Provider Perception of Insurer Administrative Performance

The American Medical Association puts out an annual scorecard which purports to rate the accuracy and efficiency of a health insurers claims process and other administrative processes.    (AMA Insurer Rpt. Card)   This years report card finds continued progress in decreasing “error” rates on claims payments.  For 2013 the rate was 7.1% compared to 20% in 2010.  United HealthCare had the highest accuracy rate among commercial payers, at 97.5% and Regence the lowest.  Medicare performed better yet, at 98%, according to the AMA.  Medical claims denials dropped from 3.48% last year to 1.82% in 2013  for private payers, but Medicare’s rate is almost 5%.   Response times, that is, giving an initial reaction to a submitted claim, have continued to improve, ranging from 6 to 14 days.  Almost all claims are paid within 30 days.  Electronic funds transfer rates are generally high, with some payers approaching or exceeding 90%.   According to the AMA, payers are getting somewhat better about disclosing the source and nature of claims edits.  Overall, the AMA and physicians should be happy about both the absolute performance rates and the general improvement.

According to the AMA’s data, patients are responsible via copays, deductibles and coinsurance for about 24% of the amounts owed to physicians under their health plans.  Calculating and collecting these amounts is often a difficult task for doctors.  And the AMA’s data confirms that patients are bearing more of the cost of their health care.  The AMA also calculated what it calls an Administrative Burden Index ranking insurers according to how inefficient their claims process is and the burden it places on doctors.  Cigna scores best on this and HCSC, a Blues plan, worst.  Funny, but we don’t see any index from the AMA about physician misbehavior which also causes administrative burdens and adds to both administrative and health spending.  That number is multiples of whatever inefficiency is caused by health plans.