ICYMI: AHIP Statement on AMA "Report Card"
Posted by The Campaign on June 14, 2010 at 1:54 PM
Statement from AHIP Press Secretary Robert Zirkelbach on the AMA report card:
"Health plans and providers share the responsibility of making the innovations and investments needed to improve efficiency in our health care system. 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. For example, health plans are working with providers in New Jersey and Ohio to implement portals that would simplify administrative processes and enable doctors in these states to spend more time with their patients.
"Government data show that soaring medical costs - not health plan administrative costs - are the key drivers of rising health care costs. In fact, the percentage of premiums going toward health plans' administrative costs has declined for six straight years."
Of Note:
According to AHIP's most recent health care claims receipt and processing time survey:
- Nearly one-fifth of all provider claims are not submitted to health plans electronically.
- There is often a notable lag before health insurance plans receive claims from health care providers. In 2009, 22 percent of claims were received from health care providers more than 30 days after the date of patient service, and 12 percent of claims were received more than 60 days after the date of service.
- Health insurance plans processed nearly 99 percent of "clean" claims within 60 days, and 97 percent within 30days.
- In 2009, approximately 75 percent of claims were adjudicated automatically -- that is, using automated verification and validation processes that do not require manual intervention -- up from 68 percent in 2006 and 37 percent in 2002.
According to AHIP's survey on out-of-network charges:
- "Some out‐of‐network providers are charging exorbitant prices - several hundred or even over a thousand percent of the Medicare reimbursement for the same service in the same area. Recent examples: $4,500 for an office visit when Medicare would have paid $134; $14,400 for removal of a gallbladder when Medicare would have paid $656; and $40,000 for a total hip replacement when Medicare would have paid $1,558."
