In just one year since their problems were spotlighted in the American Medical Association's first National Health Insurer Report Card, health plans have made notable progress in the efficiency and transparency of their claims processes. But there is still a lot of room for improvement.

The latest report card, released in July, covered eight major plans' electronic billing and payment systems. It found that nearly all insurers studied had increased their transparency when it came to claims. The report card is available online (www.ama-assn.org/go/preview-2009-nhirc).

For example, insurers were more likely to note the date they had received a claim, disclose policies on billing and make available their fee schedules. They also are more likely to make payments that hewed to those schedules. Thanks to prompt-pay laws, plans cut the amount of time they took to pay claims.

These improvements happened in large part because of the AMA's "Heal the Claims Process" campaign. That effort seeks to get all participants in the health care claims process to eliminate waste and inefficiencies.

Despite the attention the campaign focused on health plan problems, not all the news in the report card was positive. Plans need to be more efficient in handling prior authorizations, which the report card said was the No. 1 time-consumer when it came to physicians' dealings with health plans.

The report card also found a wide variation in undisclosed edits -- coding changes made based on the plan's own rules, rather than on CPT or another standard. According to the AMA, there is "inconsistency and confusion that results from each health insurer using different rules for processing and paying medical claims. The variability requires physicians to maintain a costly claims management system for each health insurer."

Currently, physicians spend up to 14% of revenue on costs associated with submitting claims. More systemic changes are needed from health plans and others to reach the AMA's goal of cutting physicians' claims administration spending to 1%. Such a drop would cut significantly the $200 billion annually spent on claims processing, and the aggregate three weeks per year an average physician spends on claims-related issues.

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