An article published on May 14th,
2008 in Wall Street Journal rank Aetna first among 130 big health insurers in
their ability to quickly and accurately reimbursing doctors. The factors
considered include how long carriers take to pay bills, the percentage of
claims they resolve after one submission and their claim-denial rates. The results were based on data from 13,000 clients of Athenahealth, Inc. which
provides doctors with practice-management and electronic medical-record
services. The average number of days it took national insurers to pay doctors
in 2007 was 27 days for Aetna, 30 days for Humana, 33 days for Cigna, and 35
days for both Medicare-B and UnitedHealth.
An Aetna spokesman said the company has improved efficiency, in part,
through technology and by clarifying its policies with doctors.
The annual ratings reflect a greater push toward performance measurements
and transparency across the health sector. A 2007 survey of hospital executives
and insurers by PNC Financial Services Group Inc. found that administration and
billing account for one of every $3 spent on health care in the U.S.
Athenahealth weighted seven criteria to assess which carriers were most
responsive. Aetna took 27 days on average to pay doctors, resolved 96% of
claims on the first attempt and denied 5.9% of claims — the three factors
given the most weight — to finish with the best overall score. Cigna Corp. finished second overall, taking 33 days on average to pay doctors,
resolving 96% of claims in one attempt and denying 6.6% of them. New York
state's Medicaid program scored the lowest among all payers in the study: The
joint federal-state insurance program for the poor took 137 days on average to
pay doctors, resolved 57% of claims on one try and denied 39% of claims.
William F. Jessee, chief executive of Medical Group Management Association,
an organization for individuals who manage medical-group practices, said
persistent delays in payment often prompt doctors to drop out of insurance
plans, which can lead to reduced access to care for patients.
Efficiency,” Wall Street Journal, May
29, 2008.
One response to “Health Insurer Efficiency”
In addition to working as a full time computer engineer for the navy, I have also managed a patient accounting system for a rural health care practice for the past five years which also entails maintaining their electronic billing. My comments to this article are more from the perspective of the entire process of filing claims from the health care provider to the health insurer. Electronic billing has came a long way over the past few years and has steadily become much more efficient shying away from the traditional paper claims that providers used to send via snail mail. This has significantly reduced the overhead associated with end to end processing of claims(especially with how much time our nurses spend on billing), but has also made the implementation complicated and costly for heath care providers. Although billing has become much more efficient, the complicated process of a health care provider filing and managing electronic claims with different health insurers can become very tedious and time consuming.
Although I have not specifically had any experience with most of the health insurers in this article (besides Medicare-B), I have to say that the lead time on payment averages about two weeks (specifically with Medicare and Medicaid). Some inefficient health care insurers can range from 2-4 weeks. Fortunately, we do not share the same long lead times in receiving payments as described in this article.
The only way for a health care provider to efficiently file eletronic claims to health insurers is by using a one stop shop(for a fee) like Athenahealth to file all claims(I use Emedian which was formly owned by WedMB). Although this adds another component in the “supply chain” for payments, it is far more efficient then directly filing claims to individual health insurers. Essentially, the one stop shop has to process and standardize the claims with respect to which health insurer the claim is going to. From the perspective of the provider filing the claim, the lead time for payment also depends on the efficiency of the one stop shop. I do not believe the data presented in the article accurately represents the time to process claims with respect to Athena Health. Service providers like Aethena Health also help increase Aetna’s first attempt processing numbers by rejecting and altering claims before they are even sent to Aetna. It would be more interesting to see statistical data based on different one stop shops and the total lead time for payments of the entire process.
In conclusion, I believe efficiency should be quantified across the whole chain, instead of just the health insurer. All three components (health care provider, one stop shop, and health care insurer) efficiencies are based on how in sync the one stop shop is with the provider and insurer. This creates a much more complicated job for the middle man(compared to the other two components which is still tough) , as HIPAA laws and insurer requirements electronic processing are constantly changing software, electronic forms, and security requirements while still offering the compatibly to different patient accounting software. Electronic Billing is the only way to go for all the players in the chain. Rome was not built over night, and it will require a lot of coordination with all the components in the chain, but the benefits of increasing efficiency and technological advancements early will be worth the investment for everyone, which I am sure Seven-Eleven and Walmart can attest to.