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AMA Report Chides Shoddy Medical Claims Processing

CHICAGO — Health insurance companies are inaccurately processing nearly 1 in 5 medical claims, slowing payments to doctors and adding bureaucratic headaches to patients, according to the American Medical Association.

In its annual report card on the health insurance industry, released this week during the group’s House of Delegates meeting in Chicago, the AMA said commercial health insurers have an error rate of 19.3 percent, up 2 percentage points from last year’s report.

Improving claims processing could save patients money and improve medical care by reducing hassles physicians have when they are forced to haggle with health plans over payments or other issues. The AMA said the report is intended to hold insurance companies accountable.

“A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes $17 billion annually,” said Dr. Barbara McAneny, an AMA board member and medical oncologist from New Mexico. “Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care.”

The AMA’s report measured timeliness and accuracy of claims processing of the nation’s seven largest health insurers, including Aetna Inc., Humana Inc., UnitedHealth Group and Chicago-based Health Care Service Corp., parent of Blue Cross and Blue Shield of Illinois and Blues plans in Oklahoma, Texas and New Mexico.

UnitedHealth had the highest accuracy rating at 90 percent, followed by Regence Group Blue Cross Blue Shield at 88 percent and Health Care Service at 87 percent. Anthem Blue Cross Blue Shield was last among the nation’s largest insurers, with a 61 percent accuracy rating, the AMA said.

The insurance industry said health plans continue to find ways to reduce costs and improve efficiencies.

The AMA report pointed out areas where health plans have improved, such as reductions in “denial rates” and in “claims response time.”

— This article appeared on page D4 of the Albuquerque Journal