Managed Care Reimbursement

Doctors Turn the Tables and Rank Health Insurance Companies

If price transparency and good service will be hallmarks of consumer-directed healthcare, then physicians will want comparable service and quality from payers. A step in this direction is the PayerViewer survey by Athenahealth Inc, of Watertown, Massachusetts. Athenahealth sells payment software and services to doctors.

Athenahealth recently asked doctors to rate payers.  It then ranked national and regional health insurers based on how efficiently they paid, their knowledge of payer billing, how quickly they paid, their denial rates, and their adherence to Medicare standards.  The overall rankings were:

1.      Cigna

2.      Aetna

3.      Medicare-B

4.      Humana

5.      United Health Group

6.      Wellpoint

7.      Coventry Health Care

8.      Champus/Tricare

Data for the survey and rankings came from a national sample of more than 8,500 medical providers. These providers represented 28 million medical charge lines for services billed in 33 states. The resulting claims were submitted to payers in 46 states.  Members of this sample were clients of Athenahealth.  Not surprisingly, some insurance companies argue that the sample was too small to be statistically significant.

Cigna Corp was ranked fifth on the survey last year. Cigna says its improved rank reflects investments in claims-paying technology and infrastructure.  Cigna's average number of days to pay claims is now 31.9 and 96.3% of Cigna's claims are successfully resolved on the initial submission.   United Health Group topped the number of average days required for payment at 38.3.  Average time to pay and successfully resolution on initial submission were similar for many of the top national insurance companies. However, the difference in which companies ranked at the top was due to numbers such as the denial rate, patient liability for claims, non-compliance with standard coding, and the percent of claims requiring medical documentation.

Athenahealth states on its Web site, "We look to help physicians across the country deal with the daily challenges of running their practices.  This is why we launched PayerView-to bring transparency to healthcare and create an industry-wide dialogue on behalf of medical providers.  You will be happy to know, we are seeing results."  Athenahealth's survey is just one more way in which health care is becoming transparent.  Quality of service is becoming transparent to patients, while quality of insurance companies is becoming transparent to physicians.

Laboratories that frequently deal with the major health insurance companies in the United States will find the results of this survey both interesting and useful.  The results should mirror their experience about such factors as the average number of days in which they should expect payment.  It will also give them a resource to voice their concerns to when payment does not arrive, when claims are denied inappropriately, and when codes are not properly used.  Athenahealth welcomes comments about its survey at (866) 817-5740.

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