Medical offices are accustomed to dealing with a variety of payers, but they are starting to see patients who have consumer-directed health plans (CDHPs), which place greater financial responsibility on patients. With CDHPs comes a potential for increased accounts receivable (A/R) -- A/R due from patients, not payers. CDHPs represent a growing piece of the insured market. As CDHP enrollment grows, medical offices that experience a growing A/R have a promising option: real-time claims adjudication (RTCA). RTCA provides a paradigm shift in the medical office workflow. With a change in workflow and software, providers can bill for a service and receive an explanation of benefits before the patient leaves the office. Economic forces seem to be converging in a way that makes RTCA inevitable, and the concept certainly has advantages for payers and providers. Even so, providers should evaluate RTCA's impact on workflow and compliance, and determine whether the ROI makes the investment worthwhile.
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