Physicians received the wrong payment for nearly 1 of every 10 claims (9.5%), and there was a 69% increase in denied claims last year. Imagine your credit card bill – 1 out of 10 charges are incorrect!
The AMA publishes an annual report card of the claims revenue cycle activities of the major commercial health insurers and Medicare. The NHIRC provides metrics on the timeliness, transparency and accuracy of claims processing of these payers in an effort to educate physicians and the public, and to reveal opportunities for improvement.
The review was based on a claims processing firm’s random sampling of data obtained for the AMA from Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corporation, Humana, Regence, and UnitedHealthcare, as well as Medicare.
The firm examined about 1 million claims for nearly 2 million medical services submitted in February and March 2012 by more than 380 physician practices in 79 medical specialties in 39 states. The government’s Medicare program was the only payer that provided both a reason and some additional comments for all denied claims.
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