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More Health IT Business Intelligence Packs™
Visit Healthcare IT Transition Group online
Real-Time Adjudication
Drivers and Deliverables
70 minutes; standard DVD format (NTSC, SD); chapter menu.
Includes accompanying CD-ROM with handouts in PDF format, slides in PPS format, and RTA resource links page.
Catalog ID: DVD-RTA08A-0058
$395.00 USD
Real Time Adjudication (RTA) may just be The Next Big Thing in healthcare information technology.
Unlike standards-based implementations, there is no regulatory push for adoption. Instead, it’s a pure economic pull. This 70-minute video presents Healthcare IT Transition Group's independent, vendor-neutral analysis of the RTA environment.
Learn why payers want to implement it for their own cost savings and competitive advantages and why providers need it to soften the impact of the High Deductible Health Plan phenomenon. You'll gain insights from numerous success stories and learn about the outstanding challenges. We’ll also suggest a design approach that might help resolve them for the benefit of all concerned.
A recent report indicated that 40 percent of the nation’s largest employers now offer high deductible health plans (HDHPs). HDHPs are supposed to limit discretionary healthcare spending by making the employee “feel” the pain of first-dollar costs. But providers see a significant threat that goes beyond the reduction of unnecessary care: patients walking out on the bill. Right now, that “walking out” is literal – in most cases, patients leave the clinic or facility without knowing what the bill will be, much less paying for their own portion of it.
Payers know that the providers need to collect that revenue this year to avoid contractual adjustments next year.
Employers want the patient to know the price so they can make informed decisions.
Providers want to know how much – and whether – the patient is covered for the service. That’s a complicated question that relies on answers to a number of preliminary questions: Is the patient eligible for this service under this plan? Is there a contracted rate for the procedure or procedures in question? Has the patient satisfied any deductible, and if not, how much remains? Once the deductible is satisfied, what is the coinsurance amount?
As for the consumer, while some patients might not be thrilled to make payments up-front, most would be glad to do away with the avalanche of paper explanations of benefits, statements and bills that typically follow an episode of care.
Real time adjudication answers all of these needs.
We’ll talk about the economic forces driving adoption for all parties, establishing a return-on-investment (ROI) framework for each participant in the transaction. We’ll share the experiences of early adopters, some of whom have been conducting claims in real time for over five years. And we’ll talk about whether a standards-based solution – any provider to any payer – is feasable under today’s regulatory and technological infrastructure.
"One of the few people in the industry who can truly be called a leader in thought."
~Michael Apfel, Truman Medical Centers
Martin Jensen is Chief Analyst and a principal partner at Healthcare IT Transition Group, a consultancy whose clients include healthcare providers large and small, health IT software and service companies, and some of the nation's largest health plans. Recently, Marty has recently been involved in Health IT remediation projects in state Medicaid, vendor and payer organizations. His seventeen years in healthcare IT include work in health plan remediation and provider outreach, engagements with software vendors in product development and systems design, and over fourteen years in business analysis and project management for provider organizations. In 2007 Marty was honored with the Workgroup for Electronic Data Interchange (WEDI) Distinguished Service Award.
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