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While it is common for health insurance companies rate doctors on their performance, is doing it backwards. American Medical Association published its first health insurance report card at the group's annual meeting Monday. The main focus is how quickly and accurately doctors get paid. "Physicians are spending 14 percent of its total revenue to simply obtain what they have earned, "said Dr. William Dolan, a board member of the AMA.
Dr. Dolan, said the report card is an effort to reduce the cost of claims processing to doctors and help as you negotiate contracts with insurance companies, adding that the report card will help patients if it reduces wasteful administrative costs. The report card compares Medicare and seven national commercial health insurers on the timeliness and accuracy of claims processing. It is based on a random sample drawn from 3 million claims.
There are no notes as A, B and C, and many of technical measures may not mean much to most patients. But business leaders and health policy are interested in reducing an annual estimate of 210 billion U.S. dollars in lost administrative claims processing costs, AMA leaders said.
Four years ago, Dr. Marcy Zwelling was so frustrated with the time and cost to ensure that it accurately paid by insurers stopped dealing with them. She now runs a so-called "boutique" practice. Most of his patients pay an annual fee of not their own pockets.
"It is best to become a doctor" instead of a claims processor, said Zwelling, of Los Alamitos, Calif. She says he has no more money than her when she accepted insurance, but have more time with patients.
UnitedHealthcare had the lowest rate of contract compliance, according to the report of the AMA. About 62 percent of medical services billed were paid by UnitedHealthcare at the contract rate, compared with 71 percent Aetna and 98 percent for Medicare.
UnitedHealthcare spokesman Gregory Thompson said doctors and their billing services share responsibility for prompt payment. "The data show that there is often a significant delay between the time services are provided and physician claims submitted," he said.
He said UnitedHealthcare has improved its electronic claims systems and noted the AMA gave the company the highest scores on other measures.
Medicare performed better than the private insurers in most areas, said Dr. Lawrence Casalino, University of Chicago health economist and former physician. Commercial insurance plans compete by promising employers that are strong in the holding by the cost of credit, he said.
"There is no doubt that administrative costs for doctors and the country would be much less in a single-payer system, "Casalino said in an interview after the meeting. However, a market-based system has advantages of competition, choice and innovation, he said. "Are the benefits sufficient to justify the cost?"
Peter Lee Pacific Business Group on Health welcomed the report card but said he hoped the AMA would be a wide range of areas that would be helpful to consumers.
"Increased payments to physicians means increased premiums and increased costs in a system that is spiraling out of control, "Lee said.
Susan Pisano, spokeswoman for America's Health Insurance Plans, said that for claims to be processed accurately and quickly it takes two parties: insurers and doctors. He complained that while insurance companies to doctors general rate of sharing information with doctors before making it public, the AMA did not share its report with insurers before releasing it online Monday.
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