The American Medical Association recently released its 2010 report card on the national payers.

This report is worth a read, though you better have your billing expert handy because it gets pretty detailed.  That is a good thing because if we are to continue to improve the accuracy and timing with which physicians are paid, we need this type of bright light shining into the corners of this complex process.

I know enough about the details of the billing process to know what matters, even if I have to punt to the pro's on our team when the detailed questions come.  Three things stand out from this report.

First, there are some real improvements being made by the big payers.  They are getting faster at giving us that first response on the claim and they are reducing their denial rates.  All good things.

Second, about a quarter of the time, the payer processes the claim and makes no payment, generally because they patient has not met their deductible.  With higher deductibles on 'normal' plans and the continuing rise in 'high deductible plans,' this is not a surprise and the trend will likely continue.  If practices have not come to grips with the fact that patient pay matters a lot and needs to be managed accordingly, then here is another data point.

Third, in spite of the progress, there is still an overall error rate of about 20%. That is one in five claims.  If you think every practice gets about the same results on the billing and collections performance...well, are you interested in buying my bridge?  There is great variation on the realized payment for services from practice to practice based on how good the revenue cycle management process is. If yours is not good, fix it.  One in five of your claims is probably paid wrong the first time.  Wanna guess how many of those were in your favor?