"I'm at the office late every night taking care of mindless paperwork, just so the insurance companies can deny payment," a physician colleague told New York Times columnist Pauline W. Chen, MD, for a piece titled, "Fueling the Anger of Doctors."
This anecdotal frustration is corroborated by a new study published in Health Affairs. Led by Bonnie Blanchfield of Massachusetts General Hospital, a team of researchers analyzed the billing system of a physician's group affiliated with a large, urban, academic teaching hospital, and found that 12.6 percent of submitted claims are initially rejected. After considerable staff time and effort, 81 percent of these are eventually paid. In some cases, the researchers report, providers miss a chance to collect billed revenue simply because of the initial rejections.
But the scenario could be turned around significantly, they discovered, by standardizing the medical billing system. Specifically, by using a single set of payment rules for multiple payers, a single claim form and standard rules of submission, physicians and staff could spend four and five fewer respective weekly hours on this administrative burden. Moreover, the hypothetical model revealed that such standardization could save U.S. physicians and their practices about $7 billion per year.
"The savings from reducing administrative complexity could be translated into decreased costs in general," the study authors said in a statement. "Mandating a single set of rules, a single claim form, standard rules of submission, and transparent payment adjudication--with corresponding savings to both providers and payers--could provide system wide savings that could translate into better care for Americans."
To learn more:
- Read this report in the Wall Street Journal's healthcare blog
- Read this New York Times article
- Read the study abstract in Health Affairs
- Read this UPI report
- Check out this report in National Underwriter