麻豆传媒

CHICAGO -- The percentage of claims incorrectly processed by health plans fell for the third straight year to 7.1% in 2013, according to the American Medical Association (AMA).

The error rate of commercial health plans in the National Health Insurer Report Card has dropped significantly since the 2011; that year, the report found that more than 19% of all medical claims were incorrectly processed. Last year, the AMA found about 9.5% of claims were incorrectly processed.

The at its annual meeting.

The survey is based on a random sampling of nearly 2.6 million electronic claims from 450 physician practices submitted between February and March 2013. Payers included were Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corporation, Humana, Regence, UnitedHealthcare, and Medicare.

The AMA estimated that more than $43 billion could have been saved if commercial insurers had paid claims correctly since 2010. If insurers sent a timely, accurate, and specific response to every claim received, billions of dollars in administrative waste would be prevented, the nation's largest physician group said.

The AMA report card also found great variation in the accuracy of commercial payers.

For example, UnitedHealthcare processed 97.52% of claims accurately the first time. Regence trailed all other insurers included in the report card, with an accuracy of 85.03%. Medicare led all insurers with an accuracy of 98.10%.

The AMA report card showed medical claim denials fell by nearly half in 2013 after a sharp spike upward last year. The denial rate went from 3.48% in 2012 to 1.82% this year.

The timeliness of medical claims processed has also improved by 17% since the AMA first started its report card in 2008.

The AMA added this year to rank commercial insurers according to their level of unnecessary cost. The burden index -- which gives each commercial plan a "star rating" in various areas, such as the burden associated with claim denials -- is a way to allow physicians to translate the AMA's health insurer report card into meaningful practice.

"The high administrative costs associated with the burdens of processing medical claims annually should not be accepted as the price of doing business with health insurers," .

The report card found administrative tasks with health plans -- avoidable errors, inefficiency and waste in the medical claims process -- cost an average of $2.36 per claim for doctors and payers.

But again, there was great variation between payers. Cigna had the best cost per claim at $1.25, which was 47% below the commercial payer average. Health Care Service Corporation had the worst cost at $3.32 per claim -- 41% above the commercial average.

Overall, $12 billion a year could be saved if health plans eliminated unnecessary administrative tasks, the AMA said -- an amount equal to 21% of physicians' total administrative costs to ensure accurate payments from insurers.

At its 2008 meeting, the AMA launched its , which has a goal of reducing the cost of managing claims from as much as 14% of revenue to 1%.

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