The healthcare industry has been notoriously slow at adopting technologies, but if it gets on board with real-time claims processing, the money could flow in.
There’s no reason to fear technology said David Hawkes, executive vice president of Phoenix-based technology company Eldorado. Real-time claims processing, if done right, can boost a hospital’s reputation and the financial implications are enormous.
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Hawkes talked with Healthcare Finance News to suggest five tips for attaining real-time claims processing.
1. Aligning the interests of providers and payers. The shared risks and rewards in the accountable care organization model aligns the interests of providers and payers, making both groups interested in adopting a real-time claims processing system because of its ability to streamline and speed up claims said Hawkes.
2. The Internet is your friend. The ability to submit a claim via web services across secure Internet connections in real-time can significantly improve real-time claims processing, Hawkes said.
“If the billing system used by the hospital, clinic or doctor’s office can send a claim submission to a clearinghouse or an electronic post office and the claims processing systems can accept and auto-adjudicate that claim and ship payment information back through the clearinghouse to the practice management system within seconds, practice management systems can then produce information that the provider administrator can access before the patient leaves the office,” he said.
3. Keep your hands off. “The moment an administrator touches the claim, the process is no longer occurring in real-time,” Hawkes said. “The biggest challenge to this comes from the provider, particularly in a traditional doctor’s office where technology adoption is still poor and manual processes still reign supreme.”
4. Embrace change. As it stands, claims currently travel in batches of HIPAA 837 transactions between providers, clearinghouses, networks and other negotiators. Hawkes is adamant that model must change in order for real-time claims processing to be achieved.
“Either the functions of each of these players must be combined into a single computer application or each of these parties must work together to enable the transportation of claims in real-time using web services across the Internet,” said Hawkes.
5. Adapting to the consumerism of healthcare and the healthcare IT mindset. “Anything short of real-time is becoming intolerable …,” Hawkes said. Healthcare claims processing is no exception. “The sooner payers and providers get on board with this concept, the sooner we’ll see real-time claims adjudication becoming more widely adopted.”