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 percent 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.
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