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