More doctors file electronically, industry says

The percentage of claims that private payers receive electronically from physicians and hospitals surged from 44% to 75% in the last four years, according to a survey released by America's Health Insurance Plans.

The survey, which is based on a sample of nearly 25 million claims processed by 26 health plans of varying sizes during a one-week period after Oct. 1, 2005, found that 98% of all electronic and paper claims are processed within 30 days of being received by payers, meaning that those claims are either paid or denied, said Larry Akey, a spokesman for AHIP. The industry group's survey did not say how many claims are denied.

About 14% of claims are "pended" or returned to clinicians because of incorrect or incomplete information, Akey said, noting "pended" claims become "clean" when the required information is submitted to the plans. Those claims, which on average take an additional nine days to process, are among the majority of claims processed within 30 days, Akey said.

AHIP also found that 30% of claims are received by payers more than 30 days after the date of patient service and 15% after more than 60 days, with one-third of paper claims received after 60 days.

The survey results, which exclude Medicare and Medicaid claims, show "that many people have moved away from paper and toward electronic claims submission and that by working together [with doctors and hospitals], we can perhaps improve the electronic submission rate even more," Akey said. That will further "speed up payment to practitioners and reduce administrative overhead throughout the system," he said.

AHIP says it costs 85 cents for a health plan to process a clean electronic claim compared with $1.58 for a clean paper claim.

The American Academy of Family Physicians isn't surprised that 75% of all claims are filed electronically, said Trevor Stone, a private-sector advocacy specialist at the AAFP. But AAFP doesn't know whether that means doctors who file claims electronically are actually getting paid more quickly than before, because it hasn't specifically asked members that question, Stone said. The AMA, however, has maintained that, despite electronic submission, plans still are dragging their feet when it comes to paying physicians promptly.

Some industry observers agree that the industry has made progress in improving the rate of electronic claims submission over the past four years, although they come up with different numbers.

Based on his research, Pat Kennedy, a Rockville, Md., consultant who annually surveys health plans, said that 55% of claims were submitted electronically in 2002, and "I'd say the number [for 2006] is closer to 70% if Medicare and Medicaid are excluded, because the Blues are 75% to 77% electronic on average. If you add the commercial payers, which are in the 60% to 65% range, you're going to come in around 68% to 70% range. I came up with 68% without the government, but that's still pretty good."

A key reason for surge in the electronic claims rate is that billing software vendors have done a better job of integrating electronic data interchange into their systems, enabling doctors and hospitals to submit claims electronically to claims clearinghouses, payers or both, Kennedy said. Other key drivers are that insurers have focused on getting those filing paper claims to file electronically, and more and more payers are offering free services to doctors, he added.

AHIP declined to comment because it had not seen Kennedy's research, Akey said.