A small group of Florida internists is having luck with real-time claims adjudication. Nearly half the claims filed by Orlando (Fla.) Internal Medicine are adjudicated in real-time, with the practice receiving near-instantaneous transmissions from its payers about the money it will receive for a given claim and what the level of patient responsibility is.
Pradeep Vangala described the system in play at the HIMSS 2010 Conference, noting that nearly 45% of its patients are on Medicare, one of three payers that support real-time adjudication. The other two are Humana and the Florida Blues plan.
Vangala described how the transaction occurs. First, a charge is entered into the group's practice management system, from Allscripts. The claim is dispatched electronically, through a clearinghouse. The payer calculates the payment and patient responsibility automatically, notifying the group.
Patients are notified of their portion of the cost through a kiosk, from NCR, which is interfaced to the practice management and electronic health records systems. Patients are prompted at the kiosk, which also handles registration at the front-end of the visit, and can pay using a credit card.
This story has been reprinted with permission from Health Data Management.
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