Physicians Practice - June 2008 - (Page 32) FINANCE NORTHEASTERN PAYERS RANK 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 PAYER Medicare B-CT BCBS-RI BCBS-PA Independence BC Aetna & Aetna/US Healthcare Connecticare BCBS-MA BCBS-NH Keystone Health Plan East BCBS-NY Rochester Health New England United Healthcare BCBS-CT Network Health (MA) Cigna/HealthSource Tufts Medicare B-MA Medicare B-PA Medicare B-NY Upstate Preferred Care - NY Boston Medical Ctr-Health Net Medicare B-NJ Harvard Pilgrim Americhoice BCBS-PA Capital Blue Cross MVP Health Plan of NY Fallon Commonwealth Indemnity Plan HealthFirst-NY BCBS-NJ NHP-RI Oxford HP Affinity Health Plan of NY NHP-MA Medicare B-NY Empire Health Net-NE BCBS-PA Highmark Group Health Inc (GHI) Amerigroup-NJ Medicaid-MA BCBS-NY Empire HIP of Greater NY Health Plus-NY Medicaid-NY DAYS IN ACCOUNTS RECEIVABLE 26.77 15.87 31.54 27.04 30.67 20.26 21.89 30.46 28.14 28.03 36.10 27.20 34.04 31.99 31.98 29.14 42.18 34.33 20.91 29.15 33.34 40.81 40.59 33.11 37.20 38.62 38.27 63.65 35.50 41.23 47.81 77.92 45.71 44.57 40.24 37.97 65.11 69.13 46.82 59.04 60.89 91.93 137.30 RANK 5 1 14 6 13 2 4 12 9 8 22 7 19 16 15 10 31 20 3 11 18 29 28 17 23 26 25 38 21 29 35 41 33 32 27 24 39 40 34 36 37 42 43 FIRST PASS RESOLVE RATE 96.74% 96.76% 95.90% 95.73% 95.10% 95.47% 95.28% 94.64% 92.81% 96.07% 95.78% 94.58% 92.42% 95.69% 93.27% 93.71% 95.79% 93.46% 92.51% 94.07% 94.22% 94.47% 93.43% 88.54% 91.67% 94.06% 94.46% 91.38% 94.08% 84.84% 94.45% 89.46% 87.65% 92.28% 91.94% 87.61% 88.37% 89.39% 83.99% 91.60% 86.86% 85.10% 57.30% RANK 2 1 4 7 11 9 10 12 25 3 6 13 27 8 24 21 5 22 26 19 17 14 23 35 30 20 15 32 18 41 16 33 37 28 29 38 36 34 42 31 39 40 43 PERCENTAGE OF PATIENT LIABILITY 1.64% 6.63% 3.40% 6.44% 5.31% 6.81% 8.59% 3.80% 5.47% 6.79% 7.79% 4.89% 0.38% 8.34% 5.70% 2.13% 2.23% 1.61% 5.04% 0.53% 1.84% 4.86% 0.28% 9.71% 4.71% 2.39% 6.17% 0.57% 6.02% 0.36% 5.55% 0.67% 0.73% 1.99% 3.22% 8.57% 4.57% 0.57% 0.27% 5.82% 1.50% 0.86% 1.26% RANK 14 36 21 35 28 38 42 22 29 37 39 26 4 40 31 17 18 13 27 5 15 25 2 43 24 19 34 6 33 3 30 8 9 16 20 41 23 7 1 32 12 10 11 Among private payers, however, regional differences were slight. It’s a little better to be a physician in the South than in the West, as Southern payers pay a bit faster and are somewhat less involved with consumerdirected healthcare. But overall, it’s much better to have the right payers than the right ZIP code. TRENDS REVEALED Overall, payer performance dipped slightly compared to last year. Melissa Lukowski, director of payer 32 | PHYSICIANS PRACTICE | JUNE 2008 outreach for athenahealth, suggests that National Provider Identifier (NPI) issues, which hurt days in A/R, first pass resolve, and denial rates (see Overall Trends) may have been a contributing factor, though multiple dynamics were in play. The May 23, 2007 deadline for implementing NPI was extended, but providers ended up managing multiple payer-specific timelines and directions. According to Lukowski, some physicians didn’t get the word when payers started using NPI edits for informational purposes. The result? Increased calls, delayed claims, multiple resubmissions, and overall confusion. There were also incidents of payers unintentionally turning on NPI-related edits, incorrectly denying claims, and then asking providers to resubmit. Regional payers had worse problems than national payers, experiencing a 2.6 percent increase in denial rate and a 0.9 percent decrease in first pass resolve. WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM
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