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Medical Mutual of Ohio launches real-time claims processing service

The state’s largest insurer says the new system boasts benefits for both doctors and patients. It will make it easier for doctors to collect payment from patients immediately following care. As more patients enroll in high-deductible health plans and consumers’ budgets have tightened due to the recession, collecting payment from patients has become a greater concern for physicians and other medical providers in recent years.

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CLEVELAND, Ohio — Influenced by the rise of so-called “consumer-driven health care,” Medical Mutual of Ohio has launched a Web portal that allows for real-time claims adjudication at provider offices. The system will allow patients and doctors to know the amount a patient owes out-of-pocket within seconds, according to the company.

The state’s largest insurer says the new system boasts benefits for both doctors and patients. It will make it easier for doctors to collect payment from patients immediately following care. As more patients enroll in high-deductible health plans and consumers’ budgets have tightened due to the recession, collecting payment from patients has become a greater concern for physicians and other medical providers in recent years.

For patients, the new system will help them understand exactly what medical services they’re being charged for and allow them to settle their bills before they leave the doctor’s office, rather than being billed weeks or months later, said Kevin Lauterjung, Medical Mutual’s  vice president of health care finance and network management.

“It’s about encouraging the timely exchange of information between our customers and providers about the services being performed,” Lauterjung said. “It’s about [our members] better understanding their health care.”

Medical Mutual’s real-time claims adjudication system was piloted at four physician offices beginning in October 2008. So far, about 30 providers have signed up for it, Lauterjung said. The company does not have a goal for what percentage of its providers it would like to eventually use the system, he said.

Most doctors who contract with Medical Mutual typically send claims data to the insurer through clearing houses, which collect claims from medical providers and route them to the appropriate insurers. The new system could begin to change that.

Medical Mutual competitor Humana launched a real-time claims adjudication process in 2006, according to a statement on its website. A Humana spokesman wasn’t available for comment.

Physicians spend the equivalent of nearly three workweeks every year interacting with insurance companies, according to a May report in Health Affairs. Physicians currently enter different kinds of information for each insurance provider they work with, which increases time spent on data entry and billing, doctors groups and insurers say. Medical Mutual’s new system would eliminate the duplication and provide faster feedback on patients’ insurance policies, including data such as co-pays, coverage and deductibles.

The Health Affairs report in May stated that medical practices spend $68,274 per physician, per year interacting with health plans, which equated to $31 billion in annual expenses. The Ohio State Medical Association cited figures that claim a 10-physician practice spends 2,600 hours a year verifying patient information: a total of $39,000 annually.

In 2007, adults with employer coverage faced an average of $729 annually in out-of-pocket costs for medical services, a 34 percent increase from 2004, when the average was $545, according to a study published in June by the Commonwealth Fund.