How Real-Time Claims Service Can Increase Your Practice Revenues
Several payers are now offering real-time claims adjudication. But are you taking full advantage, yet? If not, here’s what you need to know before your office jumps on the RTCA bandwagon.
Getting past claim estimates
Some payers who already offer RTCA to their physician clients are United Healthcare, Humana, Tricare, and Blue Cross/Blue Shield of South Carolina. The main advantage of RTCA is that it allows you or your staff to view, at the time of service, exactly how much insurance will pay and how much the patient will have to pay. That’s why RTCA is a growing trend among payers and practices.
It works simply. Before your patient leaves your office, you submit the claim, complete with CPT and ICD-9 diagnosis codes, using a Web portal. With RTCA, you submit a claim electronically and receive an immediate, definitive response from the payer. The goal is always to get the final result, less any contractual adjustments and exclusions.
Capture patient payment immediately and improve cash flow
Faster patient collections top the list of good reasons for using RTCA. Performing real-time adjudication while the patient is still in your office increases the likelihood that you will collect what the patient owes right away. RTCA allows you to immediately find out if the patient has met their deductible and then calculate the patient’s responsibility.
Being able to correct any errors and instantly resubmit will also help your accounts receivable. By handing the patient an explanation of benefits at the time of service and then collecting patient payments, you avoid sending statements through the mail and following up one or more times to collect. It’s just like every other service in America – you buy something, you pay for it and you leave.
When the patient receives the explanation of benefits at the time of service, they can ask questions if they don’t understand something on the statement. If there’s a claim denial, there is a real person with real billing knowledge right there to explain what happened with the claim and how the patient can fix it.
Reduce your office’s claims hassles
The billing staff in your office will have fewer problems and fewer denials to contend with since real-time adjudication provides immediate claim status. You can handle corrections right away, which will improve office efficiency. The labor savings alone from RTCA amounts to about $10 per claim, according to an industry expert.
You’ll also see a reduction in the number of days your claim goes unpaid. The faster the payer recognizes your correct claim, the faster you’ll get paid, normally within 24 hours.
ONE BIG CAVEAT: Most implementations are via Web portal, rather than directly integrated into the various billing applications used by different practices and payers. Ask questions.
Getting past claim estimates
Some payers who already offer RTCA to their physician clients are United Healthcare, Humana, Tricare, and Blue Cross/Blue Shield of South Carolina. The main advantage of RTCA is that it allows you or your staff to view, at the time of service, exactly how much insurance will pay and how much the patient will have to pay. That’s why RTCA is a growing trend among payers and practices.
It works simply. Before your patient leaves your office, you submit the claim, complete with CPT and ICD-9 diagnosis codes, using a Web portal. With RTCA, you submit a claim electronically and receive an immediate, definitive response from the payer. The goal is always to get the final result, less any contractual adjustments and exclusions.
Capture patient payment immediately and improve cash flow
Faster patient collections top the list of good reasons for using RTCA. Performing real-time adjudication while the patient is still in your office increases the likelihood that you will collect what the patient owes right away. RTCA allows you to immediately find out if the patient has met their deductible and then calculate the patient’s responsibility.
Being able to correct any errors and instantly resubmit will also help your accounts receivable. By handing the patient an explanation of benefits at the time of service and then collecting patient payments, you avoid sending statements through the mail and following up one or more times to collect. It’s just like every other service in America – you buy something, you pay for it and you leave.
When the patient receives the explanation of benefits at the time of service, they can ask questions if they don’t understand something on the statement. If there’s a claim denial, there is a real person with real billing knowledge right there to explain what happened with the claim and how the patient can fix it.
Reduce your office’s claims hassles
The billing staff in your office will have fewer problems and fewer denials to contend with since real-time adjudication provides immediate claim status. You can handle corrections right away, which will improve office efficiency. The labor savings alone from RTCA amounts to about $10 per claim, according to an industry expert.
You’ll also see a reduction in the number of days your claim goes unpaid. The faster the payer recognizes your correct claim, the faster you’ll get paid, normally within 24 hours.
ONE BIG CAVEAT: Most implementations are via Web portal, rather than directly integrated into the various billing applications used by different practices and payers. Ask questions.