As healthcare progresses through a series of major changes designed to foster coordination, cost savings, and better data, payers will continue to take on a significant role in the continuum of care. A positive financial, administrative, and technical relationship with providers will be the foundation for allowing physicians and hospitals to tackle the hurdles placed before them: ICD-10, accountable care, EHR adoption, and health information exchange. EHR and practice management system vendor athenahealth has released its 2013 PayerView rankings to help the industry gauge its progress towards the timely and seamless reimbursements that will allow stakeholders to keep their revenue cycles steady as healthcare evolves.
The report covers data collected in 2012 from major payers including private health plans as well as Medicare and Medicaid. Humana scooped the top spot for overall performance, with a low denial rate and high marks for eligibility accuracy and a short “days in accounts receivable” period. “We have always been committed to our provider relationships and are excited that our commitment and our integrated care delivery approach are paying off with positive results,” says Bruce Perkins, president of Humana’s Healthcare Services segment. “Humana’s ranking proves that the cornerstone of our integrated care delivery model is not only working for providers, but for the entire health care system by creating a more effective and more efficient, member-focused model of care.”
But the news wasn’t all positive for providers looking to payers for support during the upcoming ICD-10 transition. This year’s survey covered the Version 5010 transition that took place in January of 2012, and the data showed a clear dip in the number of claims successfully resolved upon initial submission during the first quarter of 2012, a statistic that may predict a similar disruption in the aftermath of ICD-10.
Providers are already struggling to collect full reimbursement from payers, with many health plans performing worse than 95% benefit accuracy. Six of the 138 payers returned correct copay information less than 50% of the time, leaving providers unsure of what to expect, especially ahead of the myriad problems anticipated with ICD-10.
“Collecting co-pays, challenging claims denials, reviewing billing performance – are all tasks that continue to challenge me and my staff, but are necessary when it comes to ensuring my practice is making, not losing, money,” said Dr. John Kulin, CEO and medical director of NJ-based The Urgent Care Group, PA. “The insight I glean from PayerView allows me to benchmark challenges and successes against other practices, prepare for future profitability, and ensure my practice thrives in light of the upcoming ICD-10 conversion and shifting reimbursement models.”
Date: June 27, 2013