Thursday, May 29, 2008

Payer Transparency - oxymoron no more?

Providers "know" that payers are inefficiently, slowly, underpaying them. Providers don't understand the payers' unwritten rules and are unable to keep up with changes in handling of claims. Post-HIPAA, payers and providers are moving literally tons of paper around the healthcare system and rework in claims handling is enormous.

So how are the payers actually performing, from the perspective of the physician?

athenahealth and Physicians Practice just announced the 2008 PayerView survey results. PayerView gives providers visibility on payer performance by payer type, by region and by key performance metrics.

athenahealth collects the statistics on payer performance as they handle the claims processing for thousands of physicians.

The best overall commercial payer? Aetna. And the worst payer for Days in AR? New York State Medicaid.

Other trends:
  • Denials increased due to inconsistent payer rules related to the exchange of CMS National Provider Identifier (NPI) information needed for claims handling. They forecast that the adverse impact of this will grow during the coming year.
  • Surprisingly, patient liability was just about flat in the year over year comparisons, compared to a 19% increase in the prior year.

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