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Rate of Inaccurate Claims Payments Increased Over Last Year

The rate of inaccurate claims payments has increased since last year among leading commercial health insurance companies, according to the AMA's fourth annual National Health Insurer Report Card.

The AMA study found that commercial health insurers have an average claims-processing error rate of 19.3 percent, an increase of 2 percent compared to last year. The increase in inaccurate payments represents an extra $3.6 million in incorrect claims payments, which adds approximately $1.5 billion in unnecessary administrative costs to the healthcare industry.

According to the AMA, eliminating health insurer claim payment errors could save the industry around $17 billion. Most commercial insurers failed to improve their accuracy rating over last year; UnitedHealthcare was the only insurer to demonstrate an improvement, while Anthem Blue Cross Blue Shield scored the worst with an accuracy rating of 61.05 percent.

The report also found that physicians received no payment at all from commercial health insurers on nearly 23 percent of submitted claims. The most common reason for non-payment was deductible requirements that shift payment responsibility to the patient until a dollar limit is exceeded.

Read the American Medical News release on inaccurate claims payments.

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