Urologists can improve billing with real-time claims adjudication

September 1, 2010

With real-time claims adjudication, a patient receives a service in your office and then in real time, while the patient is in the office, she receives an explanation of benefits that details her charges, what the insurance company allows, the amount of the co-pay, and the status of the patient's deductible.

Key Points

For this article, which discusses the benefits of RTCA, we interviewed Doral Jacobsen, a consultant with Dixon Hughes, PLLC, Asheville, NC, who is an expert on the financial aspects of physicians' practices.

System offers many advantages

Jacobsen points out that there are numerous advantages of RTCA for a medical practice. These include no billing, no patient balances, no phone calls prodding patients to pay their bills, no calls to insurance companies questioning the bills, no payment plans for remaining balances, no statements, no collection letters, a decrease in accounts receivable, an increase in cash flow, and patients who know exactly what they are expected to pay. Most insurance companies that offer RTCA will transfer funds to the practice or send payment in 24 to 72 hours.

RTCA is easily accomplished because the transaction occurs using the Internet, Jacobsen notes. Since most practices have Internet access, the process only requires logging in to the payer's Web site and entering the patient demographic information and patient ID number. The key is that the International Classification of Diseases and Current Procedural Terminology coding is accurate and available to the employee responsible for checking out the patient.

According to Jacobsen, not all insurance companies offer RTCA. At present, it is available through Humana, United Healthcare, and Blue Cross/Blue Shield in a few states (Oklahoma, South Carolina, Florida). She believes more insurers will be using this technology, as the patient satisfaction is so favorable that practices receive glowing customer service reports. Patients like to see their EOBs and understand what part of the fees they are responsible for. Patients are happier when they understand what they need to do.

Jacobsen also believes that the payers' administrative costs will decrease with the increasing popularity of the program. One example is the decrease in the number of denials that are filed and need to be explained to patients. Now, when a service is not covered, the practice can explain the denial, shifting the explanation process from the payer to the practice.

Even though medical practices are eager to speed up their payment processes, many of their offices are not yet ready to perform RTCA. According to Jacobsen, one of the hurdles is the requirement that the office will be required to key the data into the computer, which is another layer of processes that must be performed by the office staff. Most offices balk at the thought of duplicate keying. Another problem, which can be easily overcome, is that the practice must have the bill ready at the point of service. This is often difficult, as the coding is not always complete in real time. At the present time, Humana has an electronic bridge for many practice management software (PMS) programs, and other vendors will probably be offering this in the near future.