white paper-in-house dispensing 2014.9.29
TRANSCRIPT
Is In-House Dispensing Right for my Practice?
A White Paper
by Ron Poe Script Dispense Inc.
www.scriptdispense.com
October, 2014
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Is In-House Dispensing Right for my Practice? In-‐House Dispensing is an ancillary service that provides clinical care benefits, improved patient compliance and new revenues for a growing number of medical practices in the USA. By choosing an appropriate In-‐House Dispensing vendor, all stakeholders in a medical practice can benefit: patients, providers, staff and the practice itself. In order to attain these benefits, medical practices must understand some key aspects of a successful In-‐House Dispensary including some important topics which may not be disclosed by many vendors. This paper will explain these key issues in order to help medical practice owners and managers to make an educated decision about whether an In-‐House Dispensary is suitable for them.
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Preface As the healthcare industry in America continues to undergo numerous changes, almost all medical practices are facing tremendous challenges—particularly the business issues of a medical practice—which are stimulating these medical practices to consider various ancillary services that will not only improve the care of patients but also benefit the business aspects of the practice. One of the fastest-‐growing ancillary services available to medical practices today is an In-‐House Dispensary. As medical practices are evaluating In-‐House Dispensing, the key topics to consider can be organized into the following categories: 1. In-‐House Dispensing Market 2. Legal Issues and Concerns 3. Impact on Patients 4. Business Analysis 5. Operational Issues 6. Program Recommendations
In the following pages, each of these subjects will be addressed with the goal of providing medical practices with an objective, thorough understanding of the In-‐House Dispensing business. With this information, a medical practice’s owners and management can then make a determination as to the suitability of this ancillary service to their practice and, if deemed appropriate, how to proceed. 1. In-House Dispensing Market For the purpose of this paper, the term “In-‐House Dispensing” is defined as a pharmacy operated within a medical practice. Such a facility is often called a “dispensary” rather than a “pharmacy” although these two terms are essentially interchangeable within a medical practice. This paper will use the term In-‐House Dispensary. Because an In-‐House Dispensary is meant to serve only the patients of the medical practice, the In-‐House Dispensary can dispense only pre-‐packaged medications exclusively to the patients of that practice.1 This limitation is one distinguishing characteristic of an In-‐House
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Dispensary compared to a retail pharmacy. Also, because all medications for an In-‐House Dispensary are pre-‐packaged, there is no requirement for a pharmacist to be present.2 An emerging sector of the In-‐House Dispensing business called Clean Dispensing is addressing this market by both defining the targeted Clean Dispensing market while separating the business model from other parts of the dispensing business including workers compensation and compounding. This paper will address the method of dispensing in which insurance claims are processed electronically in real time—a process called Live Adjudication or Electronic Processing. This paper will use the term “Live Adjudication.” Through utilizing a Live Adjudication system, insurance reimbursement claims are processed in real-‐time from within the medical office using an online claims approval and payment process; a process enabled through a healthcare industry data-‐sharing technology called HL73. Because of the capabilities provided by the Live Adjudication process, medical practices operating an In-‐House Dispensary will always know medication will be reimbursed before being dispensed to any patients. In-‐House Dispensing vendors are sometimes called Management Companies. Each Management Company varies in the breadth of services offered. These services include: processing physician applications for licensing with state medical boards, contracting with payers (through Pharmacy Benefits Management companies; PBMs), supplying medications, a Live Adjudication-‐capable order-‐processing technology platform, ordering equipment needed (computer, printer, bar-‐code scanner), providing technical support and other services as well. Some Management Companies offer turnkey solutions which provide an end-‐to-‐end set of all products and services needed to operate an In-‐House Pharmacy. Conversely, other Management Companies may provide only some components needed to operate an In-‐House Dispensary. As with any form of ancillary service, each Management Company’s service offering must be evaluated individually by each medical practice.
