Date Published: 29 October 2008

AMA wants physicians to stake a claim for accurate insurer payments this fall

Health News from the United States of America (USA).

As part of its national campaign to save the health system billions of dollars by improving the accuracy and efficiency of medical claims processing, the American Medical Association (AMA) today announced it has selected November for the first national Heal that Claim Month.

Many physician practices often experience an increase in claim denials from health insurers during the last quarter of the year, making November an ideal time to appeal inappropriately underpaid and denied claims. An estimated 90% of claim denials are preventable and 67% of denials are recoverable, according to the Advisory Board Company, a Washington-based research organization. Based on those estimates, physicians collectively lose billions of dollars a year of revenue to health insurers.

"The AMA is encouraging both physicians and insurers to take steps to prevent claim denials and improve the efficiency of billing and collections during Heal that Claim Month," said William Dolan, MD, AMA board member. "Insurers should pay claims accurately the first time, and comply fully with federal standards for electronic transactions to make claims processing as easy and transparent as possible. Physicians can also play a role in ensuring accurate payments by reviewing their claims process, double-checking claims results and appealing any irregular insurer payments."

To help physicians participate in Heal that Claim Month, the AMA is offering tools to physicians for cutting through the ambiguity and bureaucracy of processing claims with health insurers. The AMA's easy-to-use online resources can help physicians and their administrate staff create a systematic approach to claims management and offer instructions on preparing claims, tracking claims and appealing claims when necessary. The tools are available to all physicians at no charge through the AMA's Practice Management Center.

"The AMA's Practice Management Center can help physicians focus on caring for their patients, instead of battling health insurers over delayed, denied or shortchanged payments for their services," said Dr. Dolan. "Studies suggest that physicians divert 14 percent of their revenue to a costly fight for fair reimbursement. The AMA is committed curing the ailing claims process and helping physicians reduce the cost of submitting claims to 1 percent of revenue."

The Practice Management Center's library of education materials includes the following practical tools:

  • Prepare That Claim is designed to help physician practices review their claims-management process. It includes sample workflows for patient registration, clinical documentation, patient check-out, coding, billing and collection. It also includes sample forms to help physicians work efficiently and effectively in preparing, submitting and collecting claims.
  • Follow That Claim is a look at how health plans process claims, both electronic and paper. It includes flow charts and tables detailing how plans typically handle their internal and external claims processing, adjudications and payments. This information can help physicians better understand and comply with health plan policies, thereby assisting in receiving timely and complete payment.
  • Appeal That Claim offers charts, tips and advice for setting up an internal claims-auditing system, which is key to knowing what claims should be appealed. The booklet helps physicians and staff reduce their administrative burden, yet gain greater awareness of how and when to appeal an underpaid, delayed or inappropriately denied claim.

These tools also include interactive user-friendly tools and resources, such as template appeal letters and printable checklists and logs that help physicians simplify their claims management revenue cycle. To access the AMA's Practice Management Center, and any of the educational tools associated with Heal that Claim Month, please visit the AMA Web site.

Heal that Claim Month is part of the AMA's ongoing Heal the Claims Process campaign, which launched last June with the unveiling of the AMA's first National Health Insurer Report Card, an objective comparison of the nation's largest health insurers and their claims processing performance. The findings of the National Health Insurer Report Card are available on the AMA Web site.

Source(s): American Medical Association (AMA).

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