EMRs, charge capture may boost real-time claims adjudication

Tools

Real-time claims adjudication may finally be ready for prime time.

As the New York Times reports, Humana has been pushing RTCA since 2003. "But progress toward universal adoption has been slow," the article says. In the absence of EMRs and charge capture, RTCA remains more suited for low-volume, big-ticket specialties than primary care.

That could be changing with the move toward EMRs, though. (The fact that the Times has picked up on the story is a sign, too.) Harvard economist David Cutler tells the paper healthcare administrative expenses can be cut in half within five years with the adoption of EMRs, charge capture and real-time claims adjudication. That's a savings of $125 billion to $150 billion annually, based on Cutler's estimates.

Accenture consultant Marylou Bailey agrees with the premise--and the need for related technology. "We already have data standards and utilities for connecting different systems" in healthcare, Bailey is quoted as saying. "But without the underlying clinical data captured at the point of care, you don't have anything meaningful to exchange."

Coincidentally or not, vendor RealMed last week introduced two new products that support RTCA and electronic claims processing.

For further details:
- take a look at this New York Times story
- see this RealMed press release

Related Articles:
SPOTLIGHT: CIGNA offers real-time cost estimator, pre-care
Payment terminals help practices cut bad debt
Insurers getting behind machine-readable ID cards