MGMA research reflects importance of transparent, standardized processes

Medical Group Management Association (MGMA), Englewood, Colo., has released results from its study of MGMA member satisfaction with major health plans. Respondents were most satisfied with the disclosure of payers’ fee schedules and prompt payment of claims. Administrative processes that were standardized and transparent also produced high satisfaction scores.

"Instead of pursuing one-off plan specific administrative processes, MGMA is strongly encouraging health plans to adopt standardized approaches in areas that include machine readable patient ID cards, and uniform companion guides and operating rules in support of HIPAA administrative transactions,” Anders M. Gilberg vice president, Public and Private Economic Affairs of MGMA tells Managed Healthcare Executive. “In addition, plans need to come together to provide Web-based, multi-payer solutions for real-time claims adjudication and eligibility verification. We assert there are no competitive advantages to a health plan adopting proprietary administrative processes. This only causes unnecessary redundancy and burdens for physician practices."

MGMA members expressed a high level of satisfaction with the major private health plans regarding their provider credentialing processes, but citied dissatisfaction with this process for Medicare.

“We believe this is result of Medicare’s refusal to participate in the standardized physician credentialing system (CAQH Universal Provider Datasource) that is widely used in the private sector,” says William F. Jessee, MD FACMPE, MGMA president CEO. “Our members appreciate payers that provide clear, consistent processes, especially processes that are based on industry-wide standards.”

MGMA members gave Medicare Part B highest marks on questions related to responsiveness, transparency, prompt payment and overall satisfaction with general administrative functions. “Despite the fact that Medicare consistently underpays and places member practices in an increasingly difficult financial situation - with a looming 21% cut to physician payments - MGMA members were positive about the standardized and predicable nature of how the program is administered,” says Jessee.

MGMA’s membership includes practice administrators, CEOs, physicians in management, board members and numerous other practice management professionals. MGMA represents group practices that are major suppliers of physician services for health plans.