Payer Rankings Don't Tell Providers' Stories

Jacqueline Fellows, for HealthLeaders Media , December 5, 2012

In nearly every category, Medicare Part B and Cigna were in one of the top three positions. Stephen Mandolesi, chair of MGMA-ACMPE's Payer Contracting Society and Director of Network Management for Lifeline Vascular Access in the east, called Medicare Part B's consistency "amazing."

"About 15 years ago Medicare Part B was the worst payer," says Mandolesi. "Now what you find is a lot of practices tend to compare the contractual allowable that a health plan is going to pay them based upon what Medicare is reimbursing, so Medicare has become the benchmark for reimbursement."

Mandolesi also says in some ways, practices find dealing with Medicare Part B easier simply because the federal agency has made everything available online, including fee schedules. In fact, Medicare Part B received the highest score of the entire poll on the question of willingness to disclose fee schedules. MGMA-ACMPE members gave the agency a score of 4.18 out of 5.

With Medicare Part B dominating nearly every category, it was surprising to see that their overall satisfaction score was 3.53, based on a scale of 1–5, putting it halfway between neutral and moderately satisfied. That's not exactly the same as practice professionals saying " 'Great job!' "

Mandolesi attributes the midrange score to the fact that Part B claims are processed by federal contractors. "There's probably still issues out there with the way those contractors process the claims, one; with the policies they have in place, two, and with the RAC [recovery audit contractors] audits."

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