Revenue Cycle Management Blog | GroupOne Health Source

AMA: Inaccuracy in Medical Claims Payment Increases to 20%

Written by Kaitlyn Houseman | June 23, 2011

How Do These Errors Affect Your Revenue?

According to the National Health Insurer Report Card released by the American Medical Association, commercial insurers had an average claims processing error rate of 19.3% this year, a 2% increase from last year.

According to the report, electronic claims processing errors among commercial health insurers contribute to about $17 billion annually in unnecessary administrative costs.

The report card also ranked health insurers on their claims processing accuracy rate. It notes that:

  • UnitedHealth Group had the highest rating, with a 90.23% claims processing accuracy rate;
  • Regence Group Blue Cross Blue Shield had an 88.41% accuracy rate; and
  • Anthem Blue Cross Blue Shield had the lowest rating, with a 61.05% accuracy rate

How do medical practices deal with the errors?  Is your billing staff simply accepting denials and payments as determined by the insurance companies?  59% of in-house billers do not review EOB’s and 55% of in-house billers have never appealed a denied claim, although 50% of appeals are successful.  Does your current billing process have the expertise to recognize these errors?  How much revenue are these errors costing you?


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