Health insurers, on average, are paying physicians seven days faster and denying 12 to 18 percent fewer claims than last year, according to the fifth annual PayerView Rankings athenahealth and Physicians Practice released Wednesday. The findings show the potential of increased automation and transparency to reduce administrative costs and increase the speed of reimbursements.

The PayerView Rankings are designed to examine payers’ performance based on a number of criteria that together quantify the "ease of doing business with the payer." All data used for the rankings come from the claims performance data of athenahealth providers and reflect athenahealth’s direct experience dealing with individual payers nationwide.

For the second consecutive year, Humana Inc. ranked first in overall performance in the major payer segment, which includes Aetna, Champus/Tricare, Cigna, HCSC, Medicare B, UnitedHealth Group, and Wellpoint. Humana also ranked first in the national commercial payer segment, which includes Aetna, Cigna, and UnitedHealthcare.

Payers’ progress across several key metrics supports athenahealth’s ongoing efforts on behalf of its national physician network to use PayerView as a lens through which to look into process gaps that exist in the complex relationship between payers and medical providers.

Likewise, the data support continuing government and private sector efforts to drive down costs throughout the healthcare supply chain while expanding access to care for millions of patients through improved automation, transparency, and the exchange of healthcare information.

Based on the largest data set to date, the 2010 PayerView index tracks performance data from more than 23,000 providers representing more than 39 million charge lines and $7 billion dollars in services billed in 45 states for the full year 2009. The data is derived from athenahealth’s Web-based medical billing and practice management platform, athenaCollector, and ranks health insurers in areas of financial performance, administrative performance, and transaction efficacy.

This year’s rankings, and athenahealth’s ongoing collaborations with national and regional payers and physician advocacy work, underscore pressures on the healthcare industry to address complex administrative burdens and processes and reduce costs across the healthcare delivery supply chain – efforts that are increasingly critical as the U.S. prepares to absorb some 30 million newly insured patients under reform legislation and expand highly stressed state Medicaid programs.

“The administration passed legislation that simultaneously aims to expand access to care and rein in costs of healthcare delivery; it probably stands to reason that addressing the gaps in billing and administration has just become a more urgent mission,” said Jonathan Bush, chairman and CEO of athenahealth. “We know from the PayerView data ... that plenty of challenges and opportunities still exist to address breakdowns between the front office and the exam rooms. The good news is we are seeing continued innovation, primarily driven by the private insurers like Humana who are leading through implementation of practical, tactical programs like bringing medical information online and being more transparent.”

The recent Physician Sentiment Index, issued by athenahealth and Sermo in March, sheds light on physicians’ frustrations trying to balance quality patient interactions with complex reimbursement protocols. The findings revealed a strong desire for greater transparency, automation, and efficiency in medical billing and practice management, so that doctors can focus on their role as caregivers.

“PayerView was conceived with two ideas in mind,” says Bob Keaveney, editorial director of Physicians Practice. “First, to give physicians the only data-driven basis for judging their payers’ administrative performance along dimensions that matter to providers, such as speed and ease of payment collection. Second, to shed a light on the inefficiencies of the payment process in hopes of spurring payers to improve, while simultaneously highlighting areas in which providers themselves can improve as well. Although there is still room for improvement, these latest results suggest that both objectives are being met.”

“We are proud about our position as a top performer in the PayerView Rankings,” said Bruce Perkins, senior vice president of healthcare delivery systems and clinical processes for Humana. "For us, this is further evidence that our work to streamline and standardize claims processing, improve payment performance, and, broadly speaking, to shift more of the onus of administration off the shoulders of physicians, is paying dividends. The transparency afforded by PayerView and the athenahealth network introduces accountability into the payer community. It has become a mechanism for positive change. Humana and athenahealth are like-minded in mission making it easier for doctors to be in business by leveraging automation and the Internet.”

The complete 2010 PayerView Rankings and trends, evaluating 137 national, regional, and government payers in 43 states, can be found at www.athenahealth.com/PayerView.