AMA: Many medical claims processed inaccurately

Posted June 14, 2010 at 2:59 p.m.

By Bruce Japsen | One in five medical claims are processed inaccurately by the nation’s
largest health insurers, slowing payments to doctors and causing
confusion for consumers, the American Medical Association said Monday.

In a report released during the AMA’s annual meeting in Chicago, the
national doctors group said making claims processing 100 percent
accurate would save the health care system $15 billion largely by making
health care more efficient and by reducing administrative costs.

Improving claims processing could also save patients money and improve medical care service by reducing or eliminating hassles physicians have when they are forced to haggle with health plans over payments or other issues.

“Because doctors are not confident in their ability to know what they are going to get paid before it happens, they are then not confident in telling patients what they owe,” said Mark Rieger, chief executive officer with National Healthcare Exchange Services, a Sacramento, Calif.-based company hired to put together the AMA’s third annual health insurer report card.
The AMA has said the report card is designed to hold the health plans accountable.

“The finding that one in five medical claims are processed by insurers with errors emphasizes the huge potential for reducing administrative costs for physicians and insurers,” said Dr. Nancy Nielsen, the AMA’s Immediate Past President.

The AMA’s report measured timeliness and accuracy of claims processing of the nation’s seven largest health insurers, including Aetna, Inc.; Humana Inc. UnitedHealth Group and Chicago-based Health Care Service Corp., parent of Blue Cross and Blue Shield of Illinois.

The AMA’s finding show the health insurance industry has about an 80 percent “accuracy rate for processing and paying claims,” the group’s data showed.

Coventry Health Care, Inc. had the best rating at 88.41 percent followed by Health Care Service at 87.83 percent. Anthem Blue Cross Blue Shield was last among the nation’s largest insurers with a 73.98 percent accuracy rating, the AMA said.

AMA officials say the insurers have largely improved on their claims processing accuracy since the doctors’ group began rating health plan business practices three years ago. The AMA report’s findings are based on a random sample of about two million electronic claims. 

The health insurance lobby said claims processing could improve even more if all doctors submitted their health claims electronically to health plans.

“Health plans and providers share the responsibility of making the innovations and investments needed to improve efficiency in our health care system,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the Washington lobby that represents the nation’s largest health plans.” A recent AHIP survey found that nearly one-fifth of all provider claims are not submitted to health plans electronically, and more than 1 in 5 claims are submitted by providers at least 30 days after the delivery of care.  Health plans are investing in cutting-edge technologies to make it easier for providers to submit claims electronically and receive payment quickly.”



  1. jack (me) June 14, 2010 at 9:49 a.m.

    Not surprising that the first two recommendations (regarding the 21% cut and raise Medicaid pay) are just “we don’t want our own pocketbooks affected.”

  2. hbs June 14, 2010 at 10:17 a.m.

    Yet again, the AMA is disorganized internally. How can they be considered relevant when they do not agree internally? It must be tough when less than 20% of all practicing physicians are members of a dying organization…..

  3. stu June 14, 2010 at 3:28 pm

    If the government slashed Medicare pay by 21% many doctors would no longer see patients with Medicare, considering they haven’t even had a raise in Medicare reimbursements in over 15 years, it is already one of the lowest paying insurance plans in the country. A cut would drastically cut service to an already depleted workforce.