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2. Legal Issues and Concerns When looking into the In-‐House Dispensing business for the first time, even experienced medical professionals raise the question: Is this legal? In almost every state in the USA, the answer is: yes. Utah is the only state where In-‐House Dispensing is illegal. Other states have imposed various levels of restrictions on In-‐House Dispensing including Arkansas, Massachusetts, Montana, New York and Texas. For medical practices in these states, additional due diligence must be done with the respective state boards of health and pharmacy. In the other 44 states not mentioned in the preceding paragraph, physicians (MDs and DOs) have the right to dispense medications to their patients. Some states do require a physician to add a dispensing endorsement on their medical license which is a simple, administrative procedure. In a few states like North Carolina, prescriptions written by mid-‐level providers—ARNPs and PAs—must be issued under the direct supervision of an MD or DO. Additional details about each state’s legal requirements can be found at www.licenselogix.com. General Liability Risk In almost all In-‐House Dispensing programs, medications are delivered to the medical practice in pre-‐sealed containers which are bar-‐coded in order to facilitate quality control of both inventory management and dispensing. As such, in most states a medical practice must simply carry a general liability (a.k.a. slip and fall) insurance policy in order to operate an In-‐House Dispensary. Some PBMs require medical practices operating an In-‐House Dispensary to carry a general liability policy that covers $1 million per incident and $3 million in aggregate—a so-‐called 1/3 policy. Because the carrying of a 1/3 general liability insurance policy is a requirement is made by PBMs, the policy is needed by a medical practice in order to receive medication reimbursement payments from payers through Live Adjudication system.
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Malpractice Risk Most physicians already dispense pharmaceutical samples and some practices provide other treatments with medications. With these procedures already addressed under a medical practice’s existing malpractice insurance, a medical practice is already covered by malpractice insurance. The operation of an In-‐House Dispensary should not fundamentally change the risk profile of a medical practice. In fact, the risk to the medical practice would arguably be no different than sending a prescription to a retail pharmacy.
Clinical Note: Since up to 30% of prescriptions go unfilled4, one could argue that In-House Dispensing may actually lower malpractice risk of a medical practice because an In-House Dispensary will ensure patients actually receive their needed medications. As such, physicians can improve Patient Adherence to care plans which will improve clinical outcomes.
In some states physicians are not required to carry malpractice (a.k.a. professional liability) insurance. However, even in these states some payers may require medical practices operating an In-‐House Dispensary to carry malpractice insurance. Of course, each medical practice should consult with their own insurance provider and a healthcare attorney regarding all matters relating to insurance coverage and each state’s legal requirements. 3. Impact on Patients Every physician’s first priority should naturally be the care of their patients. From a legal perspective, In-‐House Dispensaries must operate primarily “for the benefit of patients.”5 Patients benefit from In-‐House Dispensing in the following ways:
• Care – When patients have their medications in hand, they are in a better position to follow their care plan.
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• Convenience – By receiving medications directly from their doctor’s office, patients do not have to make an extra trip to a retail pharmacy. Also, the process of receiving medications from an In-‐House Dispensary is a quick transaction as opposed to the often-‐hour-‐long process of picking up medications from a retail pharmacy—a tremendous time savings for patients. For patients using Non-‐Emergency Medical Transportation (NEMT) services, these patients can continue to use such services to reach their doctor’s office. NEMT services cannot legally transport patients to retail pharmacies6. For patients who do not drive themselves, an In-‐House Dispensary eliminates the logistical challenge of simply getting their medications in hand.
• Compliance – Patients’ “lack of adherence has dramatic effects on health. In the United States, it is estimated to cause approximately 125,000 deaths, at least 10% of hospitalizations and a substantial increase in morbidity and mortality. Nonadherence has been estimated to cost the U.S. health care system between $100 billion and $289 billion annually.”7 Not surprisingly, patients who receive their medication(s) from their doctor’s office are much more adherent to their doctor’s care plan.
