they use to
manage process and pay claims. Launched in June 2008, the campaign’s goal
is to spur improvements in the industry’s billing process so physicians
and patients are no longer at the mercy of a chaotic payment system.

“In spite of notable improvements by insurers in the 4 years since
the AMA’s introduced the National Health Insurer Report Card, precious
health care resources are wasted because each insurer uses different rules for
processing and paying medical claims,” McAneny stated. “This
variability adds no value to the health care system and only increases
unnecessary administrative costs.”

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