Health Insurance Claims Processing Errors on the Rise

The rate of inaccurate claims payments increased last year among commercial health insurers, according to the American Medical Association’s annual National Health Insurer Report Card.

Commercial health insurers had an average claims-processing error rate of 19.3 percent, a 2 percent increase from 2010, according to the AMA findings, which are based on a random sampling of 2.4 million electronic claims in February and March.

The AMA estimates the increase in overall inaccuracy represents an extra 3.6 million in erroneous claims payments compared to last year and adds $1.5 billion in unnecessary administrative costs. Eliminating health insurer claim payment errors would save $17 billion annually, the AMA estimated.

Physician billing and practice management companies have had to implement new tools and techniques to insure that their clients done feel the effects of this insurance industry trend.  

Physician Alignment Presents Challenge in Forming ACOs, Survey

Healthcare administrators and physicians report one of the biggest obstacles they face in forming accountable care organizations (ACOs) is physician alignment, according to a survey conducted by AMN Healthcare, a healthcare staffing organization.

The survey of more than 800 administrators and physicians found that 58 percent said they were in the process of forming ACOs or are considering doing so, while 42 percent said their facilities would not be forming ACOs in the foreseeable future.

Of the administrators and physicians moving toward ACOs, 42 percent said physician alignment is the most serious obstacle to their efforts. Forty percent of the physicians and administrators who are not forming ACOs said physician alignment was the reason.

Other obstacles to forming ACOs included lack of capital, the absence of integrated IT systems, and no evidence-based treatment protocol data, according to the survey.