AMA report: Health care insurers should process medical claims more accurately

Despite an 80% overall accuracy rate among the health insurance industry when it comes to processing and paying health care claims, 1 in 5 U.S. medical claims are processed incorrectly, according to the American Medical Association’s third annual check-up of the nation’s commercial health insurers.

In a June 14 press release from the American Medical Association (AMA) on the its 2010 National Health Insurer Report Card (NHIRC), AMA immediate past president Nancy H. Nielsen, MD, said, “The finding that one in five medical claims are processed by insurers with errors emphasizes the huge potential for reducing administrative costs for physicians and insurers.”

This year’s “Report Card” was the first to benchmark overall claims processing accuracy. It placed Coventry Health Care Inc., with a national accuracy rating of 88.41%, on top among 7 health insurers whose performance was measured in the new AMA report.

Less paperwork

AMA officials contend that standardizing rules and requirements for claims processing could greatly simplify the work, avoid much of the confusion surrounding claims processing and be cost-effective.

“Creating a single transparent set of processing and payment rules for the health insurance industry would create system wide savings and allows physicians to direct time and resources to patient care and away from excessive paperwork,” Nielsen said.

The AMA estimates that $777.6 million in unnecessary administrative cost could be saved if the health insurance industry improves its claims processing accuracy by as little as 1%.

Other payers who participated in the 2010 NHIRC, a document for information purposes only, were Aetna, Anthem Blue Cross and Blue Shield, CIGNA Corp., Health Care Service Corporation, Humana Inc., and UnitedHealth Group.