Medicare assignment rates and carrier practices: A national study

Acceptance of assignment by physicians influences the amount of health insurance protection that is provided to the aged by Medicare and the financial burden on the elderly. Assignment rate has been noted as a major issue for health policy. This study uses national data to analyze the effect of socioeconomic variables and carrier discretionary practices on assignment rates.

The socioeconomic environment in the carrier territories was taken into account by use of variables from the Area Resource File and the AMA. The principal variables of interest were claims investigation, denial, and reduction rates, and processing speed. Additionally, discretionary practices concerned with pricing in the absence of information needed to develop reasonable charges in the standard manner were tested. Factor analysis was used for data reduction.

The results explained 41% of the variance for all carriers but more was explained when Blue and non-Blue carriers were separated. Variables from the health economy and from carrier practices entered the equations. High investigation and denial rates were associated with low assignment rates.

While the response of individual physicians to the socioeconomic environment and to certain discretionary practices is not fully explained by analysis on aggregated data at the carrier level, the responsiveness of medical doctors to carrier aggressiveness in claims control is an important finding for Medicare administration.