The AMA's second annual National Health Insurer Report Card, released in July, showed significant progress in areas such as transparency and accuracy. But the report also found continuing problems that would have to be addressed to reach the American Medical Association's goal of 1% or less of a practice's revenue devoted to billing and collections.

The report looked at 18 metrics, including payment timeliness, accuracy, claim edit sources and denials, all supplied by the National Healthcare Exchange Services, an electronic billing system interchange. The report also analyzed transparency of contracted fees and improvements of claim cycle, which were self-reported by the payers. Some of the nation's largest payers were evaluated: Aetna, Anthem Blue Cross and Blue Shield, Cigna, Coventry, Health Net, Humana, UnitedHealthcare and Medicare.

The annual report card was released as part of the AMA's Heal the Claims Process campaign. Data were provided by physician groups the AMA identified as having adopted best practices for electronic data interchange. The study's authors believe the results may be better than for practices that have not adopted those technologies.

According to the report, prompt-pay laws seem to have encouraged insurers to respond to electronic claims submitted by physicians with relatively quick payments. The median days to the first payment remittance showed some improvement from last year's report. Humana's response time, for example, went from a median 13 days to 9.

Payers are not required to report the date claims are received, but physicians need that information to track compliance with the prompt-pay law. Humana disclosed the date it received its claims nearly 40% of the time, which is far less than Coventry, which disclosed the date 100% of the time. Aetna, UnitedHealthcare and Medicare disclosed the date more than 99% of the time.

Payment accuracy also improved, according to the report. In the metric that looked at the accuracy between the fee schedule rates and the rate that was paid, Aetna, Anthem and Cigna scored more than 80%, compared to 70%, 72% and 66%, respectively, from last year. Humana and Medicare scored 93% and 98%, respectively, compared to 84% and 98% last year. UnitedHealthcare improved its score from 62% to 74%. Health Net was not included in this analysis due to lack of data.

"There must be an agreement between the physician and payer on the contracted fee schedule rate on every claim to maximize efficiency," the study said. But it acknowledged further research was necessary to determine if these discrepancies were to blame for inaccurate payments, as opposed to other discrepancies, such as eligibility or confusion over noncovered services.

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