A year ago I wrote an article about how health insurance companies were generally doing a better job in 2008 of paying claims faster and denying fewer claims than they did in 2007. The annual Athena Health study results are now out for 2009, and overall there was another significant increase in the speed with which health insurance companies paid claims (7 days faster than in 2008) and a decline among most payers in terms of the percentage of claims denied. A big congratulations to Humana, which ranked first overall in the major payers category for the second year in a row.
It makes sense that as more systems become automated and computerized, claims get paid faster and fewer billing errors will be made, resulting in fewer denied claims. But we still have a long way to go. I mentioned yesterday that my mother broke her leg a few weeks ago. In the emergency room, my sister made sure that my mother’s health insurance card was placed on file within an hour of my mother arriving at the hospital. But in the weeks that have followed my mother has received EOBs from her own health insurance company as well as a company she had never heard of, and more from her previous health insurance carrier. Apparently the clinic where she had a mammogram a few years ago is associated with the hospital where she was treated for the broken leg, and someone managed to attach her current claim to the health insurance she had at the time of the mammogram. As for the health insurance carrier she had never heard of, a person in billing told her that it looked like someone just typed in the wrong code in the billing office and somehow the claims got sent to a random health insurance carrier.
In addition to EOBs coming from multiple carriers, my mother got ten EOBs in one day last week, half of which were from her current health insurance carrier letting her know that they had denied the claims for preventive lab work during her recent hospital stay (she has an HSA qualified policy with only basic preventive care coverage). Turns out that someone in the hospital had accidentally coded the lab work that was being done as preventive care, and thus all the claims got denied and had to be resubmitted with the correct code.
The reason I’m mentioning this story is that it’s important to note that claim denial and delayed payment is sometimes due to simple billing errors (obviously in the case of my mother’s surgery and hospitalization, her lab work should not have been coded as preventive, and only her current health insurance carrier should have been billed). As we continue to automate and standardize our health care reimbursement system, we should see fewer errors like this.
