Could there be changes looming on how billing services and health insurers work together to manage claims processing and related transactions more efficiently and effectively. Representatives from the Healthcare Billing & Management Association (HBMA) gathered at Institute 2009 in San Diego in June to discuss this and present survey findings to executives of America's Health Insurance Plans.
"HBMA is committed to its ongoing outreach efforts, and is focused on securing cost reductions that will ultimately benefit all stakeholders, including payers, providers and patients," says Brad Lund, HBMA executive director. "As part of HBMA's efforts, we will also be reaching out to individual health insurance companies to identify practical administrative simplification solutions."
In addition to identifying opportunities to drive down costs and produce administrative efficiencies, a survey of HBMA members—third-party medical billers and billing professionals—found that:
• 46% of member firms reported that fewer than 60% of insurance companies transmit denial information using HIPAA-standard codes
• 68% of member firms reported that the insurance company ultimately pays 60% or more of all denials after appeal or intervention
• 69% of member firms reported that cumbersome protocol for filing appeals is the most challenging aspect of handling claim denials
Through the reciprocal exchange of ideas and coordinated efforts, HBMA collaborates with a broad range of industry associations including the American Medical Association, Blue Cross Blue Shield Association, CAQH, Cooperative Exchange, Emergency Department Practice Management Association, Medical Group Management Association, Radiology Business Management Association, Workgroup for Electronic Data Interchange and others.
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