Last summer our newsletter contained an article titled, “Commercial Carriers Continue to Pay Claims Incorrectly.” Basis for this evaluation was the AMA’s study of carrier payment patterns (The National Health Insurer Report Card, or NHIRC), which showed commercial carriers averaging an 84% efficiency rate when comparing allowed amounts to contracted rates. The 2011 report card has come in and this is how the carriers faired.
Blue Cross had a decline in accuracy of 15% from 2010 to 2011, moving from 77% down to 62%. Cigna also declined over 4%, bringing them to an efficiency rate of 86%. Aetna and Humana also realized small decreases in accuracy. United Healthcare was the only commercial carrier to improve over the year. They now underpay 1 out of 12 line items instead of 1 out of 10 as seen in 2010. The overall score for commercial carriers remained at 84%, confirming that 1 out of every 6 line items were underpaid in 2011.
APS continues to verify that every account is paid correctly for each client in real time, thanks to our proprietary contract management system. All incorrect payments are flagged, a specialist is notified and underpayments are collected. Please contact your Account Representative with any questions.
The APS team constantly updates and educates us on any new changes in billing/coding that are happening or will be happening.