Posted by admin | Posted in Credentialing, Provider Enrollment | Posted on 09-11-2010
The Medical Group Management Association (MGMA) recently conducted a survey to ascertain it’s members satisfaction levels with their interactions with key payer. The survey included a review of the seven largest payers including Medicare Part B, CIGNA, Aetna, Coventry, Humana, Anthem and UnitedHealthcare. The MGMA membership is exclusively composed of persons serving in practice management roles. The relationship areas survived included: payer communications, provider enrollment, payment policies, system transparency and overall satisfaction levels.
In general, the results indicated that the MGMA membership is most satisfied with the disclosure of payer fee and fee schedules along with the prompt payment of claims and the standardization and transparency of admin procedures. Medicare Pat B achieved the highest score in the first two categories.
The areas of greatest dissatisfaction were credentialing and contracting, siting it’s complexity and time consuming nature. The membership was universally dissatisfied with the contract negotiation process with all payers, indicating that, in their opinion, their practices were at a distinct disadvantage and the payers didn’t conduct good-faith negotiations. Overall CIGNA ranked first and Medicare Part B last on general contracting and credentialing issues. Physician rating system and/or pay-for performance program transparency and the claims denial process were two other areas where virtually all the payers were found to be deficient.
The top to bottom scores (on a scale of 1-5)and rankings of the payers are as follows:
Ranking/ Payer/ Score
- Medicare Part B /3.4
- CIGNA/ 3.1
- Aetna /3.0
- Coventry / 3.0
- Humana /2.9
- Anthem/ 2.9
- UnitedHealthcare / 2.6
It’s the hope of the MGMA that in conducting these satisfaction surveys the payer will review their performance and ranking and make the necessary policy and procedural modifications to achieve higher scores especially in the area of provider enrollment.