Wednesday, May 24, 2006

On the topic of "Don't Get Me Started..."

NYT 25 May 06: Kudo's to AthenaHealth for their take-off-the-gloves exposure of what we physicians have seen happen time and time again: non-payment of insurance claims by our esteemed insurance middlemen. And why did Athenahealth do this? Because their collections are tied to their client's (physicians) reimbursement. But this problem might be endemic throughout the insurance industry.

Hard to believe Humana scored so well on the time to payment score, but perhaps that's because they're reimbursement rates are so low relative to other payors. Interesting that Medicare was fastest of all. And Unitedhealth, they have no right to suggest that these data are skewed when their own leadership has been caught with their pants around their ankles in the option-timing scandal, fleecing their shareholders and members. These guys need to embrace such reporting, not shirk it as inaccurate or flawed. Perhaps then physicians and insurers could have a real dialog on this topic.

What I have noticed is the incredible complexity and changes to the rules of claims processing midstream seem clearly designed to delay phyician payments (last months' clean bill wouldn't be clean this month). And have you ever tried to speak with the people running these outfits? Most have no clue what's going on, particularly if a claim falls anywhere outside their rubric of rules for reimbursement.

Constant updating of Athenahealth's Monitoring Site (available after 25 May 06) and exposure or poor compliance with reasonable timing and tracing of reimbursements might also leave these slow or non-paying firms open to litigation.

Revenge is sweet.

Thanks Athenahealth.


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