The results of the annual Health Insurance Report Card are in and, as usual, the AMA’s yearly check-up on health insurance companies and their claims processing trends is not pretty.

Although the data generated from these Report Cards is derived from MD practices, the big picture perspective is one that is still relevant for us to view as chiropractors. Here are a few interesting tidbits from this year’s Report Cards:

• 1 out of 5 claims are processed incorrectly by health insurance companies
• More than $777 million in unnecessary administrative costs could be saved if health insurers could improve claims processing accuracy by just 1%
• Increasing claims processing accuracy to 100% would save US healthcare costs up to $15.5 billion annually
• Physicians spend as much as 14% of their revenue to ensure they receive proper payments from insurers

What to Do Next

While the size and magnitude of these numbers are startling, I have yet to speak where seminar attendees were surprised by such revelations.  However, what I do commonly see is a sort of “analysis paralysis” where DC’s feel there is nothing they can do about such things.

While the parallel to the Biblical account of  David and Goliath may be an accurate representation of the battle scenario, the end result is also possible: David won and so can the rest of us “little guys.”  Apart from getting on your knees in prayer and appealing to the man upstairs (not a bad idea given the current sad state of the healthcare marketplace), here are three quick tangible actions to take in light of the recent report card results:

1.  Pay Attention! If 1 in 5 claims are processed incorrectly, odds are that yours will be among them sooner or later.   In the absence of a unified effort against a particular insurance company, you need to track your reimbursements to ensure that you are being correctly paid.  This involves a working knowledge of fee schedules, accurate balance posting, and an eye for detail on the part of whoever is doing your billing.  Without this, you will allow insurance companies to slowly extract the profits from your pockets to theirs.

2.  Do the Math on ROI Externally: Let’s face it.  Not all insurance companies are worth the time or effort give the number of hoops they require you to jump through and/or their pitiful fee schedules.  Sometimes, you just have to do the hard math and give them the boot.  But do it by the numbers and not by emotions.  If you haven’t read my article on “The Annual Payor Survey or How to Drop an Insurance Company” – read the report cards and then consider it for any big “offenders” who are stealing the life and profits from your practice.

3.  Demand ROI Internally: Knowing that the average doc spends 14% of revenues trying to bring in the money, as a business owner you should be acutely aware of where your billing service/department stands as a revenue generator.  In other words, don’t assume they are doing a good job, but track their performance and hold them accountable so that you can mitigate losses the insurance companies are trying to force feed you.  For more specific details on the how, when and whys, see How to Oversee Your Chiropractic Billing Service or Staff.

Those of you who can’t quite figure out the mess you are in, suspect you are leaving too much money on the table, or know that some directed effort in this area would produce tangible returns in your practice may wish to complete a no-obligation Practice Analysis Questionnaire and get an objective opinion on what’s going on in your business.  There’s no obligation and no cost, but great potential to gain from realizing potential strategies for improvement.

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