The state government Medicaid plan known as MassHealth, which covers low-income patients who can’t afford insurance, was the slowest payer of health claims to Massachusetts doctors last year, averaging 56 days, and denied the highest share of claims, 23.8 percent, according to rankings set to be released today.
Blue Cross and Blue Shield of Massachusetts took an average of 22.8 days to pay physicians who submitted claims last year, the fastest rate among Massachusetts health insurers, the rankings show. Tufts Health Plan, meanwhile, denied 4.9 percent of its claims, the smallest share among the five large payers billed by Bay State medical providers.
The rankings were prepared by Athenahealth Inc., a Watertown company that helps doctors handle billing and records electronically, in collaboration with the Physicians Practice management journal.
Athenahealth has been ranking in surers for four years, drawing from its database of more than 18,000 medical providers nationally, including about 2,500 in Massachusetts. This year’s rankings come at a time when the medical community and lawmakers are focused on the Obama administration’s healthcare reform proposals, which aim to slash US health costs by about $2 trillion over the coming decade.
Administrative costs stemming from interactions between healthcare providers and insurers are estimated to total $31 billion a year, a recent study by the Commonwealth Fund foundation and Robert Wood Johnson Foundation’s healthcare research organization reported.
The 2009 PayerView Rankings, which are being posted online today at www.athenahealth.com/PayerView, evaluated 172 national, regional, and government payers in 40 states. They open a window onto some of the myriad complexities and bureaucratic obstacles weighing down the medical billing process, with each insurer handling the itemizing or modifications of medical charges in different ways, subject to varying contracts and payment timetables.
"This is the biggest problem we have in healthcare – the inability to close supply chains and to practically and tactically connect doctors with payers and patients," said Jonathan Bush, the chairman and chief executive of Athenahealth. "These connections are broken."
Donna Masucci, office manager for the Everett pediatric practice of her husband, Dr. Peter E. Masucci, said her dealings with insurers have gotten progressively more complicated over the past three decades. "Billing is probably the most stressful part of the day for me," she said. "There’s no incentives for insurers to pay on time."
While the data showed insurers paid physicians an average 5.3 percent faster and denied an average of 9 percent fewer medical claims last year than in 2007, national health insurers still took an average of 33 days to pay physicians and denied an average of 7.1 percent of claims. Massachusetts payers took an average of 38.6 days to pay doctors and denied an average of 9.2 percent of claims.
The three highest-ranked insurers nationally, on criteria that included speed of payment and fewest claims denied, were Humana Inc., Aetna Inc., and Cigna Corp. None do significant business in Massachusetts, where nonprofits have long dominated the market.
Physicians in Massachusetts got paid in an average of 22.8 days by Blue Cross-Blue Shield, 32.8 days by Tufts, 39.7 days by Harvard Pilgrim Health Care, 42 days by Fallon Community Health Plan, and 56 days by MassHealth, according to the Athenahealth ranking of days claims spent in accounts receivable.
On its ranking of "denial rates," the percentage of claims rejected or sent back for rework, Tufts denied 4.9 percent, Harvard Pilgrim 5.4 percent, Fallon 5.7 percent, Blue Cross-Blue Shield 6.2 percent, and MassHealth 23.8 percent.
Representatives of the Massachusetts Executive Office of Health and Human Services, which oversees MassHealth, didn’t return phone calls yesterday.
Some other health insurers sought to clarify their rankings or took issue with the sample after receiving advance copies. Tara Murray, spokeswoman for Blue Cross-Blue Shield, said her organization was pleased with its overall rating, but pointed out its leading reason for denying claims was doctors submitted duplicates that already had been paid by the insurer.
The data compiled for Fallon represents less than 2 percent of its overall claim volume, said Christine Cassidy, spokeswoman for the insurer. "It’s obviously not a complete picture," Cassidy said.
Others credited the survey with spotlighting the need for better collaboration between payers and healthcare providers.
Jim Roosevelt Jr., the president of Tufts Health Plan, said, "We strive for accuracy and speed in our claims processing, and are gratified that Athenahealth’s survey confirms that our efforts support providers in ways that make a measurable difference in their practices."
Harvard Pilgrim managers have been meeting monthly with Athenahealth to use its data to help simplify claims processing, said John Kelly, Harvard Pilgrim director of e-business architecture. "We’re definitely not perfect," he said, "but we believe that having a payer report card helps to make us better."
Robert Weisman can be reached at weisman@globe.com.
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