Before we get to that, though, a few disclosures:
First, although the data we use are ample, we agree it would have been better if we’d gathered more data from more sources. Our sample size is significant but limited. Athenahealth will be adding new data quarterly at www.athenaPayerView.com, which will house the PayerView index. We’ll create and publish new rankings each year in Physicians Practice.
Second, athenahealth has some nonrevenue-bearing relationships with several payers. These are information-sharing relationships aimed at streamlining payment processes on behalf of athena’s physician clients. The PayerView rankings are strictly data-based.
Third, the parent company of Physicians Practice — MedIQ — has a business relationship with Humana, which finished first among national payers in our rankings. MedIQ publishes a quarterly magazine called Humana’s Your Practice on the insurer’s behalf that is distributed to physicians in the Humana network. Again, the rankings we came up with are strictly data-based. Humana was treated no differently than any other payer.
What we found
OK, now for the results. (For our ranking of national payers, click here.)
First, Medicare isn’t so bad after all. Physicians love to rail against Medicare, largely due to its low fee schedule relative to many commercial insurers. But if you are looking for easy billing, Medicare is The Man.
Nationally, Medicare’s index score in our report is 92.2 percent, and on a regional basis, some Medicare carriers performed even better. Medicare B of Illinois turned in an impressive 94.2 percent index score.
Medicare has a bad rep among physicians, but there’s no real surprise in its success. Medicare sets the rules, and all its policies are published and publicly available, so it should be easy for providers and Medicare carriers to be successful in their communications regarding claims. Plus, the system has a high level of accountability. Carriers who don’t follow the rules are fired. Individuals can go to jail.
Medicare has “committed to being more transparent than some other payers. With other payers we say, ‘Tell us what you want [from claims], and we’ll give you that, but other payers can’t even tell us what they want,’” says Jeremy Delinsky, director of process innovation for athenahealth. He adds that Medicare has “sufficient scale that it’s in their interest to be lean. They are concerned about administrative loss ratios.”
Given Medicare’s advantage as the guys who set the rules, what is surprising is that any commercial payer outdoes them. But Humana swept the national payer field with an index score of 94.7 percent. That’s better than anyone, nationally or regionally, with the sole exception of little First Carolina Care in the South.
Humana also did especially well in our “not-on-file” measure — how many claims get “lost in the mail,” so to speak. It’s a surprisingly common phenomenon among payers, but much less so with Humana.
Mark Smithson, vice president of provider process and network operations at Humana, credits the company’s success to its efforts to streamline submission through electronic payment and its single processing point. “Not many claims are mailed, and what is mailed goes to only one address. I think that streamlines things a lot. I see our process starting with claims acquisition.”
“Reducing administrative complexity in the healthcare system plays a large role in the accuracy and timeliness of the payment process, which is where our efforts are squarely focused,” agrees Bruce Perkins, senior vice president for Humana.
Another surprise about Humana is that its days in A/R are relatively few even though physicians have to frequently call regarding a lot of their claims. Humana came in 23rd in terms of percentage of phone calls. You’d think all those calls would slow down payment. The fact that payment is still pretty fast shows that “when something goes wrong they are good at explaining what exactly went wrong and what has to happen to fix it,” says LaFontana.
