Insurers speed payments to physicians, but lack consistency

Health insurers paid physician claims an average of seven days faster in 2009 than in 2008, according to the fifth annual 2010 PayerView Rankings survey evaluating 137 national, regional and government payers in 43 states. 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, according to the survey conducted by Watertown, Mass.-based athenahealth Inc., which provides Internet-based business services to physician practices, and Physicians Practice journal.

Slow payments can not only impact payer/provider relationships, they can also get health insurers into hot water with state governments. State regulators issued 469 fines totaling $236 million to insurers from December 1997 through December 2009. About seven out of every 10 fines related to insurers failing to pay provider claims timely, according to a Medscape Medical News analysis of an American Medical Association (AMA) report. However, those fines have seen a steep decline over the past few years, with regulators issuing only six fines involving slow payments in 2009--a finding that is consistent with the PayerView statistics on DAR.

Last year's overall improved payment speed was driven largely by reduced denials, with payers denying 12 to 18 percent fewer claims than in 2008. But again, some insurers were worlds apart. Portland, Ore.-based ODS Health Plan was No. 1 at 3 percent, while the Pennsylvania Medicaid program stumbled in at No. 136 with a 34.2 percent denial rate.

In fact, Medicaid payers ranked last in four of the seven performance categories measured in the survey and consistently congregated in the lower end of the rankings. For example, state Medicaid programs were eight of the 10 worst payers in the overall-performance category. That's a little worrisome when health reform is expected to dramatically push Medicaid enrollment growth in the coming years, notes the Boston Globe.

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

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