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Doctors Want Insurers to Pay Up

Posted by Jane Akre
Tuesday, June 15, 2010 1:44 PM EST
Category: Major Medical
Tags: Insurance, Big Insurers, Medical Claims, American Medical Association, AMA, Health Care Reform


IMAGE SOURCE: iStockphoto/ sick money/ author: Elnur

Insurers are on the hot seat this time by the doctors who depend on them to reimburse medical procedures.

The American Medical Association is releasing its third annual report card on insurers and finds one in five medical claims is not processed correctly.

Medicare reimbursements were intentionally omitted from this report card because traditionally Medicare pays quickly and accurately.

In this focus, the private insurance companies agreed to pay the doctor’s bill about 80 percent of the time, reports AP.

Doctors want to be reimbursed for the full amount they submit and about 20 percent of the time there is a challenge to the billing.

The annual report’s goal is to reduce the cost of paperwork and manpower associated with processing insurance claims, estimated to be as high as $210 billion annually.

The good news is the cost of processing claims and the associated administrative costs have been in a decline for six straight years.

In response, Robert Zirkelbach a spokesman for the lobby representing insurers, America’s Health Insurance Plans, said it takes doctors to promptly submit claims to speed up the process.

Administrative costs are a large contributor to the rising cost of health care, though Zirkelbach argues that medical costs themselves, not administrative costs, drive rising health care costs.

Insurers that pay the bill “accurately,” reflecting what is submitted, were rated with Coventry Health Care Inc., ranking the highest of seven commercial insurers. With a “accuracy” ranking of 88 percent it represents the top, while Anthem Blue Cross is ranked at the bottom with an accuracy ranking of 74 percent.

Anthem Blue Cross is owned by WellPoint Inc, which says it is constantly improving and has a new electronic claims processing system in five states.

How important is reducing the administrative costs of processing claims?

The AMA estimates that if “accuracy,” or paying a bill as submitted, was increased to 100 percent, it would save the insurance industry and doctors about $15.5 billion a year.

Meanwhile the House has voted to overturn a 21 percent cut in Medicare reimbursements required by a 1990s deficit reduction law and the legislation is pending in the Senate. #

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