Practice Management Alert

Several payers are offering real-time claims adjudication -- are you taking full advantage yet? You may think claims approval in minutes can only happen in your billing dreams, but those dreams may soon come true. Real-time claims adjudication (RTCA) is beginning to catch on in practices, and more payers are offering you this cost-saving option. Here's what you need to know to find out if your office should jump on the RTCA bandwagon. Move Beyond Claim Estimates UnitedHealthcare, Humana, Tricare, and Blue Cross Blue Shield of South Carolina are just a few of the payers that offer RTCA to their physician clients. RTCA allows you to view, at the time of service, how much insurance will pay and how much a patient will owe. RTCA is a growing trend among payers and practices. "Many of the major payers and the patient management systems are well on the way toward piloting RTCA," says Daniel Kazzaz, chair of Accredited Standards Committee (ASC) X12 and president of Rapid Data Interchange in Bethesda, Md. How it works: Before the patient leaves your office, you submit the claim, complete with CPT and ICD-9 diagnosis codes, using a Web portal. "RTCA refers to a technology that allows a provider to submit a claim electronically and receive an immediate, definitive response from the payer," says Martin Jensen, COO and chief analyst for the Healthcare IT Transition Group in Tulsa, Okla., and editor of the HIT Transition Web log (blog.hittransition.com). "It's not the same as a claims estimator. The goal is to get the final result, less any contractual adjustments and exclusions." Capture Patient Payment Right Away Faster patient collections tops the list of pros for using RTCA. When you perform real-time adjudication while the patient is still in the office, you-re more likely to collect the payment the patient is responsible for. "You can immediately find out if the patient has met their deductible and thereby calculate patient responsibility," says Ron Sterling, president of Sterling Solutions Ltd. in Silver Spring, Md. Being able to correct any errors and instantly resubmit will help your AR, Jensen adds. By handing the patient his explanation of benefits at the time of service and then collecting patient payments in this way, you avoid having to send statements through the mail and having to follow up one or more times to collect, says Doral Davis-Jacobsen, BHS, MBA, CMPE, manager of the physician services consulting unit of Dixon Hughes PLLC in Asheville, N.C. "It's just like every other service in America -- you buy something, you pay for it, you leave," she adds. Patient plus: When the patient receives his explanation of benefits at the time of service, he's able to ask questions [...]