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Results of MGMA's Major Health Plan Study Are In: Medicare B a Winner


Payers request transparent, standardized, administrative processes in dealing with health plans.

Medicare Part B performs well against private payers

In results released today, Oct. 25, from the Medical Group Management Association's (MGMA's) annual study of MGMA member satisfaction with major health plans, respondents were again most satisfied with the disclosure of payers’ fee schedules and prompt payment of claims. The study reflected several common themes, as well as wide variation in performance among plans on a number of questions related to administrative transactions. The study did not address payment levels.

Medicare Part B scored highest on questions related to responsiveness, transparency, prompt payment and overall satisfaction with general administrative functions.

“Aside from its problematic credentialing system, our data show Medicare’s administrative operations being viewed as transparent and reliable in comparison with the private sector," said William F. Jessee, MD FACMPE, MGMA president CEO. "However, this is in stark contrast to Medicare’s payment system, which once again is on the brink of disaster with cuts totaling near 30 percent looming in December and January.”

MGMA member research also released today reflects the potentially devastating impact of these Medicare payment reductions on group practices.

In this year's research, MGMA members again expressed a relatively high level of satisfaction with private health plans’ credentialing processes but dissatisfaction with this process for Medicare.

“MGMA strongly urges Medicare to join the private sector in making the Council for Affordable Quality Healthcare Universal Provider Datasource the standard among all health plans. Credentialing is a major area where Medicare fails to operate in a standardized and efficient manner, and consequently, MGMA members gave it the lowest scores for this function among all plans in our study. It’s a good example of where a lack of standardization results in needless costs to our health system,” Jessee said.

What makes this study unique is the direct, daily interaction MGMA members and their staffs have with health plans. MGMA’s diverse membership comprises practice administrators, CEOs, physicians in management, board members and numerous other practice management professionals. They work in medical practices and ambulatory care organizations of all sizes and types, including integrated systems and hospital- and medical school-affiliated practices.

“MGMA represents group practices that are major suppliers of physician services for these health plans. As such, we expect payers to reflect on these results and work with us to create solutions in areas identified as needing improvement. The results speak for themselves. It is our goal that all plans — public and private — achieve positive satisfaction scores from MGMA members on all of these key administrative functions,” Jessee said.

MGMA is a membership association for professional administrators and leaders of medical group practices. Since 1926, MGMA has delivered networking, professional education and resources, and political advocacy for medical practice management. Today, MGMA’s 22,500 members lead 13,700 organizations nationwide in which some 275,000 physicians provide more than 40% of the health care services delivered in the United States.

MGMA’s mission is to continually improve the performance of medical group practice professionals and the organizations they represent. mgma.com.

View the full results.

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