Physicians Practice - June 2008 - (Page 30) FINANCE he adds. It’s not so much expecting patients to pay that is the problem, Smithson argues, it’s equipping physicians to deal with it. “We’re seeing some of the fruits of our efforts coming into play in the latter part of the year. I think we have some real opportunity next year,” he concludes. Medicare was in the middle of the pack. Its fourth-place showing was respectable largely because its billing rules are public and mostly comply Richard doesn’t think this should count against United: “This is not a measurement of how accurate or timely we process claims, and because UnitedHealth Group is the market leader in consumer-driven health plans, this measure unfairly impacts our ranking and skews the perception of our claim performance. …We have a number of programs and tools, such as a claim estimator tool, real-time adjudication, and debit card technology for consumers linked directly to date of service. TRICARE, using a different standard, reports that it takes care of all the claims it gets in 7.6 days, on average. Any additional processing time is caused by providers’ and clearinghouses’ delays in getting claims to it in the first place. It also doesn’t really see a problem with its denial rate: “Fourteen percent of TRICARE medical claims for care rendered in the United States during FY 2007 were denied on first pass. This is consistent with industry denial rates,” said TRICARE spokesman Austin Camacho. Of course, part of what PayerView tries to address is the assumption that a 14 percent denial rate is OK. REGIONAL INSIGHTS DENIAL DROP Aetna reduced its denial rate 10 percent. with CCI edits — and because Medicare, being a government payer, has little involvement in the consumer-directed movement. You may have noticed regional differences in Medicare’s performance. These are mainly driven by variations in athenahealth’s specialty mix. UnitedHealth Group was hurt in our rankings by its more-frequent practice of passing charges onto patients. It has more than 2.3 million individuals enrolled in a consumerdriven health plan, more than double its closest competitor, according to Daryl Richard, vice president of communications for the company. their health accounts, which ensure higher deductibles common with consumer-driven plans do not put additional liability on the physicians.” Richard further notes that some of United’s tools, including real-time adjudication and electronic payment and statements, which speed up payment, weren’t being used by athenahealth clients until late in 2007. Therefore, its performance may look better next year. Also, PayerView next year will likely reward payers for helping physicians with patient liability. And the worst performing plans? Well, TRICARE, last on our list this year, disagrees with our data. For example, we assess days in A/R from For the second year in a row, Blue Cross Blue Shield (BCBS) of Rhode Island had the fewest days in A/R and lowest denial rate in the nation. It helps that this payer operates in the smallest state and is a dominant payer in the market. Like Aetna, BCBS has emphasized transparency, making clear what it needs to process claims quickly. Our data on the Blues can be found at PhysiciansPractice.com On the other end of the spectrum, Medicaid of New York has the most days in A/R in the nation (see Medicaid). This year, it also assumed the worst first pass resolve rate in the nation. The state program has complex referral authorization requirements, insists on proprietary claims forms, and original signature requirements on paper claims — all things that slow the process down. While Medicaid programs perform poorly in general, there is wide variation state to state, with North and South Carolina at the top of the heap. OVERALL TRENDS WEIGHT 25% 25% 7.5% 20% NATIONAL REGIONAL METRIC Days in A/R First Pass Resolve Rate % Patient Liability Denial Rate 2007 34.85 95.18% 8.2% 7.51% 2006 34.4 95.3% 8.17% 7.48% % CHANGE 1.3% -.1% .4% .4% 2007 35.41 93.67% 8.18% 8.64% 2006 36.4 94.49% 8.36% 8.42% % CHANGE -2.7% -.9% -2.1% 2.6% 30 | PHYSICIANS PRACTICE | JUNE 2008 WWW.PHYSICIANSPRACTICE.COM http://PhysiciansPractice.com http://WWW.PHYSICIANSPRACTICE.COM
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