Real-time adjudication lets a checkout person see within seconds where a patient stands with his deductible and exactly what he owes. A great tool. But even when it’s available not every practice uses it, says Lukowski.

Why not? It might be that the checkout staff isn’t comfortable collecting large amounts. Or it may be that payer solutions aren’t what practices really want.

“The payers tout these ‘investments’ but the problem for payers is that there [are so many] of them. Providers don’t want to deal with eight or 10 different mousetraps,” explains Nathan Kaufman, a consultant for Davies Public Affairs.

Humana’s Smithson points out that most real-time adjudication systems force practices to enter claims data twice, once at a provider site and then again into the practice management system. Humana is trying to integrate with practice management systems to set itself apart, a strategy it will roll out nationwide this year.

Practices are increasingly using electronic remittance advice, electronic funds transfer, more-robust payer Web sites with complete data for eligibility checks, and technologies that speed up payment and decrease denials, ameliorating the impact of NPI. Lukowski suspects these improvements are responsible for fewer days in A/R and fewer denials among regional payers, which are just now adopting tools originally implemented at the national level.

Electronic remittance advice, which essentially allows payers to issue explanations of benefits electronically, has been around for years, but it has been difficult for providers to use it because payers vary so widely. Uniformity has been lacking. Responding in part to PayerView, this is improving. “It really cuts the payment cycle,” argues Smithson. Payment can be five to seven days faster.

Shave another few days using electronic funds transfer, which enables payment to go right to the bank instead of directly to you in the form of a paper check, and we’re really talking about better performance.

Bottom line

So, what does all this data mean for you? Look at where your payers stand, and take notice if they are doing worse by your practice. It might be that some of the problems are with your own processes if it’s taking you much longer to get paid or your denials are through the roof.

Also, keep the data handy at contracting time. Even payers with high reimbursement might not be “good” payers for you if it takes 60 days or painful machinations to get the money from them. A quick note pointing out their lackluster performance relative to others might help.

Pamela Moore is senior editor, practice management, for Physicians Practice. She can be reached at pmoore@physicianspractice.com.

This article originally appeared in the June 2008 issue of Physicians Practice.