Getting to clean claims: Costs start to add up for payers, providers on the first error | Healthcare Payer News

insurancebillingErrors in insurance claims are costing the healthcare industry billions in wasteful spending, and both the payers and the providers are at fault, experts say. Errors in insurance claims are costing the healthcare industry billions in wasteful spending, and both the payers and the providers are at fault, experts say. “What the payer wants from the provider is a clean claim,” said Bruce Hallowell, managing director in the healthcare practice at Navigant Consulting. “If I submit a clean claim, I’ll get paid in five days.” While error rates for commercial health insurers for paid medical claims dropped significantly from nearly 20 percent in 2010, to 7.1 percent in 2013, more than $43 billion could have been saved if commercial insurers consistently paid claims correctly, according to the American Medical Association National Health Insurer Report Card, citing figures from 2010 to 2013, the latest available data. In 2013, Medicare led all insurers with an accuracy rating of 98.1 percent, followed by UnitedHealthcare at 97.5 percent, Humana and Cigna at 96.5 percent each, Aetna at 96 percent, Anthem at 90 percent and Regence at 85 percent, according to the AMA. [Also: CMS proposes sharing claims data with providers, employers to improve care] According to Hallowell, accuracy depends on clean claims, but the problem is the definition of a clean claim can be fuzzy. Despite the adoption of the national uniform bill in 1982, creating a single billing form and standard data set for handling claims, insurers often have their own rules and providers don’t always know what they are, Hallowell said. “Payers don’t understand why the hospital can’t follow the basic rules,” Hallowell said. “There’s poor data quality from the provider and poor answers from the payer.” The best recommendation is for payers to communicate what they need so that providers can get paid right away.

Source: Getting to clean claims: Costs start to add up for payers, providers on the first error | Healthcare Payer News

Advertisements

Author: Stephen G. Barr, Group Publisher

Author, Syndicated Columnist, Editor In-Chief and Group Publisher at SGB Media Group, a social media marketing firm specializing in digital media content production, publishing, affiliate marketing, public relations and advertising. Over 25 years experience in retailing, advertising, website & online forum development, niche social networking, affiliate marketing, search optimization, branding and identity, site location, non-profit fund raising. Event planning, promotion, production and MC/Host at public events. Author, Editor & Publisher of 35 syndicated, digital publications utilizing multiple digital distribution channels in conjunction with launching and administrating national advertising campaigns for major Fortune 500 advertisers in partnership with Google, Ning, Facebook, Myspace, Yahoo, DoubleClick, LinkShare, PepperJam and other industry leading third party affiliate networks. Product development team member from conception to launch on many websites, tangible goods and organizational structure for start ups. Specialties: Public relations, retailing, advertising, website & online forum development, niche social networking, blogging, email campaigns, affiliate/performance marketing, search optimization, branding and identity, site location, event production & promotion, non-profit fund raising and tasteful, responsible adult content publishing. An internationally recognized and read social media columnist & pundit on The Examiner, Associate Content, Vator.tv, X-Biz.net and Technorati and his own affiliated sites.