Even with technology that helps him track payer data, keeping up with denials is still the biggest challenge for emergency medicine physician John Kulin.
"It's something we've dealt with for a long time," says Kulin, medical director for urgent care at multispecialty practice Shore Medical Center in Somers Point, N.J. Because of the work involved in staying ahead of the curve, Kulin meets with his billing staff biweekly. But those meetings, combined with business analytics technology from his revenue cycle management vendor, athenahealth, makes it much easier to get paid promptly than when he worked with a private billing company.
"I love looking at the data," says Kulin. "It always tells a story for me. For example, more and more payers seem to give denials or delay payments on anything that's accident-related."
The software that Kulin uses, athenaClarity, leverages the data locked in Shore's practice management system to provide insight that allows managers to easily spot changes in payer policies that result in denials.
Shifting payer policies are becoming more common around the country as payers are increasingly requiring practices to fight for every last dollar, according to the latest PayerView report, athenahealth's annual ranking of insurers based on how easy — or difficult — they are for practices to work with.
To compile the PayerView rankings — found in part here, and in deeper detail on PhysiciansPractice.com — athenahealth examines data from the millions of claims it processes for its medical practice clients around the country. It runs the data through an algorithm it developed that measures payers' efficiency, using metrics such as average time it takes to pay a claim.
Over the next few years, the Affordable Care Act (ACA), ICD-10, and other regulatory and industry changes promise to shake up payer-physician relations, according to athenahealth's experts. Let's have a look at some of the numbers and what they mean for your practice.
*How are your payers performing? Find out with our in-depth national and regional data: / Major Payers / Blues / Medicare / Medicaid / Northeast / Midwest / South / West / Best Payers / Worst Payers. This information is also available at athenahealth.com.
Inside the data
The 2013 PayerView data revealed modest improvements in a number of metrics. The average denial rate declined slightly, to 7.2 percent. But insurers are cutting costs in other ways, for example, by asking more often for additional information before paying a claim. "It certainly continues to be a phenomenon, new requests for information for a claim to get paid," says Todd Rothenhaus, athenahealth's chief medical information officer. "I do think that if there is belt tightening on the side of the payers, there is a return on investment for policy changes that are going to lead to denials. Some of the best payers have particularly low denial rates, but what they were doing was paying everything. While denials are going down nationally, some payers are denying more."
Other metrics reflected a continuation of negative trends.
Higher deductibles continue to impact provider collection burden, a measure of how much of the patient's bill must be collected by the practice. Although this burden declined for the country's largest payer, Medicare Part B, it increased for most private insurers for the second straight year.