BUSINESSES FOR SALE


* Upscale Medical Spa Great location, large repeat customer base.


Motivated seller wants to relocate. #69189JH


* Rehabilitation Center Incls. 21,000 sf therapy ctr w/ state-of-the-art


equipment. #68582MM


* Eye Care & Lasik Practice Great location/reputation. Profits over $1M.


Owner planning retirement. #69039JH


* Family General Medical Practice Established 40 yrs. Opportunity to expand.


#69246RB


* Home Healthcare Services Also, DME sales on-line. Motivated Seller;


make offer! #69269DL


* Medical Imaging Services Full state & fed certifications. #69147RB


* Long-term Care Facility Medicaid approved. Incls 30,000 sf bldg.


#59331JE


International Business Exchange 512-310-2966 * ibectx@aol.com


to the new Administrative Burden Index included in the report, which ranks com- mercial health insurers according to the level of unnecessary cost they contribute to the billing and payment of medical claims. Cigna had the lowest administra- tive cost per claim of $1.25, or 47 per- cent below the commercial insurer av- erage; Health Care Service Corporation (the parent organization of Blue Cross and Blue Shield of Texas) had the high- est cost per claim of $3.32, or 41 percent above the commercial insurer average. However, the nation’s largest com-


mercial health insurers’ performance im- proved overall in terms of the accuracy, denials, timeliness, and transparency in claims processing. The AMA report card showed that:


• Error rates for commercial health insurers on paid medical claims dropped from nearly 20 percent in 2010 to 7.1 percent in 2013. Medi- care led all insurers with an accuracy rating of 98.1 percent, followed by UnitedHealthcare at 97.5 percent. Re- gence had the lowest accuracy rating of 85 percent.


ternational Business Exchange Ad.8/2.indd 1 RESEARCH


PHYSICIAN Nationwide Travel


Research corporation needs a physician for an ongoing national health/nutrition study. Individual will be part of a large medical team.


Must be licensed in at least one state. FULL-TIME CONTINUOUS TRAVEL REQUIRED. Fluency in reading, writing, and speaking English is required. Competitive salary is augmented by paid malpractice, meal/travel allowance, holidays, and individual housing/car; subsidized health insurance available.


To learn more about this position and apply, go to www.westat.com/ careers, select “Search Field Data Collection Jobs,” and enter the keyword “Physician.”


EOE www.westat.com 38 TEXAS MEDICINE September 2013 8/5/13 11:28 AM


• Medical claim denial rates were cut nearly in half, from 3.48 percent in 2012 to 1.82 percent in 2013. Cigna had the lowest denial rate at 0.54 percent, while Medicare had the high- est denial rate at 4.9 percent.


• Health insurers’ response times to medical claims improved 17 percent from 2008 to 2013. Humana had the fastest median response time of six days; Aetna was the slowest at 14 days. Medicare’s median response time of 14 days has not changed since 2008.


• Transparency of rules used to edit medical claims also improved by 37 percent from 2008 to 2013.


The findings came from a random sampling of about 2.6 million electronic claims for roughly 4.7 million medi- cal services submitted in February and March of 2013 to Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corporation, Humana, Regence, UnitedHealthcare, and Medicare. Claims came from more than 450 physician


practices in 80 medical specialties pro- viding care in 41 states. For the first time, the AMA report


card also looked at the portion of health care expenses that patients are respon- sible for through copays, deductibles, and coinsurance, and found they are paying roughly one-quarter of a medical bill. At the same time, AMA says insurers do not always equip physician practices with the tools they need to give patients a timely and accurate estimate of their out-of-pocket costs. Read the full report at www.texmed .org/AMA2013ReportCard.


TMA ready to help Problems with health insurance claims? The TMA Payment Advocacy Depart- ment’s Hassle Factor Log®


can help. The


program helps doctors bring their insur- ance-related issues to TMA’s attention so staff can investigate problems and work with private health plans, Medicaid, and Medicare to get claims paid correctly. The Payment Advocacy Department’s work has paid off over the years. In 2012 alone, the department helped TMA members recover nearly $50 million. Physicians can use the Hassle Factor


Log to document their disputes, the type of payer they are dealing with, and the reasonable attempts they have made to resolve claim issues, including the ap- peals process. Download the Hassle Factor Log and learn more about the program at www .texmed.org/hassle, or email the TMA Payment Advocacy staff for assistance at paymentadvocacy@texmed.org. You also may contact the TMA Knowledge Center at (800) 880-7955. n


Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at amy.sorrel@texmed.org.


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