An annual review of the nation's health insurers has placed Hartford, Conn.-based Aeatna at the top of the list.
The sixth annual PayerView Rankings are published each year by athenahealth, a Watertown, Mass.-based healthcare IT vendor, and Physicians Practices, a practice management journal for physicians.
This year's results indicate that most health insurers have made progress over last year in paying physicians, averaging one day faster in payments while denying 5 percent fewer claims.
Aetna was the No. 1 payer in the Major Payer segment, which includes Humana, Champus/Tricare, Cigna, HCSC, Medicare B, UnitedHealth Group and Wellpoint, and ranked first in the National Commercial Payer segment, which includes Humana, Cigna and UnitedHealthcare.
The 2011 PayerView Rankings evaluate 132 national, regional and government payers.
According to athenahealth officials, this year's index tracks data from more than 27,000 providers representing more than 47 million charge lines and $9 billion dollars in services billed in 41 states. The data is derived from the company's athenaCollector web-based medical billing and practice management platform and ranks health insurers on financial performance, administrative performance and transaction efficacy.
Among the survey's findings:
- National payers outperformed government payers – Aetna ranked top in first pass resolve rate (96.8 percent) and Humana had the lowest DAR (22.5 days) of the eight payers included in the Major Payer segment.
- After being ranked No. 1 in Eligibility Accuracy in 2010, Medicare's performance significantly declined in 2011. According to athenahealth, the data suggests that coordination of benefits information contained in Medicare's eligibility transaction does not correlate with Medicare's back-end adjudication systems.
- BlueCross BlueShield plans led payers in the transfer of responsibility to patients (according to PayerView, patient liability amounts are increasing across the industry).
- ERA Transparency – a metric new to PayerView this year – indicates that while the industry at large has had a difficult time transitioning to the standard ERA code set, in some instances causing providers to rely on paper remittance, state Medicaids have had the most difficult time adopting the standard (average ERA Transparency rate of 76.7 percent compared to Medicare's rate of 97.1 percent).
The rankings also highlight the pressures on the private and government sectors to improve complex administrative processes and reduce cost waste across the healthcare delivery supply chain, athenahealth officials said. These efforts become even more urgent when set against the expansion of highly stressed state Medicaid programs under reform legislation.
"PayerView has developed into something that allows physicians to regain leverage with payers because they now have as robust of a data set as the payers have," said Jonathan Bush, chairman and CEO of athenahealth. "We're pleased to see that PayerView has become a motivational tool, used proactively by payers to identify and then mend their process breakdowns and improve their performance on a host of administrative issues that have long been sore points for practicing physicians."
"Payers used to only react to these rankings, as opposed to engaging and collaborating year-round in PayerView's mission of closing costly administrative breakdowns and getting doctors paid sooner for service rendered," added Bob Keaveney, editorial director of Physicians Practice. "Six years in, this has morphed into an iterative process used to advantage by both sides – payers and physicians. It's an uncensored, completely transparent gauge of strides made and strides yet to be made. This year's data show that the government and private sectors in healthcare are capable of employing tactical, practical things like electronic transactions to drive efficiencies."