“Having an In-House Dispensary is the best solution for ensuring my patients are adherent to their care plans. Unless I am going to insert the pills into patients’ mouths, what else can I do?” - an MD in Hollywood, Florida
• Control – In recent years, many physicians report feeling they are increasingly in less control of their practice. At the same time, physicians are under increased pressure to improve the clinical outcomes of their patients even though they have no control over their patients once they leave the office. Finally, physicians do not have any way of knowing if their patients ever picked up the medications prescribed, thereby exacerbating physicians’ feelings of a lack of control. By operating an In-‐House Dispensary, physicians gain some control over their practice by having certainty that their patients have actually received their medications.
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Conjecture: How many patients know their pharmacists name? Virtually all patients know their doctor’s name.
• Cost – Patients pay the same co-‐payment at an In-‐House Dispensary as would be charged at a retail pharmacy.
Although most patients are not currently accustomed to receiving their medications from their doctor’s office, studies have shown that patients prefer to receive their medications from the doctor’s office and that percentage of preference increases over time. When patients are due to receive refills of their medications, physicians can authorize those refills without seeing their patients in person. However, for many patients taking long-‐term medications, a lot of physicians prefer to see such patients in person at least every 90 days in order to assess each patient’s status. By having these patients visit their doctor more often, physicians have more opportunities to provide better care to their patients simply by being able to catch problems that might be missed with less-‐frequent office visits. While patients are in their doctor’s office for these visits, they are also able to pick up a 90-‐day supply of their medications. 4. Business Analysis Beyond the clinical care benefits already detailed in this paper, medical practices need to perform their own due diligence on the financial aspects of operating an In-‐House Dispensary including the initial costs, ongoing capital requirements, effects on cashflow and additional costs that may be required. Ultimately, the practice must evaluate their Return On Investment (ROI) from both monetary and workload standpoints. Initial Costs Depending on the level of services provided by a Management Company, the initial costs vary widely—from no up-‐front fee to several thousand dollars. Management Companies that require no up-‐front fee are most-‐often engaged in the Workers Compensation segment of the In-‐House Dispensing market
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which is not the Clean Dispensing method of dispensing covered in this paper. As with most businesses, any product or service offered for free must be inspected in even-‐more detail to determine the reason for such a seemingly-‐generous offer. However, for large-‐scale medical practices, some Clean Dispensing Management Companies may be willing to discount the Initial Costs charged because the Management Companies will expect to recover this investment through the greater volume of business done with such a large-‐scale medical practice. Beyond the Initial Costs paid to Management Companies, medical practices may also incur some costs related to shelving or lockers used to store medications. In most cases, these costs will be negligible—especially if the practice is not going to stock controlled medications which require extra security, procedures and audits. For medical practices that are not stocking controlled substances, the facility Initial Costs are usually limited to a lockable room or storage closet. Some states have other requirements which should be researched through consultation with Management Companies or through each state’s boards of pharmacy and health. Capital Requirements When medical practices are evaluating the deployment of an In-‐House Dispensary, one of the most common questions is: How much inventory is required? In order to operate an In-‐House Dispensary, a medical practice must maintain an inventory of pre-‐packaged medications available to dispense. In most states, the cost of these medications must be paid directly by the medical practice because Management Companies are not legally allowed to provide the medications on any form of consignment. As such, the costs of reordering medication will commonly be billed to a credit card on file with the Management Company. Management Companies’ recommendations on the level of inventory that should be stocked vary widely. Some Management Companies recommend a minimal inventory while some Management Companies promote an inventory of tens of thousands of dollars. When evaluating the right starting inventory for a medical practice’s new In-‐House Dispensary, the practice should determine the mix of medications and volumes necessary to successfully
