Top Payers Ranked in First Annual Report
Author Available for Interviews at TEPR; First Annual Rankings Highlight Technology Shortfalls

Baltimore, Maryland — May 18, 2006 — In a response to the growing rift between health insurers and physicians, Physicians Practice®, America's Leading Practice Management Journal, this month will release the Physicians Practice PayerView Index, a first-of-its kind ranking of the best and worst payers for physicians to work with. Pamela Moore, senior editor for Physicians Practice, and a featured speaker at the 2006 TEPR Conference & Exhibition, will be available at the conference and by telephone to discuss the details of this groundbreaking data-based index.

"The primary function of payers is to pay for medical care," says Moore. "This report highlights what a poor job many of them are doing at it, from a physician perspective."

Physicians Practice partnered with athenahealth, Inc., a national software and billing services company, to create PayerView -- an index that ranks claim performance based on data collected by athenahealth on more than 7,000 national and regional payers according to specific measures of administrative performance and medical policy complexity. The rankings will be the cornerstone of the June 2006 cover story of Physicians Practice that will include in-depth analysis and payer profiles compiled by the editorial staff.

PayerView ranks payer performance based on data from the fourth quarter of 2005 in a number of categories, which combine to provide an "ease of doing business with" index illustrating the ability of insurers to efficiently and appropriately pay claims. To ensure accuracy, the rankings include national payers with at least 10,000 charge lines of data, and members in most if not all regions of the country. For regional payers, 3,000 charge lines were the minimum. The ranking metrics are designed to examine financial and administrative performance as well as an insurer's system complexity.

Metrics for each category include:
Financial Performance

• Days in Accounts Receivable (DAR) – length of time it takes a health plan to pay a claim
  
• First Pass Pay Rate (FPP) – percentage of claims paid on the first submission within 90 days
  
• Percent Patient Liability – percentage of billed charges that insurers transfer to patient responsibility. It accounts for the amount of burden placed on physicians to track down patient collections due to member cost shifting and consumer-directed or high-deductible plans
  
  

• Denial Rate – percentage of claims requiring practices to go back to health plan and appeal
  
• Percent Phone Call – percentage of claims requiring phone calls to health plan for clarification/corrective action
  
• Percent of Not on File (NOF) – percentage of claims marked “not on file” after inquiry with payer (i.e. claims lost by payer)
  
  

• Unclear Zero Pay – percentage of claims not receiving payment as a result of payer’s departure from national coding standards