Humana, Medicare Lead in Payer Performance

Article excerpt

In an assessment of performance by one of the nation's largest physician revenue management companies, Humana and Medicare were rated highest when it came to paying quickly and being easy to work with.

The performance data were tabulated and made public by AthenaHealth, a Watertown, Mass.-based company that manages $2 billion in revenues for 7,000 physicians, nurses, and other health care providers in 33 states.

In explaining why the company decided to make the data available free of charge, Jeremy Delinsky, director of process innovation at AthenaHealth, said, "We were a little skittish about making it public, but we found the story was too compelling to sit on." And, physicians who know more about their insurers will have more leverage in contracting and a better opportunity to improve their bottom line, he said.

The company assessed 5 million "charge lines" worth of claims data from the fourth quarter of 2005. To be a part of the ranking, national payers had to have at least 10,000 "charge lines," or line items, and regional payers at least 3,000.

Insurers were ranked according to an overall index that gave the most weight to financial performance. That performance included days in accounts receivable, percentage of claims paid and closed on the first pass, and percentage of charges transferred to the patient.

In addition to financial performance, the index included an administrative measure encompassing the claims denial rate, the percentage requiring a phone call to clarify a response from the insurer, and the percentage of claims lost. Finally, a small amount of weight was given to the difficulty of working within the payer's rules.

Nationally, Humana ranked number one, followed by Medicare, United Health Group, Aetna, Cigna, Champus, and Wellpoint. According to AthenaHealth, Aetna denies claims twice as often as Humana, and the reasons are so unclear that 17% of claims need follow-up calls. Wellpoint tended to take the longest to pay, and more than any other payer, the company aggressively shifts responsibility to physicians to get payment from the patient.

For all payers, claims stay in accounts receivable for an average of 38 days. …

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