By Bruce Japsen, Chicago Tribune
Jun. 17–Turning the tables on the health insurance industry’s rankings of doctors, the American Medical Association on Monday said it will begin rating business practices of health plans that it says can slow payments to doctors and often confuse consumers.
The national physicians group, in Chicago this week for its annual policymaking meeting, said it is for the first time providing a report card that examines the timeliness and accuracy of claims processing of seven national commercial insurance companies, as well as Medicare. Aetna Inc., Cigna Corp. Humana and UnitedHealth Group are among the insurers rated online at ama-assn.org/go/curefor claims.
While the report card is aimed at helping doctors negotiate contracts with insurers and reducing claims-related costs, the AMA said it also could lead to improvements in consumers’ understanding of their medical bills and how medical care is priced.
“The goal of the AMA campaign is to hold health insurance companies accountable for making claims processing more cost effective and transparent and to educate and empower physicians so they are no longer at the mercy of a chaotic payment system that takes countless hours away from patient care,” said Dr. William A. Dolan, an AMA board member.
Insurers say they are making strides to improve prompt and accurate payment of claims.
“We have ongoing dialogue with physicians to better understand and address their business needs,” said Scot Roskelley, a spokesman for Aetna Inc., one of the nation’s largest health plans. “We also continually enhance our suite of electronic options for health-care professionals to obtain information and transact business with us.
“We will review and consider the information shared in the AMA’s campaign in our ongoing work to make our processes even better for physicians.”
Susan Pisano, a spokeswoman for America’s Health Insurance Plans, said both insurers and doctors need to work together for claims to be processed accurately and promptly. She said while insurance companies that rate doctors generally share the information with doctors before they make it public, the AMA did not share its report with insurers before releasing it.
As health-care costs rise, insurance companies, employers and consumers are demanding quality information, and health-plan-led efforts are increasingly grading and ranking doctors on a variety of quality measures. Physicians and patients also are demanding more insurer transparency so they know the cost of a procedure and how the payment is allocated.
The larger issue of “inefficient and unpredictable” medical claims processing can add up to $210 billion in costs annually, the AMA said. Meanwhile, diverting such resources as clerical-staff time to correct and grapple with inaccurate claims can cost doctors up to 14 percent of their total revenue, the AMA said.
“The difficulty consumers have understanding their bill is no different than the doctor has understanding their payment,” said Mark Rieger, chief executive of National Healthcare Exchange Services, a Sacramento company hired to put together the report card.
The Associated Press contributed to this report.
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