Medicaid payers consistently slow to reimburse doctors, survey finds

With health reform expected to dramatically push Medicaid enrollment growth in the coming years, news of consistently poor performance from Medicaid payers in terms of speed and quality in reimbursing physicians has to be just a little bit worrisome. 

According to the fifth annual 2010 PayerView Rankings survey evaluating 137 national, regional and government payers in 43 states, Medicaid payers ranked last in four of the seven performance categories measured. What's more, state Medicaid programs were eight of the 10 worst payers in the overall-performance category.

Jeremy Delinsky, a senior vice president at athenahealth, called the amount of waste in healthcare today "mind boggling," according to the Boston Globe. "Healthcare transactions in the United States are not done in real time the way transactions are done in almost every other industry," he said. "Even in the fastest cases, it can still take three weeks for doctors to get paid.''

Overall, health insurers paid physician claims an average of seven days faster in 2009 than in 2008, according to the survey. However, within the industry, payers demonstrated significant variability in days in accounts receivable or DAR (i.e., the days from the date of charge entry to the remittance post). The winner running away in this category was Blue Cross and Blue Shield of Rhode Island (BCBSRI) in Providence, which posted a 12.2 DAR in 2009--more than five days faster than the second-place finisher. At the opposite end of the spectrum, last-place finisher the New York Medicaid program had a dismal 112.3 DAR.

Among eight major payers, Humana Inc., in Louisville, Ky., was No. 1 in overall performance for the second year in a row, reports EMR Daily News. (Humana was second in overall performance among all 137 payers, behind BCBSRI.) Humana also achieved the No. 1 ranking in DAR for major payers at 22.4 days. By comparison, Cigna Corp., in Philadelphia placed last among the major payers with a 28.8 DAR. Humana has improved its DAR performance by more than 25 percent since the PayerView rankings began five years ago. The four national commercial payers--Humana, Cigna Corp., Aetna Inc., and UnitedHealth Group Inc.--collectively perform the best across the PayerView performance categories.

To learn more:
- visit the PayerView Rankings webpage
- read this Boston Globe article
- take a look at this EMR Daily News article
- read the Humana press release
- read this Medscape Medical News analysis
- read the AMA report