Commercial health insurers inaccurately process 20% of medical claims, AMA says

By Associated Press
Tuesday, June 15, 2010

One in five medical claims is processed inaccurately by commercial health insurers, often leaving physicians shortchanged, the American Medical Association reported Monday in its third annual assessment of insurers.

This report card focused solely on commercial insurers, a break from previous reports, which also looked at Medicare. The AMA report card is an effort to reduce the cost of claims processing for doctors. As much as $210 billion is spent annually to process insurance claims.

Private insurance companies matched their payments to what they agreed to pay doctors about 80 percent of the time, and Nancy Nielsen, immediate past president of the group, said that was a dramatic improvement.

"It is the report card that forced them to pay attention," Nielsen said.

Robert Zirkelbach, a spokesman for America's Health Insurance Plans, said it takes both insurers and doctors to process claims accurately and quickly. Many doctors don't submit claims electronically or promptly, he said. "Government data show that soaring medical costs -- not health-plan administrative costs -- are the key drivers of rising health-care costs."

The AMA rated Coventry Health Care highest of seven commercial insurers. Its national accuracy rating was about 88 percent. Anthem Blue Cross was at the bottom, with an accuracy rating of 74 percent.

Medicare said Monday that it will give senators a few more days to waive a cut in the rates the federal government pays doctors who treat patients with Medicare. The 21 percent cut is required by a 1990s deficit reduction law; Congress has routinely waived the law in the past, and the House has approved legislation to do so again.

Anthem's parent company, WellPoint, said that it is continually trying to improve and is contracting with an electronic claims processing company in five states in an effort to streamline claims.


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