Physicians Practice Releases Latest PayerView Analysis

Payer Performance Plateaus, But Tough Times Likely Ahead

Jun 26, 2013, 11:27 ET from UBM Medica US

NORWALK, Conn., June 26, 2013 /PRNewswire/ -- UBM Medica US today announced the release of PayerView 2013, the sixth annual ranking of the best and worst health insurance companies for physicians to work with. Published by Physicians Practice, UBM Medica US' award-winning practice management resource, the yearly report on payer performance provides physicians with data to help them improve the financial viability of their practices.   

According to PayerView 2013, the administrative performance of America's health insurance companies remained largely flat in 2012, based on measurements including payers' speed in processing claims, denial rates, and transparency in denial explanations. Among national payers, Humana received highest marks in the rankings, owing to its quick turnaround of claims and transparency in its reasons for denying claims. Among regional payers, Medical Mutual of Ohio earned the top score. In 2012, as in most years, the least-efficient payers in the country are state Medicaid programs: those of California, Oklahoma, Pennsylvania, New Jersey and Texas.

The Physicians Practice report cautions practices to expect relations between physicians and insurers to worsen in the months ahead, as both sides implement numerous changes resulting from healthcare reform and regulatory changes. To help physicians prepare for a smooth transition, the article also offers steps practices can take to improve payer relationships once they've examined their own billing data.

"Payer performance, which was on the decline after several years of improvement, appears to have reached a plateau, at least for now," said Keith L. Martin, executive editor of Physicians Practice. "But several coming developments may soon agitate payer-physician relationships: the increased number of patients covered as a result of the Affordable Care Act; the vastly expanding number of medical billing codes in the ICD-10 code set; and increasing adoption of EHR systems."

The rankings are based on an examination of 2012 claims data by athenahealth, a provider of healthcare billing, technology, and practice management services, and are reported by Physicians Practice in partnership with athenahealth. Physicians Practice takes no role in compiling the rankings.

The PayerView 2013 rankings are now available online at and will be published in the July/August 2013 issue of Physicians Practice.

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