MDNews - San Antonio

to dispute a claim or speak with a patient, administrative time is wasted — a reoccurring problem. According to the AMA, medical practices spend an average of 10% to 14% of their total operating costs interacting with insurance companies. After dissecting the mishandled claims, the NHIRC outlined the following overall issues in its 2011 annual report: + Coding discrepancies. Claims are not always fi led correctly. Whether due to physician eligibility or coding issues, inap- propriately fi led claims can leave medical practices and patients scrambling for answers. If the claim remains in limbo or isn't paid by the insurer, the patient is often held responsible for the remaining balance. While UnitedHealthcare has improved its fi rst electronic remittance advice (ERA) by 4% since the 2010 report card, Anthem Blue Cross Blue Shield decreased its ERA by 14%. + Delayed service. Physicians and medical staff are on hand to treat medical conditions upon the arrival of injured or ill patients. Insurers are not, yet they play a huge role in the treatment patients receive. In an effort to maintain authorized approval from insurers, medical services often stall for lengthy periods of time until a decision has been made about what the insurance company will cover. Requiring prior authorization more frequently than other insurers, Humana maintains its 5% approval requirement. However, according to a recent AMA survey of roughly 2,400 physicians, nearly 64% of them report diffi culty determining which test or procedure requires preauthorization by insurers. + Unpaid claims. Whether a claim was denied, deferred to a patient or edited, 23% of physicians received no payment from health insurers for all claims submitted in 2011. Insurance companies aren't paying claims because they're shifting responsibility. As they increasingly place certain restrictions on deductibles, patients and medical practices are shouldering the burden of higher deductibles and co-payments at later dates. To review the 2011 American Medical Associat ion's National Health Insurer Annual Report Card, visit www.ama -assn.org. s HIGHLIGHTING AREAS OF IMPROVEMENT FACING ECONOMIC AND health care uncertainty, 47 million Americans are currently without health care insurance — a number that has steadily increased over the past few years. Those fortunate enough to have coverage are often plagued with deductible and co-payment uncertainty. Unaffordable prescription rates and a spike in overall health care costs have pushed insurer inaccuracy to the forefront of the health care controversy. Although insurance companies continue to raise rates, many are taking the initiative to solve costly claim issues. Some of the improve- ments being made by the health insurance industry include: + Decreased denials. With new health care reform laws in place, insurance companies are required to not turn away people with pre-existing medical conditions. According to the U.S. Department of Health and Human Services, insurance companies will be required to renew any policy as long as policyholders pay their premiums in full. From 2010 to 2011, the American Medical Association saw a decrease in denial rates from Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation and UnitedHealthcare. + Implementation of real-time claims. These claims are slowly gaining popularity because they reduce the hassle associated with unpaid claims by immediately pricing and processing a claim. Although real-time claims would save time and help prevent claim inaccuracies by eliminating the middleman, physicians play a vital role in ensuring the adoption of real-time claims. Once electronic health records are properly implemented throughout the health care community, claims will be able to be processed without delay. + Faster response time. Claims can take days or even weeks to process, and CIGNA and Humana are two insurers that have been able to dramatically slice their claims response times in half. When claims take six to 15 days on average to process, they often become a waiting game for patients and physicians. If claim information isn't relayed to a patient until the claim is processed, the only viable option is to pay at a later date. MDNEWS.COM ■ MD NEWS San Antonio | 13

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