AHIP Statement On American Medical Association (AMA) Claims Processing Report

Main Category: Primary Care / General Practice
Article Date: 17 Jun 2008 - 4:00 PDT

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AHIP President and CEO Karen Ignagni issued the following statement in regard to a report by the American Medical Association on processing of physician claims:

"Administrative simplification that benefits consumers and the physicians who serve them is a top priority for our community."

"Recent data from PricewaterhouseCoopers indicate administrative costs have been stable for four decades. As a result of the move to electronic processing, the cost for each claim has actually declined, enabling insurers to provide value added services to consumers, such as disease management programs, without contributing to rising health care costs."

"AHIP data indicate that virtually all 'clean' claims are processed within 30 days. AHIP members have worked collaboratively with physicians to make improvements in processes to promote efficiency and move to real-time payment. In order for claims to be processed as efficiency and promptly as possible, both insurers and physicians need to strive for accuracy and timeliness. For example, data show there is often a significant lag time between when services are provided and physician claims are submitted. Data also indicate that there are a significant number of incomplete and duplicate claims filed."

"Reports released last week decried 'no questions asked' reimbursement in Medicare and emphasized the need to scrutinize claims to prevent fraud. In addition, research shows more than $200 billion is spent annually on services that are not in sync with medical science, the result of wide variation in practice, overuse, underuse, and misuse of services. Our view is that discussions of efficiency are important, but that they should be broad discussions of opportunities for improvement by all the responsible stakeholders."

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