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November is “Heal That Claim” month

November 19, 2010

The American Medical Association is urging physicians to take action against inaccurate payments from private health insurers by naming November as “Heal That Claim” month.

One in five medical claims is processed inaccurately by private health insurers, according to the organization’s National Health Insurer Report Card, leading to an estimated waste of $15.5 billion annually. In addition, errors of this sort can result in up to 14 percent of a physician’s earned revenue going towards efforts to ensure proper payment as part of revenue cycle management.

According to AMA president Cecil B. Wilson, the association’s main goal during “Heal That Claim” month is to reduce those administrative costs to 1 percent in order to allow physicians to focus on caring for patients instead of “battling health insurers over delayed, denied or shortchanged medical claims.”

A long-term goal of the AMA’s campaign is to have all parties in the medical field commit to efficiency, transparency and accuracy in every step of the claims process, for the benefit of everyone involved.

First, the AMA hopes to inspire physicians, their staff and their billing partners to work as a team to implement practice efficiencies and submit timely, accurate claims. Next, it urges health insurance companies to pay accurately and quickly the first time while continuing to comply fully with the Health Insurance Portability and Accountability Act. Third, the campaign encourages employers to also comply with the HIPAA electronic standards while providing benefit transparency to their employees. Finally, the AMA hopes to involve patients to clarify their health insurance policies and payment practices and encourage them to meet their financial obligations.

The financial savings, in addition to the time saved, could be vast for practices, patients and health insurance payers, estimates the association.

“For instance, if both physicians and payers were to use electronic transactions for the estimated three billion claims submitted every year, the health care system could save more than $90 billion annually,” writes the AMA.

There is an ongoing “Heal the Claims Process” campaign, but November became the ideal time for the “Heal That Claim” month as health insurers tend to increase claim denials during the last quarter of the year, according to the AMA.

To help bolster the efforts of physicians this month, the organization is offering online resources that make it easier to prepare, track and appeal claims, including template appeal letters, printable checklists and logs.

Sage can help

Products such as Sage Intergy, Sage Intergy EHR and Sage Transaction Services provide your practice with the ability to submit claims quickly and accurately, while providing you with greater control and visibility into the claims lifecycle. Complete our Request Information form to find out how the Sage Intergy Suite of products can benefit your practice.

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