Major commercial health insurers and Medicare significantly lowered their error rates during the past year, but still incorrectly paid nearly 10 percent of claims, according to results of an annual survey from the American Medical Association.
The error rate in 2012 was 9.5 percent compared with 19.3 percent a year earlier. The association attributes the improvement to its efforts to work with insurers. The improved accuracy translates to $8 billion in savings from reduced administrative costs to reconcile errors, according to the AMA in its fifth annual National Health Insurer Report Card.
The findings are based on a random sampling of 1.1 million electronic claims for about 1.9 million medical services submitted in February and March 2012 to specific insurers. They are Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, Regence, UnitedHealthcare and Medicare. The claims were from 380 physician practices representing 79 specialties in 39 states.
UnitedHealthcare had an accuracy rate of 98.3 percent. Anthem made the most improvement during the past year, hitting 88.6 percent, up from 61 percent in 2011. But the savings from increased accuracy are partially offset by “a resurgence of intrusive managed care policies on clinical decisions,” according to AMA. Medical services requiring prior authorization increased 23 percent in one year, affecting 4.7 percent of all claims. That, says AMA, will add $728 million in unnecessary costs during 2012.
The percentage of claim lines where the payer’s allowed amount equals the contracted fee schedule varied by nearly 14 percent among the payers in 2012, from 86.05 percent for Regence to 99.95 percent for Medicare.
Insurer rates for ERA accuracy--the percentage of claim lines where the allowed amount equals the physician practice’s expected amount--in 2012 ranged from 87.36 percent by Humana to 99.48 percent by Medicare, according to the report card, available here.
This story first appeared at Health Data Management.
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