Physicians Practice - June 2008 - (Page 29) DENIAL RATE 5.92% 6.56% 6.37% 8.52% 7.57% 7.45% 8.52% 11.93% RANK 1 3 2 7 5 4 6 8 DENIAL TRANSPARENCY 85.08% 84.42% 78.43% 81.87% 83.63% 83.36% 85.56% 82.14% RANK 2 3 8 7 4 5 1 6 PERCENTAGE OF CLAIMS REQUIRING MEDICAL DOCUMENTATION 1.78% 1.54% 1.81% 1.48% 1.98% 1.78% 1.34% 2.38% RANK 4 3 6 2 7 5 1 8 PERCENTAGE OF NONCOMPLIANCE WITH CCI 0.98% 0.70% 0.62% 0.30% 0.79% 0.60% 1.15% 0.76% RANK 7 4 3 1 6 2 8 5 “We were one of the first ones to put claims rules on the Web site,” Marchetti says. Those public rules “explained our bundling and unbundling logic, how we processed claims, what we would deny for. …Transparency is really the bottom line. Our rules are transparent and you can go out and see the rules prior to submitting a claim.” The goal is to “eliminate unnecessary costs on both sides. I think the goals are pretty much aligned here.” Physicians understandably complain about the payers’ inscrutable bureaucracies, but theories about payer conspiracies aimed at getting physicians to simply give up chasing payments have always seemed OTHER OPINIONS: WHAT DO PATIENTS THINK? The University of Michigan’s American Customer Satisfaction Index (ACSI) asks their impression of health insurance companies on a 100-point scale, with 100 being the best score. 2006 Blue Cross and Blue Shield Association WellPoint Aetna Inc. UnitedHealth Group Incorporated 72 69 65 68 2007 71 66 66 65 unlikely to us. Remember, it costs payers a lot of money to process denials, too, so they have an interest in streamlining processes. Aetna works regularly with athenahealth to improve its PayerView metrics, which has positively impacted its approach. Cigna and Humana ranked second and third, respectively. Humana improved its first pass resolve rate more so than its competitors. In fact, Humana improved in every measure except patient liability. “It’s the way the industry is going,” comments Mark Smithson, vice president of provider process and network operations for Humana. “We are going to have more patient responsibility and that is just the way it is.” Humana is adding tools to make patient liability easier for physicians to manage, OTHER OPINIONS: PAYER REPUTATION WITH HOSPITALS NEGATIVE POSITIVE UnitedHealth Group WellPoint/Anthem Coventry/First Health CIGNA State/Regional BCBS Aetna -100 -90 -80 -70 -60 -50 -40 -47% -38% -37% -30 -20 -10 0 10 20 30 40 -91% -48% -35% 8% 20% 38% 44% 46% 57% 50 60 Davies Public Affairs asked hospital executives their impression of major payers. Source: Davies Public Affairs WWW.PHYSICIANSPRACTICE.COM JUNE 2008 | PHYSICIANS PRACTICE | 29 http://WWW.PHYSICIANSPRACTICE.COM
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