FEB 7, 2012 5:28pm ET

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Survey Ranks ‘Fairness’ of Payer Reimbursements

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A survey from IVANS Inc., a transactions processing vendor, finds large numbers of its provider customers believe Medicare and Medicaid reimburse more fairly than commercial insurers, even though the government plans pay less.

Ninety-three percent of respondents say Medicare is fair all or most of the time, and 62 percent say the same about Medicaid. But 62 percent believe commercial plans are not fair in all or most cases; 49 percent say commercials are fair “some of the time.”

Speed might be a factor in assessing fairness. About two-thirds of respondents said Medicare pays the fastest, 26 percent said Medicaid was fastest and only 9 percent picked commercial payers. Respondents also send far more paper claims to commercial insurers, according to the IVANS survey. Thirty-nine percent submit some paper claims to commercials, compared with 11 percent to Medicaid and 1 percent to Medicare. Other survey results include:

* The top three reasons for unpaid claims are disputes by the payer, coding errors and patient eligibility issues;

* 66 percent of respondents believe their profit margin will decrease during the next two years because of health care reform; and

* 61 percent have been audited by Medicare. Despite the burdens and worry of audits, 78 percent believe the RAC audits are reducing fraud and errors.

For an executive summary of survey results, send e-mail to cecile.locurto@ivans.com.

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Looking to build better care coordination, health systems are buying physician groups in droves. Making the deal work, however, requires careful management on the I.T. front.

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