AMA: Almost one-fifth of health insurance claims processed incorrectly
Nearly one of every five claims payments are processed inaccurately by private health insurance companies, according to a report from the American Medical Association (AMA).
According to the AMA’s latest findings, private health insurers have an average claims-processing error rate of 19.3 percent, an increase of 2 percentage points compared with 2010. AMA is the country’s largest trade group for physicians.
“A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually,” AMA board member Dr. Barbara McAneny said in a 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.”
UnitedHealthcare was the only private health insurer included in the 2011 AMA report card to improve its claims-processing accuracy. UnitedHealthcare’s accuracy rating was 90 percent. Anthem Blue Cross Blue Shield posted the worst accuracy rating among seven major health insurers: 61 percent.
Health insurers, health care providers share responsibility
Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a trade group for health insurance companies, says health insurers and health care providers share the responsibility for continuing to improve claims-processing accuracy and efficiency.
“Health plans continue to streamline health care administration to cut costs, improve efficiency and slash paperwork,” Zirkelbach says.
“In fact, the AMA report card found ‘dramatic reductions in denial rates’ and ‘improvements in claims response time and reporting correct contract fees.’ Government data also show that the portion of health insurance premiums going to health plans’ administrative costs has declined for six straight years.”
Zirkelbach says health insurers are collaborating with health care providers and investing in new technology to improve the process for submitting claims electronically and speeding up claims payments.
“At the same time, more work needs to be done to reduce the number of claims submitted to health plans that are duplicative, inaccurate or delayed,” Zirkelbach says.
For example, he says, a previous survey by America’s Health Insurance Plans found that nearly one-fifth of all health care providers’ claims are not submitted to health insurers electronically, and more than one-fifth of claims are submitted by providers at least 30 days after care is provided.
