Doctors' group wants more accuracy from insurers

Jun 14, 2010 By CARLA K. JOHNSON , AP Medical Writer

(AP) -- One in five medical claims is processed inaccurately by commercial health insurers, often leaving physicians shortchanged, according to the nation's largest doctor's group.

The American Medical Association released its third annual report card on insurers Monday.

In past years, Medicare performed well in how quickly and accurately it paid doctors, but the AMA did not release Medicare's data Monday to keep the focus on commercial insurers. Those matched their payments to what they agreed to pay doctors about 80 percent of the time.

The AMA has seen dramatic improvement from , said Dr. Nancy Nielsen, immediate past president of the group.

"It is the report card that forced them to pay attention," Nielsen said.

Insurers got a chance to see the report card in advance of Monday's release, she said.

The AMA rated Coventry Health Care Inc. highest of seven commercial insurers. Its national accuracy rating was about 88 percent. Anthem Blue Cross was at the bottom with an accuracy rating of 74 percent.

The AMA estimates that increasing the industry's accuracy to 100 percent would save doctors and insurers up to $15.5 billion a year.

The group is meeting in Chicago in its first annual meeting since the passage of President Barack Obama's health care overhaul.

The AMA report card is an effort to reduce the cost of claims processing for doctors. As much as $210 billion is spent annually just to process insurance claims.

Even though Medicare pays doctors accurately, the AMA is unhappy with the way the Medicare system sets payment rates for and has been lobbying for Congress to fix Medicare's reimbursement formula. AMA President James Rohack said Monday that both Democrats and Republicans "need to step up and fix this problem permanently."

Medicare said Monday it will hold doctors' claims through Thursday, giving lawmakers more time to prevent a 21 percent cut, required by a 1990s deficit reduction law Congress has routinely waived in the past. The fix, already approved by the House, is pending in the Senate. The cut was technically required as of June 1, but Medicare has been holding claims in hopes lawmakers will resolve the issue.

Explore further: Urbanization of rural Africa associated with increased risk of heart disease and diabetes

not rated yet
add to favorites email to friend print save as pdf

Related Stories

Uncertainty over Medicare pay sets doctors on edge

May 27, 2010

(AP) -- For the third time this year, Congress is scrambling to stave off a hefty pay cut to doctors treating Medicare patients - even as the Obama administration mails out a glossy brochure to reassure seniors ...

Suit against health insurers dismissed

Jun 20, 2006

A 7-year legal battle against U.S. health insurers filed by doctors has ended with the dismissal of all remaining claims by a U.S. District Court in Florida.

Health insurance from Uncle Sam gets a look

May 14, 2009

(AP) -- Look out Aetna, Humana and UnitedHealthcare. Senators are meeting behind closed doors to consider whether the federal government should jump into the health insurance business.

Sources: Senators weigh 3 government health plans

May 09, 2009

(AP) -- Senators are considering three different designs for a new government health insurance plan that middle-income Americans could buy into for the first time, congressional officials said Friday. Officials ...

Recommended for you

Preterm children's brains can catch up years later

15 hours ago

There's some good news for parents of preterm babies – latest research from the University of Adelaide shows that by the time they become teenagers, the brains of many preterm children can perform almost as well as those ...

Mortality rates increase due to extreme heat and cold

15 hours ago

Epidemiological studies have repeatedly shown that death rates rise in association with extremely hot weather. The heat wave in Western Europe in the summer of 2003, for example, resulted in about 22,000 extra deaths. A team ...

User comments : 2

Adjust slider to filter visible comments by rank

Display comments: newest first

CSharpner
5 / 5 (1) Jun 14, 2010
but the AMA did not release Medicare's data Monday to keep the focus on commercial insurers

Now I'm curious!!! Whenever anyone holds something back, rarely is my first thought, "Oh, that's a GOOD thing."
Skeptic_Heretic
5 / 5 (1) Jun 14, 2010
but the AMA did not release Medicare's data Monday to keep the focus on commercial insurers

Now I'm curious!!! Whenever anyone holds something back, rarely is my first thought, "Oh, that's a GOOD thing."

There are two ways to go with this:
1) The AMA doesn't want to release the medicare figures because of how well medicare has done to make Obamacare look like a looming monster. (discrediting their prior stance)
2) The AMA doesn't want to release the medicare figures because it shows that Obamacare IS a looming monster. (discrediting their current stance)
It should be interesting to see what the truth is to this one.