Humana ranked top payer in 2013
June 26, 2013 in Medical Technology
Payers are taking hits to their bottom line due to several gaps in health IT use, according to the athenahealth 2013 PayerView Report released Wednesday. Despite these challenges, Humana took the overall top spot in rankings this year.
Medical Mutual of Ohio and HealthPartners ranked second and third in this year’s survey. About half of the payers analyzed — 68 out of 138 — improved on key performance metrics, according to study findings.
The payer rankings are derived from athenahealth’s aggregated, national data set of more than 40,000 providers, 83 million charge lines and $15 billion in charges, according to athenahealth officials in a news release.
The study revealed that payers are slow to go digital with some transactions. Electronic enrollment continues to be difficult for providers across most payers, with payers still requiring 65 percent of transactions to be conducted by fax or mail.
[See also: Humana to implement telehealth pilot.]
The study also showed payers are struggling with the ANSI 5010 conversion, which went into effect in January 2012 and is a precursor to the ICD-10 transition. PayerView shows that in the first quarter of 2012 the percent of claims successfully resolved on initial submission was down.
“These conversion challenges with ANSI 5010 could be an early indicator of future breakdowns in the processing and payment of claims as the ICD-10 October 2014 deadline approaches,” said athenahealth officials, in a news release.
The report also revealed that despite modest improvements, Medicaid continues to underperform on key metrics that include days in accounts receivable, which measures the average number of days it takes a practice to collect on payments. As millions more payments are processed through the Medicaid Expansion, going into effect in January 2014 as part of the Affordable Care Act, the inability of Medicaid to process payments efficiently could have dire consequences for provider cash flow, athenahealth researchers predicted.
Other findings included:
- Providers struggle to collect full reimbursement. Many payers performed worse than the median 95 percent benefit accuracy, including six payers that only returned correct co-pay information less than 50 percent of the time.
- As reimbursement models shift, some payers seem to be staying put. Several payers did not fare well in the area of incentive program administrative burden and transparency, with just 17 percent of payers receiving the highest score and 40 percent not having any clear information available on pay-for-performance programs for participation by independent physicians.
“Collecting co-pays, challenging claims denials, reviewing billing performance – are all tasks that continue to challenge me and my staff, but are necessary when it comes to ensuring my practice is making, not losing, money,” said John Kulin, CEO and medical director of New Jersey-based Urgent Care Group, PA.