KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Instant Processing Of Insurance Claims Possible During Doctor Visit

News outlets report on developments in internet processing of insurance claims and electronic health records. 

The New York Times has a consumer health column on programs that would process a patient's insurance claim: "Here's how it could work: A claim is generated and submitted electronically before you finish tying your shoes. By the time you reach the checkout desk, your doctor has received a payment commitment from your insurance company, just as Visa and MasterCard provide to a merchant after a customer swipes a card. It's not fantasy. Instant processing has been discussed in the health care industry long enough that it has acquired a formal term: 'real-time claims adjudication.' But progress toward universal adoption has been slow." The American Medical Association reports that the median number of days for an insurer's response to claims ranged from 5 to 13. Insurance departments handling the bills "may have myriad business reasons to delay payment. … Nonetheless, some large insurers, led by Humana, have been pushing the rest of the industry to adopt real-time claims adjudication" (Stross, 6/25).

Meanwhile, "[t]he push to implement electronic health care records could mean hundreds of millions of dollars pouring into Silicon Valley," The Silicon Valley/San Jose Business Journal reports. "The Federal Reinvestment and Recovery Act plans to have final criteria in place within weeks for hospitals and doctors seeking stimulus funding. This would benefit nonprofit and private hospitals, as well as physicians, who can demonstrate the technology is making a difference in how they treat patients. The Recovery Act allocated $19 billion to hospitals and physicians for the implementation of Electronic Health Records. Hospitals can receive up to several million dollars, depending on their size, and individual physicians up to $44,000, for using certified EHR technology" (Duan, 6/28).

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