Payers and providers lose big with inefficient claims processing

By Annette M. Boyle

Health insurers want error-free claims from providers and providers want accurate payment from payers--but both must improve processes to meet those goals, experts tell Healthcare Finance.

On the payer side, error rates dropped from nearly 20 percent in 2010 to 7.1 percent in 2013, according to the article. Still, more than $43 billion could have been saved during that period if insurers had consistently paid claims accurately, according to the American Medical Association's National Health Insurer Report Card.

AMA found significant variance in accuracy among payers, ranging from Medicare's 98 percent accuracy to Regence's 85 percent.

Physicians must do their part to provide a clean claim, but that's not always as easy as it seems, the article notes. Despite the national uniform bill adopted in 1982, many insurers have their own rules that providers may not know. And payers dont always clearly communicate them, the article suggests.

About half of claims are now processed entirely electronically, reducing errors and costs.

"New technology alone will not improve productivity until inefficient, dysfunctional, routine administrative processes are streamlined," consultant Bill Heitman told the publication.

To learn more:
- here is the article
- find information about AMA's report card here

Related Articles:
Startup brings patients into claims processing
How payers can speed up the claims process
Somebody, please, fix the broken healthcare payment system

Free Webinar

Take Control of Your Escalating Claim Costs through a Comprehensive Pre-payment Hospital Bill Review Solution

Today managing high dollar claim spend is more important than ever for Health Plans, TPAs, Employers, and Reinsurers, and can pose significant financial risks. How can these costs be managed without being a constant financial drain on your company resources? Our combination of the right people and the right technology provides an approach that ensures claims are paid right, the first time. Register Now!

Suggested Articles

A new Aetna pilot program aims to harness its parent company's pharmacy reach to help address members' social needs.

A three-way deal between UpHealth, Cloudbreak, and a blank check company has created a new public digital health company valued at $1.35 billion.

Operation Warp Speed plans to distribute 6.4 million doses of a COVID-19 vaccine 24 hours after it receives emergency approval, officials said.