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Researchers: Simpler Billing Could Save Billions

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A shift to a standard insurance claim form, standard reimbursement rules and standard claim submission rules could save U.S. physicians and their practices about $7 billion per year.

A team of researchers led by Bonnie Blanchfield of Massachusetts General Hospital have published that finding in a study based on observations of a large group physician practice.

Blanchfield and colleagues found that billing and related processes caused the practice about 12% of the net revenue coming from privately insured patients.

The researchers also found that private insurers initially rejected 12.4% of the billed charges but ultimately ended up paying 81% of the bills they denied.

In some cases, the researchers report, providers lose out on a chance to collect billed revenue simply because of the initial rejections.

If insurers shifted to a single, simplified system for submitting and paying claims, the health care system could greatly reduce physician practice administrative costs and save an average of 4 hours of physician time per physician per week without hurting insurer efforts to detect fraud, waste and contract violations, the researchers contend.

U.S. residents spent about $500 billion overall on physician and clinical services in 2009, according to the federal National Health Expenditure estimates.