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When Dealing with Insurers, Electronic Payment Tools May be an Otolaryngologist’s Best Friend

by Sue Pondrom •

The business side of medical practice can sometimes be a bigger challenge than ferreting out a difficult diagnosis. Inflation-adjusted physician income has declined about 7% since 1995, according to a June 2006 study by the Center for Studying Health System Change. Flat or declining fees from both public and private payers are cited as a primary factor. Add to that excessive payment delays and too-frequent denials from insurance companies, and the business of practicing medicine continues to frustrate doctors.

On the other hand, there may be an electronic light at the end of the financial tunnel. More physicians-otolaryngologists-head and neck surgeons included-are utilizing electronic billing systems, resulting in faster payments and fewer denials.

A May 2006 study by America’s Health Insurance Plans (AHIP), a national association of health insurers, indicates that three-quarters of all health insurance claims are now submitted electronically, up from 24% in 1995, allowing 98 percent of claims to be processed within a month of receipt from the health-care provider, the AHIP said. Further, the study found that insurers now process a majority of claims within a week of receipt.

Many Variations in Claims Processing

Another May 2006 survey has ranked insurance carriers by their payment speeds, denial rates, adherence to national standards, and more. Called PayerView (available online at www.athenapayerview.com ), this survey by athenahealth, a provider of physician services including outsourced billing, analyzed claim performance data from more than 7,000 providers during the last quarter in 2005. Among its findings:

Some insurance companies don’t pay well and we know that. It’s not rocket science; it’s just practical experience. – -Lee Eisenberg, MD

  • National carrier Aetna denies claims twice as often as the top performer, Humana.
  • Cigna led all carriers in the category that measures the percentage of claims found to be not on file at the payer after inquiry by the physician.
  • Wellpoint was the most aggressive shifter of responsibility to physicians to secure payment from patients directly.
  • The average number of days a claim is in accounts receivable among national payers is 38.

In a press release announcing the survey, athenahealth co-founder and CEO Jonathan Bush claims that by making these rankings publicly available, we hope to illustrate the significance and scope of this national problem, help insurers recognize the source of process breakdown, and work to improve their reimbursement practices for everyone involved.

Otolaryngologists Skeptical

However, physicians interviewed for this article weren’t too sure the PayerView survey would have much impact on the performance of insurance companies.