Real Time Claims Adjudication Conference Call

(PRLEAP.COM) Real-Time Adjudication (RTA) may just be The Next Big Thing in healthcare information technology. Go to the clinic, and by the time you’re checking out at the desk, the billing for your visit is complete – the clinic knows how much they’ll be paid by your health plan, and they ask you for a check for the precise remainder. No more chasing patients down weeks later when the insurance company issues its verdict.

A web-based conference has been developed to bring payers, providers and the software vendors that will be enabling this transition up to speed. A choice of two dates is offered, October 24 and 25, 2007; register at http://hittransition.com/flashpoint/rta.

It’s a win-win for health plans and healthcare providers alike. And, while some patients might not be thrilled to make payments up-front, most would be glad to do away with the avalanche of paper explanations of benefits (EOB), statements and bills that typically follow an episode of care.

Unlike standards-based healthcare IT implementations, there is no regulatory “push” for adoption. Instead, it’s a pure economic “pull.” Health plans want to implement it for their own cost savings and competitive advantages. Healthcare providers need it to soften the impact of the High Deductible Health Plan (HDHP) phenomenon and related Health Savings Plan (HSA) issues. The ability to get the patient to pay immediately not only shortens the payment cycle, sometimes it means getting paid at all.

A recent report indicated that 40 percent of the nation’s largest employers now offer high deductible health plans. HDHPs are supposed to limit discretionary healthcare spending by making the employee “feel the pain” of first-dollar costs. But providers see a significant threat that goes beyond the reduction of unnecessary care: patients walking out on the bill. Right now, that “walking out” is literal – in most cases, patients leave the clinic or facility without knowing what the bill will be, much less paying for their own portion of it.

Payers know that the providers need to collect that revenue this year to avoid contractual adjustments next year. Employers want the patient to know the price so they can make informed decisions. And providers want to know how much – and whether – the patient is covered for the service. That’s a complicated question that relies on answers to a number of preliminary questions: Is the patient eligible for this service under this plan? Is there a contracted rate for the procedure or procedures in question? Has the patient satisfied any deductible, and if not, how much remains? Once the deductible is satisfied, what is the coinsurance amount?

Real time adjudication answers all of these needs. The 90-minute webinar, developed by Healthcare IT Transition Group (HITTG), a health IT policy analysis organization, will cover how it works, what the benefits are, insights from success stories, and challenges to implementation and adoption. The HITTG analysts have conducted similar programs for the health IT industry and standards development organizations (SDO), co-chairing the industry group developing the new health ID card standard within WEDI (Workgroup for Electronic Data Interchange), as well as that body’s Business Issues Subworkgroup, worked on the upcoming 5010 medical coding standard within X12, and were involved in the first-ever WEDI/X12 RTA Forum.

The presentation will discuss the economic forces driving adoption of RTA for all parties, establishing a return-on-investment (ROI) framework for each participant in the transaction, as well as the experiences of early adopters, some of whom have been conducting claims in real time for over five years. The feasibility of a standards-based solution for real-time adjudication – any provider to any payer – under today’s regulatory and technological infrastructure will be discussed. A design approach for real-time claims adjudication will be presented to assist in resolving outstanding challenges for the benefit of all the parties involved in the health insurance claim.

Registration for the webinar is open through October 24 at http://hittransition.com/flashpoint/rta.

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