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Thursday, June 27, 2013

Survey finds insurers still moving slow ahead of ACA, ICD-10 changes

If last year was any indication, the headaches that physician practices encounter in dealing with insurance reimbursement aren't going away any time soon.

A new study released Wednesday by health care technology provider athenahealth Inc. found that while about half of the 138 payers surveyed showed improvement on things like speedy claims resolution and providing accurate co-pay and eligibility information in 2012, those improvements were modest.

It said that Medicaid was among the lowest performers, now taking an average of 47.6 days to reimburse a practice, compared with 46.8 days in 2011. It still represented an improvement from 57.2 days in 2009. But the program's difficulties are expected to only increase as the Affordable Care Act next year makes millions of currently uninsured people eligible for coverage.

The survey also showed that insurers suffered a significant slowdown in reimbursements during the first quarter of last year, coinciding with the ANSI 5010 update in electronic transaction standards. Athenahealth drew parallels to the implementation of ICD-10 medical coding changes, which go into effect in October 2014, and said they could lead to delays for the first three to six months of use.

Athenahealth also determined that, despite predictions that health care will become more digital and that payment will shift to models based on performance, 65 percent of insurance enrollment transactions last year were by fax machine or mail and 40 percent of insurers failed to provide independent physicians with any clear information on pay-for-performance incentive programs.

The study comes a week after a similar appraisal by the American Medical Association presented a much more positive view of insurer behavior, finding significant improvements in the rates of claims error and denials, response times, and amount of transparency in how insurers edit claims. However, it did find that mistakes, inefficiency, and waste add an average of $2.36 in administrative costs to each claim, or $12 billion a year, which it said could be avoided through greater automation of the claims process.

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