Health Insurance Claim Errors Waste $17 Billion Annually

A recent report from the American Medical Association (AMA) provides some shocking numbers on the cost of inaccurate health insurance claim payments.

It’s not surprising that patients and physicians are frustrated by the high cost of health care due to claim-processing errors by insurance companies that waste billions of dollars every year.

The AMA’s Health Insurer Report Card found that health insurance companies are averaging a 19.3 percent error rate, up two percent from the previous year. The AMA estimates this increase in inaccurate claim payments will cost the healthcare industry an additional $1.5 billion in needless administrative expenses this year alone.

“A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually,” according to a statement from AMA Board Member Barbara L. McAneny, M.D.

“Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care.”

The 2011 National Health Insurer Report Card compiled a random sampling of approximately 2.4 million electronic claims accumulated from more than 400 physician practices in 80 medical specialties providing care in 42 states.

Payers Pass the Bill
The report focused on the nation’s largest health insurers to provide industry benchmarks on how effectively insurers manage, process and pay claims; however, the majority of insurers failed to improve their accuracy rating in this year’s report.

Out of the seven leading commercial health insurers in this year’s report, UnitedHealthcare was the only one to demonstrate an improvement in claims-processing accuracy with a rating of 90.23 percent.

At the other end of the scale is Anthem Blue Cross Blue Shield, which scored the worst of the group with an accuracy rating of 61.05 percent.

The AMA report illustrates one of the key areas previously addressed in a Thomson Reuters study that estimated the U.S. healthcare system wastes between $600 billion and $850 billion annually due to errors and inefficiency.

Who ends up paying for these mistakes? Patients and physicians end up covering the cost of the error-prone insurance companies.

Physicians were not paid on almost 23 percent of the claims they submitted to commercial health insurers, with the most common reason for not issuing payments being due to deductible requirements that shift payment responsibility to patients.

Hopefully, these reports will create some accountability for the large insurance companies and lead to improved payment accuracy, but until then, physician practices must ensure claims are impeccable on first pass and be prepared to resubmit them when the insurance company erroneously denies their claims.

How does your practice handle insurer claim errors? Post below.