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dispense at least 80% of the medications prescribed by the practice. To meet this objective, most medical practices will have to carry a two-‐week inventory of only twenty medications with each medication typically carried in 30-‐, 60-‐ and 90-‐day counts with some variance based on the specialty. In order to determine the appropriate mix of medications to carry in inventory, the practice should be able to extract a report from their Electronic Health Records (EHR) system which will show the specific medications prescribed over a period of time as well as the volume of each medication. Even without an EHR system, the Management Company should be able to consult with the physician(s) to determine the different types of medications to initially keep in stock because most physicians can recite their most-‐commonly-‐prescribed medications from memory. Over time, inventories can be adjusted to fit the changing needs of each practice through consultation with the Management Company. Some Management Companies provide automatic reordering of medications that will streamline the inventory and reordering processes. Although most In-‐House Dispensaries are implemented and operated by existing office staff from within the medical practice and each transaction with each patient may require only a minute or two of time, someone within the office must still personally complete the dispensing transaction with each patient. Especially in the first few weeks of operating an In-‐House Dispensary, a medical practice will be learning how to handle and resolve rejections from payers—a routine, administrative process experienced by any entity processing pharmaceutical claims with payers. As such, the practice must be committed to the objective of dispensing all medications prescribed by the practice’s physicians lest the practice will simply continue to send prescriptions out to retail pharmacies to be filled and miss many of the benefits of operating an In-‐House Dispensary. Without such a clear commitment from the practice’s owner(s), office staff will often prioritize other work over the In-‐House Dispensary and, as such, the In-‐House Dispensary will not deliver the clinical nor financial benefits detailed in this paper. In the end, the In-‐House Dispensary is a business within the business of the medical practice and must be operated with commensurate focus and dedication as any business endeavor. Financial Summary
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By using an online Live Adjudication system to process claims for medications, medical practices earn money through reimbursements. Also, medical practices will collect all co-‐payments directly from patients. The combination of co-‐payments, dispensing fees and reimbursements comprise the Gross Revenues for the medical practice’s In-‐House Dispensary “business.” Also, the costs of operating an In-‐House Dispensary come mostly from the purchases of medications which comprise the inventory.
In-‐House Dispensing Cashflow Summary: Co-‐Payment + Dispensing Fee + Reimbursement = Gross Revenues -‐ Cost of Medications -‐ Additional staff costs (if any) = Profit for the medical practice
For small medical practices, there should not be any additional staff expenses. In medium-‐sized practices, there is often value in hiring a technician or Medical Assistant (MA) who will be focused on operating the In-‐House Dispensary as their primary job responsibility. In medical practices with several full-‐time physicians—perhaps five to ten physicians (depending on the specialty)—a full-‐time employee should be hired to operate the In-‐House Dispensary who will have few, if any, other responsibilities. Although any staff member in a medical office can serve as the technician in an In-‐House Dispensary with no specialized certification, some Management Companies recommend hiring a Certified Pharmaceutical Technician (CPhT) because CPhTs are already educated in pharmacy matters—especially processing claims—and the hourly cost of a CPhT is not substantially more expensive than Medical Assistants (MAs) in most geographies. In most practices, the additional revenue generated from using a CPhT should readily offset any additional cost of the CPhT. Medical practices can also estimate their potential profitability from operating an In-‐House Dispensary by looking at the profitability of each prescription multiplied by the number of prescriptions given over a period of time.
