News/Commentary

A new study shows that there has been improvement in the speed with which payers pay claims and a decline in denied claims when compared with 2007 data.

This study of health claim payments and the percentage of claims denied was a comprehensive review of 40 states.

The ratings will be posted on the Athenahealth website, which performed the review in collaboration with a leading journal for medial practice management. (Citation not available)

The review included health plans and government payers.

The news about how doctors get paid is not all good.

The full story below quotes one source as saying that “nothing” happens to health plans which do not pay physicians on time. The reality is that there is no federal agency charged with oversight of plan payment practices, which would include overseeing government payers as well.

There are no penalties when plans do not pay doctors on time—-short of influential doctors in one service area (your home town, your region) refusing to contract with a plan. That is a step most physicians take only as a last resort because it puts patients in the middle and limits their access to care.

When you don’t pay your co-pay at the time of service, or you don’t pay it when billed after 30 days, you know what happens to you. Interest accrues. A collection agency may call if the bill is not paid within a certain time frame.

A doctor’s office—-be there two or twenty physicians in the practice—–has to keep the lights on, the reception desk staffed, exam supplies on hand and an administrative staff ready to submit claims for payments to insurers and collect co-pays from patients.

They have to pay for these goods and services as they use them monthly. Practices need to keep cash reserves, borrow money at the bank (increasingly harder for them to do) or, in whatever fashion the physicians can come up with, be able to cover their expenses while waiting for payment.

Follow Your Health Care Dollars

1. Plans get paid before they send any money out. They pay when they are satisfied with documentation of the services rendered and that the member is entitled to those services. This survey shows some plans pay more quickly and more often than others.

2. Physicians spend money first before getting any back in. They know, through pre-approvals, what likely will be paid, but there are no guarantees of that nor any commitment to when. Plans don’t have to do that.

3. Patients pay for services, or some portion of services, at the time of use or shortly after unless other arrangements have been made. Patients do have to do that.

4. Between the time plans are paid your premium (by you and your employer monthly) and the time plans pay your claim, there is a lot of money sitting in the plans’ investment accounts. These plans are making a lot of money investing your money, while processing your claims. That’s why some plan names you know are among the biggest companies in the world, according to Fortune Magazine annual ratings.

It used to be when kids were asked what they wanted to be when they grew up, many said they wanted to be doctors.

A smart kid today probably should say, “I want to grow up to be a health plan.”

Kaiser Daily Health Policy Report

Quoting from the Boston Globe:

“Aetna, Cigna and Humana ranked highest nationally on criteria including speed of health claim payments and fewest claims denied, according to the 2009 PayerView Rankings, the Boston Globe reports. The rankings — prepared by Athenahealth in collaboration with Physicians Practice management journal — evaluated 172 national, regional and government payers in 40 states.

“According to the data, insurers paid physicians an average 5.3% faster in 2008 and denied an average of 9% fewer medical claims compared with 2007 figures. On average, national health insurers paid physicians in 33 days and denied 9.2% of claims.

“According to the Globe, the rankings reveal some of the obstacles that can result from the complexities and bureaucracy involved in the medical billing process, with each insurer operating in different ways. Jonathan Bush, chair and CEO of Athenahealth, said, “This is the biggest problem we have in health care — the inability to close supply chains and to practically and tactically connect doctors with payers and patients,” adding, “These connections are broken.“    (Weisman, Boston Globe, 5/28). (Emphasis added)

Source: Journal of Medical Practice Management, 2009 (Publication date not provided nor implied. Abstracts not available.)

Source: Athenahealth.com (Study data posted on this website)

Source: Kaiser Daily Health Policy Report, May 29, 2009

Source: Boston Globe, May 28, 2009