5 Ways Real-Time Medical Claims Adjudication Speeds Up The Reimbursement Process
By: Abhilash Khalkar
Tags: Covid 19, Health Insurance, Insurance, Life Insurance, Medical

The rising costs of healthcare have led to the needs of the insurer to better determine the premiums, coinsurance, deductibles, and non-covered benefits of the patients for correct claim filing. Real-Time Medical Claims Adjudication (RTA) has evolved over the years as an appropriate solution to this issue. Providers have the option to pay at the point of sale for the treatment or before the customer exits the hospital. This not only decreases the risk of denials but also eliminates the logistical workload and paperwork, leading to cost savings and rapid processing times. RTA removes the need for providers to track and settle their disputes, allowing them to concentrate on the key programs they offer.

We have collated a list of 5 ways through which RTA speeds up the reimbursement process, to help you understand the benefits of RTA.

Increased Rate of Approval

The nature of the healthcare industry makes it necessary that care providers evaluate the responsibility of the patient at the time the service is being provided. Real-time medical claims adjudication works perfectly in such a scenario. At the payer’s adjudication, RTA claims are given precedence, thereby shortening the time for reimbursement. Studies show that nearly 85% of purchases can be successfully adjudicated in real-time, which reaffirms clinicians that they will be billed to the customer for their care.

Patient and Provider satisfaction

For the insurer, real-time medical claims adjudication optimizes the method of calculating the patient’s share of the cost for the healthcare facility because all related details can be obtained by presenting the identification number or claim. They can conveniently take a written copy of the EOB statement of the patient and answer his/ her further questions, which assists in improving patient satisfaction.

Speedy Payments

For medical claims adjudication in real-time, the employer receives a portion of the patient’s hospital costs before he/ she leaves the facility. The remainder of the amount of payer is received within a few days. Consequently, the possibility of bad debts that could occur due to the liabilities of the patient is minimized. Faster payment time means fewer follow-ups which help in providing a delightful experience for both, the patient and the provider.

Fewer Risks

Since the RTA system uses advanced tools to determine the likelihood of claims before care is provided to a patient, the risk of incorrect tests reduces. The RTA system is very effective in identifying abnormal patterns of consumption, thereby reducing the chances of misuse and fraud.

Reduced Operating Costs

In the absence of real-time medical claims adjudication, care centers will have to invest in human resources and administrative work that will further deplete the result. RTA helps providers reduce their hiring required to answer the queries about claims, compensations, and all other non-value adding activities. Real-time medical claims adjudication can assist organizations to revamp their billing processes, and at the same time maintain the accuracy of a high claim to ensure better operations and cash flows.

Stakeholders can rethink how they have been managing their claims, by employing real-time medical claims adjudication, to make the process more efficient and transparent. The administrative and financial implications make RTA a wise option for providers to get compensated for their programs and ensure smooth operations.