Patients Shoulder Nearly 25% of Medical Bills

John Commins, for HealthLeaders Media , June 18, 2013

"At the same time, more work needs to be done to increase electronic submission of claims and to reduce the number of claims submitted to health plans that are duplicative, inaccurate, or delayed. For example, AHIP's survey found that 16% of electronic claims and 54% of paper claims were received from health care providers more than 30 days after the service date."

"Importantly, government data show that rising healthcare costs are driven primarily by rising prices for medical services, not health plan administrative costs," Zirkelbach says. "In fact, the most recent National Health Expenditure data found that the portion of premiums allocated to health plans' administrative costs in 2011 was among the lowest in recent years, despite the fact that health plans have been incurring new compliance and regulatory costs related to the health care reform law."

The AMA said the findings from the 2013 report card are based on a random sampling of approximately 2.6 million electronic claims for approximately 4.7 million medical services submitted in February and March of 2013 to Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corporation, Humana, Regence, UnitedHealthcare and Medicare. Claims were accumulated from more than 450 physician practices in 80 medical specialties providing care in 41 states.

John Commins is a senior editor with HealthLeaders Media.
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