Based on analysis of claims data from more than 52,000 providers across 50 states, an annual ranking of insurance companies from revenue cycle management vendor athenahealth Inc. ranks Humana as the best in overall payer performance while Medicaid performed the worst last year.
The 2014 PayerView report, which analyzed 108 million charge lines and $20 billion in healthcare services billed in 2013, scored the performance of 148 payers for metrics such as days in accounts receivable, first-pass resolution of claims, denial rate, and provider collection burden, among others. The top payers, in order, were Humana, Healthpartners, BCBS Massachusetts, CIGNA-Healthsource, Group Health Cooperative, Medicare Part B in Missouri, BCBS-Pennsylvania Capital Blue Cross, BCBS in the District of Columbia, Medicare Part B in Indiana, and Medicare Part B in Oregon.
Among the findings of the report:
* For the 9th year in a row, Medicaid performed worse than commercial plans and Medicare on key metrics, such as Days in Accounts Receivable, Denial Rates, and Electronic Remittance Advice transparency. While some state Medicaids, such as Connecticut, performed especially well on select metrics, like enrollment, as a whole the category continues to underperform. Even though it is too early to determine the impact of the Medicaid expansion on payer performance, with an expected 25.6 percent increase in enrollees by 2021, all providers who serve Medicaid populations should be aware of their states expansion status and performance metrics, the vendor advises. Understanding strengths and weaknesses related to Medicaid enrollment efficiency and denial rate can help providers prepare for increased Medicaid patient volume and potential associated administrative burden, as well as mitigate risk to their business.
* Blue Cross Blue Shield plans reimburse providers the quickest, with an average of three fewer Days in Account Receivable compared to all other payers. On this measure, Blues plans represent 20 of the top 25 performers, displacing major commercial payers historical position as the leader in this category. As major participants in the health insurance exchanges, Blues plans performance signals a positive indicator that providers who serve patients covered by these plans can cater to increased patient volume without cash flow disruption.
* PayerView data indicates the provider collection burden, measured as the percent of charges transferred from the primary insurer to the next responsible party after the time of service, is increasing slightly. Historically, findings reveal that providers in the West are experiencing higher collection burden than those in other parts of the country. PayerView results reveal that Medicare and many Blues plans require providers to collect large percentages of payments from patients, while Medicaid requires minimal collection. Providers who shift their payer mix to include Medicare and Blues plans may see their collection burden increase. Those providers may also be increasingly asked to explain the meaning of things like co-insurance, deductibles, and co-pays to patients.
* While Medicaid enrollment proves particularly burdensome, national commercial payers enrollment proves simplest. According to PayerView data, no commercial payers require enrollment for electronic data interchange or for enrollment documents to be sent via mail. As providers contemplate potential changes to the mix of payers with which they work, enrollment requirements and associated efficiencies should be considered. PayerView findings show that the industry has not adopted transaction-based enrollment, despite the existence of the ANSI X12 274 transaction. This would most likely be the most efficient method for payers and providers.
This years PayerView provides clear insight into how payers are succeeding and faltering across the United States, says Todd Rothenhaus, chief medical officer at athenahealth. This information, now more than ever, is important to providers as many are shifting their payer mix to accommodate the influx of newly insured patients. The data reveals existing pain points for providers right now and, even more critically, areas of payer weakness that could have significant impact.
The report is available at athenahealth.com/PayerView.
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