The AMA has recommended that the federal government adopt standard payment rules and common claims processing requirements for insurers. It claims that inefficient and inconsistent claims processing adds as much as $200 billion annually to health care costs.
Key findings of the report card include:
* Insurers continue to vary widely in how often they deny claims. The inconsistent reasons used to explain the denials indicate a “serious lack of standardization.”
* Private health insurers correctly reported the expected contracted rate to physicians 72% to 93% of the time in 2009, compared with 62% to 87% in 2008.
* Prompt-pay laws are leading more insurers to more quickly respond to electronic physician claims.
* Most insurers now provide physicians with at least some Web access to their payment policies, although information on prior authorization of services is lacking.
The report card findings are based on a random sampling of about 1.6 million electronic claims for about 2.5 million medical services submitted in February and March to eight payers, including Medicare.
To view the findings, visit ama-assn.org.
--Howard Anderson
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