Insurers Make Progress in Claims Processing; Inefficiencies Remain

May 26, 2010 | iHealthBeat

Last year, most private health insurance companies made strides in using technology to improve their provider medical claims processing rates, resulting in marked improvements in transaction speeds of the reimbursements, according to the fifth annual PayerView rankings report released today, the Boston Globe reports.

The rankings report was compiled by Athenahealth, a vendor of billings and records applications, in collaboration with the Physicians Practice management journal. For the report, researchers drew from a database of 24,000 health care providers in 45 states to assess 137 insurers.

According to the PayerView report, health care providers in 2009 on average received their payments seven days faster than they did in 2008. In addition, insurers denied 12% to 18% fewer claims, the report found.

Inefficiencies Remain

Despite the noted progress, the researchers found that inefficiencies remain in the claims reimbursement system. Furthermore, the report notes that state-administrated Medicaid programs nationwide continue to lag behind in their use of technology to accelerate claims processing.

The majority of secondary operations at hospitals, physicians' offices and insurers still are slow and disorganized because the fragmentation of the health care industry makes it difficult to develop technology and transaction standards, according to the researchers.

Jeremy Delinsky, senior vice president at Athenahealth, said, "It's mind-boggling how much waste there is," adding, "Health care transactions in the United States are not done in real time the way transactions are done in almost every other industry." Delinsky noted, "Even in the fastest cases, it can still take three weeks for doctors to get paid" (Weisman, Boston Globe, 5/26).

More ways to help manage medical costs

By

updated 1:13 p.m. ET Feb. 10, 2009

Patients have several tools to help manage medical costs. Here are some additional tips recommended by debt reduction experts.

_ Talk to the doctor about whether all the recommended care is necessary.

_ Ask if a procedure can be done on an outpatient basis, to avoid a costly hospital stay.

_ Can you use less-expensive, generic versions of the medicine you need?

_ Avoid using your credit card. If you pay it all off with that, you lose leverage with the hospital and you may have to pay high interest.

_ Remember your manners. Billing office representatives know how the system works and may be helpful if you don't yell at them.

_ Go beyond the billing office. People with higher levels of authority sometimes can approve larger discounts.

_ Talk to the doctor. A physician may show more sympathy than a billing clerk who hears customer complaints every day.

_ Check in-network coverage. Make sure your doctor, the anesthesiologist and everyone else caring for you is in your insurance network.

_ Document everything. Keep a record of phone conversations and all paperwork so you can show what you were told, by whom and when.

Copyright 2009 The Associated Press. All rights reserved.

AHIP Members - Health Insurance Plan Links

There are times when we aggressively search the internet for details of the US Health Insurance Companies or Plans and finally find ourselves landing up on the official websites of the insurance companies to find most of the details what we were looking for. On the other hand, it might be even harder to find the official websites of certain insurance companies.

However it maybe, won't it be helpful if there is a webpage which lists the official website URLs of many US Health Insurance companies and plans?

AHIP's website has such a page titled Health Insurance Plan Links which does that, click the link to check it out...

America's Health Insurance Plans (AHIP) is the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans. Their member companies offer medical insurance, long-term care insurance, disability income insurance, dental insurance, supplemental insurance, stop-loss insurance and reinsurance to consumers, employers and public purchasers.