Collecting patients' share up-front getting easier

With Humana starting a real-time claims adjudication system, other big plans may follow. Knowing the patients' share is key to the success of HSAs.

By Jonathan G. Bethely, AMNews staff. Feb. 27, 2006.

MacGregor Medical Center in San Antonio is a big believer in the process known as real-time claims adjudication. That's because in a business where collecting 80% of outstanding patient bills is the norm, its collection rate from patients under this system has gone up to 93%.

This is why: Under a real-time claims adjudication system it tested for Humana -- a system the insurer is rolling out nationwide -- MacGregor could find out the breakdown of the patient's and insurer's share of the cost of care. That let MacGregor collect from patients before they left the office, rather than mail a bill. Not only do patient payments come in faster and more frequently, but the 10-physician, primary care practice also saves the estimated $6.50-per-bill for handling collection by mail.

"It's been a blessing," said Brian Senger, MD, a MacGregor internist. "Time is money. This is faster, and it works. Our collections alone just over the past month have increased dramatically. I think this is the wave of the future."

Many are beginning to agree with Dr. Senger. Humana's entry into the nascent world of real-time claims is the first big push by a national insurer, and analysts expect that other major insurers will follow suit.

Real-time claims adjudication is a process in which a practice electronically files a claim with an insurer, which then quickly sends a message back to the practice breaking down what the practice will be paid. For example, Humana says its system will send back an answer in 30 seconds.