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AMA Annual Payer Report Demonstrates Cost Shift to Patients

Originally posted from HealthData Management – A new report from the American Medical Association finds patients now are responsible for almost 25 percent of their medical costs.
In its sixth annual National Health Insurer Report Card, AMA for the first time studied patient responsibility via co-pays, deductibles and co-insurance. In February and March 2013, patients on average paid 23.6 percent of the amount of reimbursement that insurers set for physicians.
The report card is based on about 2.6 million electronic claims for 4.7 million medical services submitted in February and March to eight insurers: Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, Regence, UnitedHealthcare and Medicare. The claims came from 450 physician practices covering 80 specialties in 41 states. Findings of analysis of the claims data found:
* Insurers are getting more accurate in payments, with an average error rate of nearly 20 percent in 2010 falling to 7.1 percent now. Medicare had the highest accuracy rate with 98.1 percent. UnitedHealthcare led studied commercial payers with a 97.52 percent accuracy rate, while Regence was last at 85.03 percent.
* After a big increase in 2012, claim denial rates fell 47 percent in 2013, from 3.49 percent to 1.82 percent. Cigna recorded the lowest denial rate at .54 percent; Medicare’s rate was nine times higher at 4.92 percent.
* Humana had the fastest median commercial claims turnaround time at six days with Aetna the longest at 14 days. Medicare has been at 14 days since 2008.
* Between 2008 and 2013, studied insurers have improved transparency of rules to edit claims by 37 percent, reducing provider administrative costs of reconciling claims.
The National Health Insurer Report Card is available at ama-assn.org/go/reportcard.

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