What it takes for efficient payer-provider business relations


For the second year in a row, Humana sits in the No. 1 spot out of 148 payers for overall ease of doing business, according to a new report from athenahealth. Some Medicaid programs rank dead last and underperformed on key metrics, such as days in accounts receivable (DAR) and electronic remittance advice (ERA) transparency.

The annual report collected data from more than 52,000 providers to characterize the ease or difficulty of doing business with each payer. Below are a few key reimbursement trends and payer performance highlights from the report:

1. Provider collection burden (PCB) will increase

The percent of charges transferred from the primary insurer to the next party is on the rise. Factors that attribute to the increase include health plans with higher copays, coinsurance and deductibles. While Medicaid programs have a low PCB (for example, Medicaid-Mississippi's totals 1 percent), Medicare has a high PCB, with Medicare B-New Mexico at 26.5 percent, according to the report.

2. Blue Cross Blue Shield plans reimburse providers quickly

The average DAR for all BCBS plans is three days less than other payers. The Blues account for the top 15 performers on DAR and 30 of the top 50 performers overall. The findings indicate that patient volume can increase without causing a payment disturbance.

3. Commercial payers boast enrollment efficiency

Medicaid enrollment requirements are more burdensome than for commercial payers, according to the data. Out of 21 Medicaid programs, 10 require enrollment for electronic data interchange (EDI), while no commercial payers require enrollments for EDI or paper forms sent via the mail. The findings suggest the healthcare industry adopt transaction-based enrollment for a more efficient method for both payers and providers.

For more:
- here's the athenahealth announcement
- read the full report

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