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Eliminating Claim Payment Errors Could Save $17 Billion Annually, Says AMA

Claims-processing errors by health insurance companies increased since last year, accounting for billions of wasted dollars, according to the American Medical Associationís (AMA) fourth annual National Health Insurer Report Card.

The report found that commercial health insurers have an average claims-processing error rate of 19.3 percent, an increase of two percent from last year. This increase represents an extra 3.6 million erroneous claims payments, and an estimated $1.5 billion in unnecessary administrative costs to the health system. The AMA estimates that eliminating health insurer claim payment errors would save $17 billion annually.

Most of the health insurers measured by the AMA failed to improve their accuracy rating since last year. UnitedHealthcare was the only commercial health insurer included in this yearís report card to demonstrate an improvement in claims-processing accuracy; they came out on top of seven leading commercial health insurers with an accuracy rating of 90.23 percent. Anthem Blue Cross Blue Shield scored the worst of those measured with an accuracy rating of 61.05 percent.

Other key findings from this yearís report card include:

  • Physicians received no payment at all from commercial health insurers on nearly 23 percent of claims they submitted.
  • Dramatic reductions in denial rates have occurred since last year at Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation and UnitedHealthcare.
  • Response time varied for commercial health insurers from six to 15 median days.

To encourage more efficient claims payment system, the AMAís National Health Insurer Report Card provides an annual check-up for the nationís largest health insurers and benchmarks the systems they use to manage, process and pay claims.


Source: American Medical Association, June 20, 2011

2011 Healthcare Benchmarks Yearbook: Metrics, Measurements and Innovations

This 480-page resource — HIN's second annual compilation of performance benchmarks in key areas of healthcare activity and growth — delivers more than 23,000 data points from 1,000 responding healthcare organizations in an easy-to-use binder format. It contains more than 400 graphs and tables documenting adoption, activity and ROI in nine key healthcare areas, frequently drilling down to the perspectives of hospitals, health plans and employers. Key areas include: medication adherence, telehealth and telemedicine, the patient-centered medical home, and more.

2011 Healthcare Benchmarks Yearbook: Metrics, Measurements and Innovations is available from the Healthcare Intelligence Network for $447 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.

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IMPORTANT NOTICE: This information is designed to provide accurate and authoritative information on the business of healthcare. It is distributed with the understanding that Healthcare Intelligence Network is not engaged in rendering legal advice. If legal advice is required, the services of a competent professional should be retained.

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