AMA Report Card: Payors Aren’t Paying

As we first talked about in 2009, insurance companies have found that the best way to pad profits is simple: they just don’t pay. In fact the latest Report Card from the American Medical Association finds that the problem has actually gotten worse in the last year. Most payors only reimbursed 85% – 88% of their contracted fee schedules. One insurer paid just 61%!

Other lowlights from the report:

  • Commercial health insurers have an average claims-processing error rate of 19.3 percent (nearly 1 in 5!);
  • Claim payment errors cost providers $17 billion;
  • Physicians received no payment at all from commercial health insurers on nearly 23% of claims they submitted.

Applying some common sense to these numbers only makes them more alarming: if MDs are experiencing these denial rates, what is happening in less politically-leveraged disciplines like physical therapy and behavioral health?

Surely the problem is even worse for these providers. The Report Card proves once again that “coding claims better” can only do so much to increase practice revenue.

Real gains in revenue come from building a solid referral network, optimizing the authorized care you provide to every patient and increasing your billable time with more efficient scheduling, documentation and management tools.  Find out how by downloading our Free Product Guide, “The 5 Revenue Drivers of Your Physical Therapy Practice.”