If you thought the Great Recession would lead insurance companies to slow down claims payment processing times, think again. Despite the lingering effects of the downturn, payers generally paid promptly in 2010, while reducing many (but not all) extraneous administrative burdens on physicians.
That's according to PayerView, an annual ranking of payer performance conducted by athenahealth, a large revenue cycle management and EHR company, which produces annual rankings of payers based on how well, or badly, they work with physicians.
Physicians Practice has been reporting extensively on the PayerView rankings — the only payer performance analysis that's based on real claims data — since the project began in 2005. The joint objective: to improve payer-practice relations by shining a bright light on payer performance on those "hassle factor" metrics that matter most to physician practices.
Not paying enough is one thing. Making you jump through flaming hoops to get paid at all is quite another. With PayerView, we hope to prompt improvements on those processes that so often drive you and your staff batty, while providing you with vital information to analyze your own payers, especially when contract renewal time comes around.
"The insurance companies have always had more leverage in negotiations because they had the rich data," says Lucien W. Roberts, III, MHA, an associate administrator of business development at MCV Physicians in Richmond, Va. "In many ways, they knew our practices better than we did."
No more. The field is getting more level, and the payers, to their credit, are getting better.
Now let's dig into the numbers.
This year's PayerView report is based on actual claims performance data in 2010 from 27,000 providers, for more than 47 million charge lines, representing $9 billion dollars in charges. The services were billed to 132 payers by providers in 41 states.
The best evidence that claims payment timeliness did not slack off last year comes in the form of reductions in the average number of days that claims spent in accounts receivable. As a group, the Blue Cross & Blue Shield (BCBS) plans and the national commercial payers (Aetna, Cigna, Humana, and UnitedHealthcare) reduced days in A/R (DAR) to 24 days, lopping a full day or more from their performance in the previous year. Medicare, often the leader here, regressed slightly to 25.8 days, thanks to delays caused by Congress' extended debate over the Medicare fee schedule.
Of course, how well your own payers performed in working with you in any particular category could vary from our PayerView results — which are, of course, averages drawn from the experience of thousands of providers, all of them benefiting from athenahealth's services, which are designed precisely to help practices get paid quickly and correctly.
When we ranked best-in-class performance for all payers in all categories, the top performer in DAR was Blue Cross & Blue Shield of Rhode Island at 14.6 days. Does any payer in your patient mix come close to that? We also found that Oregon's Medicare B carrier was in the top spot in the key metric of first-pass resolution rate — claims paid the first time they were submitted, paying 98.1 percent of claims on first submission.
PayerView is designed to show how each payer performs in areas important to physician practices. A data team at athenahealth weights the various metrics to reflect their relative degree of importance to practices. You can see what's measured, and how much weight is given to each, in the "Weights and Measures" table.
The number crunchers then use a complex logarithm to arrive at overall rankings. But the company does not publicly report its overall "final score" for the payers; instead, it reports only the rankings and the payer performance within each individual metric.
It is important to note that the results do not include all payers. As in previous years, a minimum number of claims for which athenahealth had data was needed for a payer to be measured — 4,000 claims per quarter from at least six physician practices in 2010. If any single athenahealth client contributed a disproportionate percentage of a payer's claims, those claims were removed from the calculations.
Payers included also had to support the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction set for eligibility benefit transactions (270 and 271), electronic remittance advice (ERA) transactions (835), and claims transactions (837).
One metric from past years, Denial Transparency, has been replaced this year with the more targeted ERA Transparency. Another, Eligibility Accuracy, has been revised to include a payer's use of the "other payer" segment in the eligibility transaction, which can be used to reduce coordination-of-benefit denials.