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The American Medical Association’s public release last week of its first health insurance report card did not sit well with insurance companies -- and for good reason. The exposure of these companies’ inefficiencies in processing claims, and the resultant extra costs, isn’t exactly great for PR.
The AMA’s aim in launching its Cure for Claims campaign is to reduce administrative costs and assure the accuracy of insurance payments for doctors’ services. The campaign’s ultimate goal is to restore the efficiency of processing medical claims.
For its first National Health Insurer Report Card, the AMA examined Medicare, and seven other health insurance providers -- Aetna (AET), Humana (HUM), UnitedHealthcare (UNH), Coventry Health Care (CVH), CIGNA (CI), Health Net (HNT) and Anthem Blue Cross and Blue Shield -- rating each on the punctuality and accuracy of its claims process. The AMA looked at several metrics, including timeliness, accuracy, fee- and payment-policy transparency and denials.
The results paint a bleak situation. Among the key findings were inconsistencies in the application of codes used to explain denied payments, inaccuracies in the reporting of contracted payment rates (which plague physicians with additional costs needed to evaluate the variable figures), and the use of undisclosed proprietary edits by insurance companies, inhibiting the transparency of information relayed to physicians, according to the AMA’s report. In fact, physicians currently spend 14% of their total revenue just to receive their proper earnings, AMA board member Dr. William Dolan told the AP.
“We are hoping to get rid of ambiguity and create a more uniform system,” says AMA media spokesman Robert Mills. Mills describes the direct and indirect impact of claims processing on patients. Patients are indirectly impacted by the substantial amount of money wasted on claims that can be saved and used to improve care, allowing physicians to spend more time with patients and evade red tape. “By creating an efficient system, we will be able to lower healthcare costs and reduce insurance premiums,” Mills says.