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Profitability of In-‐House Dispensing: Patients per day: 20 Scripts per patient: 2 Total scripts per day: 40 Average profit per Script: $5 -‐ 10 Daily profit: $200 -‐ 400 Monthly profit (20 days): $4,000 -‐ 8,000 Annual profit: $48,000 -‐ $96,000 The example above depicts a single, primary care physician with an average profit of $5-‐10 per medication. Other specialties will have varying levels of patient volumes and reimbursements. Of course, multiple providers in the same office will benefit from the additional volume of patients. For example, a 5-‐physician office in the same specialty should have about five times the dispensing volume of a single-‐physician practice. The economic benefits of an In-‐House Dispensary increase with the scale of the practice due to the leverage created from diminished fixed costs. Management Companies should be able to provide a customized financial analysis on specific practices. When comparing In-‐House Dispensing to other ancillary services, research has found this service to have low capital requirements and impact on workflow. At the same time, In-‐House dispensing has had the highest impact on care, profitability of the practice and day-‐to-‐day cashflow. At-Risk Practices Within the labyrinth of insurance-‐coverage systems in the healthcare industry, many commercial payers now contract with medical practices in such a manner that the medical practice directly shares in the expenses incurred by patients covered by said payer. These medical practices are defined as “at risk.” These At-‐Risk medical practices bear tremendous financial responsibility for the expenses generated by patients under such a plan. In terms of financial advantages, medical practices operating in an “at risk” model have the most to gain from operating an In-‐House Dispensary. Because these practices are liable for all costs generated by their patients (Emergency
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Room visits, laboratory tests, etc.) these practices can mitigate their exposure to such costs simply by ensuring their patients get their medications in their hands. Commercial and Government Payers Both Medicare and Medicaid generally participate in In-‐House Dispensing. Reimbursements from these government payers are competitive with commercial payers. In many cases, government payers pay a higher reimbursement than commercial payers for the same medications. Each state’s government programs should be evaluated individually. All major commercial payers participate in In-‐House Dispensing except Cigna. For patients covered by Cigna, medical practices operating an In-‐House Dispensary will have to continue to send Cigna’s patients out to retail pharmacies. Pharmacy Benefits Management Companies (PBMs) PBMs serve as a clearing house between payers and medical practices because such reimbursements for pharmaceuticals cannot legally be paid directly to a retail pharmacy nor In-‐House Dispensary. Management Companies will sometimes assist medical practices to obtain contracts with PBMs thereby relieving the medical practices of this administrative process. Some PBMs require direct contracts with medical practices whereas some PBMs are grouped in a Pharmacy Service Administrative Organizations (PSAO). PSAOs provide a more-‐streamlined contracting process because one contract with a single PSAO can provide access to several PBMs. Each Management Company should be able to explain their respective PBM credentialing services offered. 5. Operational Issues As with any ancillary service implemented in a medical practice, some level of operational change will be necessary in any medical practice in order to successfully implement an In-‐House Dispensary—particularly workflow within the office. When comparing an In-‐House Dispensary with almost any other ancillary service, the impact on workflow is relatively minor—but not non-‐existent.
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Each medical practice has their own workflow procedures. Part of the consultation provided by Management Companies should include discussing the practice’s current workflow and how the In-‐House Dispensary can be incorporated into the medical practice successfully. One of the most-‐critical functions of the In-‐House Dispensary which must be accomplished is the actual dispensing by a technician. This process is highly-‐automated in terms of communicating with outside entities but the technician who is actually operating the system must physically perform some actions. The following procedure is followed on each dispensing transaction:
• The physician diagnoses the patient and determines the appropriate treatment plan and, if needed, appropriate medications.
• The physician asks the patient if they prefer to pick up their medications from the medical office or from elsewhere. [Note: patients must be given the choice of where to fill their prescriptions.8]
• The physician (or an assistant) e-‐prescribes the medication(s) per their normal procedure. This e-‐prescription information is automatically transmitted to Surescripts and payers by the online Live Adjudication system.
• The patient walks from their exam room to the In-‐House Dispensary. • The In-‐House Dispensary technician opens the patient’s record in the Live Adjudication system. The technician will reconfirm the patient’s:
o address and phone number o insurance information (Rx BIN, PCN, Group and ID) o authorized refills, days supplied and SIG (how many pills per day; when/how the pills should be taken).
• A safety check is then performed by the online system to prevent dispensing a medication which has already been dispensed elsewhere.
• A Drug Utilization Review (DUR) is conducted which is a check of drug interactions, allergies and patient history.
• The technician will process the claim within the Live Adjudication system which will complete the following procedures in a few seconds:
o Confirmation of the patient’s eligibility for the medications prescribed.
o Disclosure of the appropriate co-‐payment. • If the patient has a co-‐payment, the technician will collect the co-‐payment from the patient.
