Physicians Practice - June 2008 - (Page 34) FINANCE SOUTHERN 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 PAYER Medicare B-TN Southern Health Services Amerigroup-GA Cigna/HealthSource Medicare B-NC BCBS-VA BCBS-NC Medicare B-FL Medicare B-VA Aetna & Aetna/US Healthcare Medicare B-GA United Healthcare Medicare B-SC Wellcare of Georgia Humana BCBS-DC Medicare B-LA BCBS-LA BCBS-FL United HC of River Valley BCBS-SC Medicare B-AR BCBS-AR Cariten Healthcare/PHP BCBS-TN Champus/Tricare Avmed BCBS-MD Medicare B-Railroad Medicare BCBS-AL BCBS-GA Medicare B-MD Medicaid-SC NHP-FL Great West Healthcare Medicaid-NC Medicaid-LA VISTA (Florida) Medicaid-VA United HC of the Mid Atlantic Medicaid-GA Medicaid-FL DAYS IN ACCOUNTS RECEIVABLE 28.64 24.35 28.34 32.19 28.96 25.52 26.04 36.62 29.31 27.65 35.41 34.76 34.06 41.61 34.34 29.40 33.37 29.43 36.19 29.90 29.22 29.33 32.71 34.59 31.91 37.23 39.59 33.25 55.14 40.27 44.82 40.53 40.73 50.80 43.23 40.31 41.13 44.29 51.33 57.78 97.38 57.10 RANK 6 1 5 15 7 2 3 25 9 4 23 22 19 33 20 11 18 12 24 13 8 10 16 21 14 26 27 17 39 28 36 30 31 37 34 29 32 35 38 41 42 40 FIRST PASS RESOLVE RATE 95.75% 96.36% 94.07% 96.51% 95.30% 96.35% 94.71% 96.45% 93.73% 94.87% 94.94% 95.98% 94.20% 89.16% 94.65% 93.41% 93.00% 94.44% 94.68% 91.78% 94.17% 93.61% 93.67% 93.55% 91.66% 94.04% 91.38% 90.64% 92.02% 93.94% 91.52% 91.16% 91.56% 88.67% 90.93% 91.49% 87.13% 85.36% 83.16% 87.60% 79.30% 82.55% RANK 6 3 16 1 7 4 10 2 19 9 8 5 14 8 12 23 24 13 11 26 15 21 20 22 27 17 31 34 25 18 29 32 28 36 33 30 38 39 40 37 42 41 PERCENTAGE OF PATIENT LIABILITY 1.68% 7.55% 0.20% 7.88% 2.46% 9.46% 11.84% 1.79% 2.21% 8.37% 1.74% 8.82% 1.64% 0.42% 5.48% 8.03% 2.04% 15.33% 10.13% 5.54% 10.94% 1.40% 10.07% 4.84% 8.88% 3.86% 3.07% 6.37% 1.76% 6.90% 9.01% 1.83% 1.26% 6.45% 12.35% 1.29% 0.18% 3.25% 2.40% 6.20% 1.24% 0.26% RANK 10 29 2 30 18 36 40 13 16 32 11 33 9 4 23 31 15 42 38 24 39 8 37 22 34 21 19 26 12 28 35 14 6 27 41 7 1 20 17 25 5 3 READ MORE ABOUT IT! Visit PhysiciansPractice.com to learn more about payer relationships: • Learn how to assess your payer • Find out if payers are paying you contracts by typing “monitor contracts” into our Search Articles box. well by visiting the Tools section and clicking on 2007 Physicians Practice Fee schedule Survey Results. Humana’s Smithson points out that most real-time adjudication systems force practices to enter claims data twice, once at a provider site and then again into the practice management system. Humana is trying to integrate with practice management systems to set itself apart, a strategy it will roll out nationwide this year. Practices are increasingly using electronic remittance advice, electronic funds transfer, more-robust payer Web sites with complete data for eligibility checks, and technologies that speed up payment and decrease denials, ameliorating the impact of NPI. Lukowski suspects these improvements are responsible for fewer days in A/R and fewer denials among regional payers, which are just now adopting tools originally implemented at the national level. Electronic remittance advice, which essentially allows payers to issue explanations of benefits electronically, has been around for years, but it has been difficult for providers to use it because payers vary so widely. Uniformity has been lacking. Responding in part to PayerView, this is improving. “It really cuts the payment cycle,” WWW.PHYSICIANSPRACTICE.COM 34 | PHYSICIANS PRACTICE | JUNE 2008 http://PhysiciansPractice.com http://WWW.PHYSICIANSPRACTICE.COM
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