Health Insurance Daily

New Ranking Allows Doctors (and Brokers) To Measure Payer Performance

A new ranking of how well carriers pay physicians promises to improve the overall efficiency of the health care system while also giving brokers yet another tool to evaluate health offerings and anticipate employee frustrations.

Industry magazine Physicians Practice, and services provider Athena Health have partnered to create the PayerView index, which details how efficiently carriers reimburse physicians for their services.

Humana topped the first ranking of national payers with a score of 93%, followed by Medicare Part B (92.1%), United Health Group (87%), Aetna (86.6%), Cigna (86.5%), Champus/Tricare (86.3%) and Wellpoint (84.5%).

The ranking is comprised of seven data points, including things like first pass pay rate, days in accounts receivable, patient liability and denial rate, among others. Each is weighted according to its importance to the physician community.

For instance, first pass and days in A/R accounted for half of a payer's overall score. First pass pay rate, as described by Physicians Practice, is the ideal situation: physician submits claim, carrier pays claim.

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posted by Mike @ 8:04 AM