Jan 2007 Table of Contents

Grade Your Payers: The Final Call for Survey Responses



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Take our survey online or on paper by March 1 to grade your health plans on their payment rates, claims processing, contracts and more.

Fam Pract Manag. 2007 Jan;14(1):41-43.

In October, the AAFP and Family Practice Management launched a nationwide survey that enables family physicians to grade how well their health plans perform when it comes to payment rates, claims processing, formularies and other key factors. Hundreds of family physicians have already taken the survey, which was initially offered online only, but we've also heard from a number of physicians that they would prefer a paper version. As requested, a paper version of the survey appears in this issue.

How it works

There are now two ways to participate in the payer survey:

1) Complete the paper version of the survey by downloading the survey ( Download in PDF format ) and faxing or mailing it to FPM (our contact information is at the top of the survey); or

2) Complete the online version of the survey at http://www.aafp.org/fpm/payersurvey.

The survey is open to AAFP members only; it requires a valid AAFP member ID number. Your seven-digit member ID number is printed on the mailing label on the front cover of the journal, or you can look up your ID number at https://secure.aafp.org/retrieve_username/member.

The deadline for submitting your responses is March 1, 2007.

When completing the survey, you will need to list the names of up to 10 payers that you would like to grade (Medicare, UnitedHealthcare, Aetna, etc.). If you complete the survey online, you will be presented with a list of third-party payers that do business in your area, and you can simply select from that list or add additional payers. Choose the payers you deal with most often and want to provide feedback on, both good and bad.

Once you've identified your key payers, you can then grade them on a scale of A (excellent) to F (failing) in each of the following 11 categories:

  • Payment rates (whether they are adequate or too heavily discounted);

  • Adherence to Current Procedural Terminology (CPT) in claims processing (whether the payer recognizes modifiers, inappropriately bundles or downcodes services, etc.);

  • Timeliness of payments (whether clean claims are paid within an appropriate amount of time);

  • Accessibility, knowledge and responsiveness to your practice's concerns (whether payer representatives are easy to reach, helpful, etc.);

  • Member eligibility and benefits information (whether it is accurate and easy to access);

  • The payer's Web site (whether it provides accurate information and smooth transactions);

  • Formularies (whether the information is easy to access, how often it changes, etc.);

  • Prior authorization (how often it is required, how reasonable the decisions are, etc.);

  • The appeals process (whether decisions are timely, reasonable, etc.);

  • Physician performance data (whether data is accurate, valid and used fairly);

  • The contracting process (whether the payer is willing to negotiate, disclose its fee schedule, etc.).

Using the report card

Your responses will help us generate a payer report card, which will be published in FPM in the coming months. It will demonstrate which health plans are doing well and which need to improve their performance, and it will help bolster the AAFP's advocacy efforts on behalf of family physicians. It will also provide you with a tool to use in contracting decisions.

So sharpen your red pencils, and take the survey. This is your chance to be heard.

Send comments to fpmedit@aafp.org.

Copyright © 2007 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact fpmserv@aafp.org for copyright questions and/or permission requests.

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