Claims Adjudication is Costly and Complex, But There is a Solution

Claims Adjudication Solution

Medical claims adjudication remains a time-consuming and costly process for both providers and patients. The ultimate goal is real-time adjudication, with claims being processed so quickly that the practice would know its expected reimbursement and patients would now what they owed. This would speed up the process – and reduce costs – for all involved.

But various barriers have prevented real-time claims adjudication from becoming a reality: workflow issues among providers, inadequately designed practice management systems, complicated claims management systems among payers, and the complex nature of health care billing itself.

 “Claims inefficiency is an immense problem,” says David Cutler, a professor of applied economics at Harvard’s Kennedy School of Public Health. “We spend more on administrative cost than we do heart disease and cancer; claims adjudication is the biggest part of the expense.”

Though that ultimate, industry-wide solution doesn’t exist yet, there are ways to improve medical claims adjudication within an organization. If your company is seeking a way to streamline its medical claims adjudication process, outsourcing to an experienced provider that utilizes leading-edge technology could be the solution. When selecting a provider, however, be sure to choose one that offers:

• A highly trained staff with superior service levels, proven processes and best practice techniques
• Flexibility to customize training to fit your specific system requirements
• Guaranteed accuracy levels and turnaround times (TATs)
• Full and guaranteed HIPAA compliance

As Cutler said, administrative costs add up to more than the actual costs of treating patients. But with the right outsourcing provider, your organization can streamline the adjudication process and improve your bottom line.