Annual Survey: Payer Performance in Claims Processing Falters
For the first time in the seven-year history of athenahealths annual PayerView Rankings of insurance company performance in processing and paying claims, industrys performance showed no sign of year-over-year improvement.
For the first time in the seven-year history of athenahealth’s annual PayerView Rankings of insurance company performance in processing and paying claims, industry’s performance showed no sign of year-over-year improvement.
The vendor annually mines aggregate claims data from a network of 33,000 providers to analyze the burden level that insurers place on providers.
Payer performance in 2011 remained flat and in some cases decreased, according to the analysis. Jonathan Bush, CEO at Athenahealth, which provides outsourced physician billing/collections services bundled with EHR and practice management software, speculates that the HIPAA 5010 transition contributed to lower performance for days in accounts receivables and first-pass resolution rates, and wonders what providers can expect with the coming ICD-10 transition.
Because HIPAA 5010 conversions started late in 2011, performance could well stagnate in 2012 as well, according to the analysis.
Major commercial payers averaged 25.2 days in accounts receivable in 2010 and 26.1 days in 2011, and Medicare averaged 25.8 days in 2010 and 26.7 days last year. Medicaid, which is much slower than other insurers, was the only segment to show improvement, from 48.6 days to 46.5 days.
First-pass resolution rates in 2011 fell 0.4 percent for major commercial payers, 0.1 percent for Medicare and 0.8 percent for Medicaid.
The 2012 report is available at athenahealth.com/PayerView.
The vendor annually mines aggregate claims data from a network of 33,000 providers to analyze the burden level that insurers place on providers.
Payer performance in 2011 remained flat and in some cases decreased, according to the analysis. Jonathan Bush, CEO at Athenahealth, which provides outsourced physician billing/collections services bundled with EHR and practice management software, speculates that the HIPAA 5010 transition contributed to lower performance for days in accounts receivables and first-pass resolution rates, and wonders what providers can expect with the coming ICD-10 transition.
Because HIPAA 5010 conversions started late in 2011, performance could well stagnate in 2012 as well, according to the analysis.
Major commercial payers averaged 25.2 days in accounts receivable in 2010 and 26.1 days in 2011, and Medicare averaged 25.8 days in 2010 and 26.7 days last year. Medicaid, which is much slower than other insurers, was the only segment to show improvement, from 48.6 days to 46.5 days.
First-pass resolution rates in 2011 fell 0.4 percent for major commercial payers, 0.1 percent for Medicare and 0.8 percent for Medicaid.
The 2012 report is available at athenahealth.com/PayerView.
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