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• The technician prints labels which are then affixed to each bottle and the technician also prints the instructions for each medication.
• The technician puts all medications into a bag and hands the medications to the patient.
• Within 21 days of dispensing, the medical practice will be reimbursed for the medication.
Note: Although there appear to be many steps, because of the speed of the online Live Adjudication system, this process will take only 2-‐5 minutes per patient. If a claim is rejected for any reason, the technician must resolve the rejection which will usually require the technician to call the payer.
If a medical practice is not currently e-‐prescribing, the practice can still operate an In-‐House Dispensary in which all prescription-‐related information will have to be entered manually by the technician operating the In-‐House Dispensary. Administrative Tasks Many years ago, the administrative burden of operating an In-‐House Dispensary was heavy—particularly in terms of meeting government-‐mandated requirements. But in the modern era of online Live Adjudication systems, the management of such government-‐related functions occur automatically and require very little work from the technician in an In-‐House Dispensary. On a day-‐to-‐day basis, the technician will print a report which lists all medications for each physician for that day. Each physician simply signs their respective report each day. This daily report is the extent of the administrative workload required of physicians. Location of the In-House Dispensary The physical space required for an In-‐House Dispensary is relatively modest: usually a small room or even a closet. Most practices will place the In-‐House Dispensary relatively-‐near the medical practice’s Check Out desk. Some practices have the In-‐House Dispensary technician also complete all Check Out procedures. Some states have additional facility requirements which must be researched with each state’s Board of Pharmacy.
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6. Program Recommendations In-‐House Dispensing can give medical practices benefits from improving clinical care to bolstering their financial bottom line. In order to achieve these benefits, medical practices must weigh many factors to answer the question: Is In-‐House Dispensing right for my practice? When evaluating Management Companies, medical practices should enquire about the breadth of suppliers used by each Management Company. If all medications come from a single source, there is some risk of the supply of medications being interrupted if this single supplier encounters any interruptions to their operations such as inclemate weather, financial distress, logistical distribution delays or any other issues that affect all businesses. At the same time, if multiple suppliers are used by a Management Company, the medical practice should enquire as to how orders are processed; some Live Adjudication systems will manage the reordering of medications from multiple suppliers in a seamless manner. To ensure the success of an In-‐House Dispensary, a Management Company should be able to provide the following products and services: -‐ Processing of dispensing endorsements on physicians’ medical licenses. -‐ Credentialing with PBMs and/or PSAOs. -‐ An online, Live Adjudication system utilizing HL7 technology. -‐ All hardware needed: computer, printer, bar code scanner. -‐ A backup logbook to register all medications dispensed. -‐ Training on setup, technology, operations and reordering as well as access to a Fraud, Waste & Abuse course.
-‐ Ongoing Support. Note: The entire process should be completed in 2-‐3 months.
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Summary Many medical practices are evaluating the opportunity to operate an In-‐House Dispensary. As with any ancillary service or business decision made by any medical practice, proper due diligence and research must be done in order to determine the viability of an In-‐House Dispensary for each respective medical practice. Once a decision is made to investigate the opportunities associated with operating an In-‐House Dispensary, each medical practice must choose an appropriate Management Company that will meet their specific needs. Before making a decision about any ancillary service, medical practices should consult with their attorney, accountant and any relevant government agencies. The Author Ron Poe Director, Script Dispense Inc. Ron leads the nationwide development of partner engagements and major accounts for Script Dispense. He previously founded one of Script Dispense’s partner companies where his team promoted the Script Dispense solution to medical practices in Florida. Ron has previously owned and operated companies in a breadth of industries including electronic health records (EHR), recruiting, executive search and educational media. He is a graduate of the United States Naval Academy and served as an officer in the Marine Corps. Script Dispense Script Dispense is a pioneer in the In-‐House Dispensing industry with a focus on Clean Dispensing. Originally founded in South Florida, Script Dispense is expanding throughout the United States and striving to improve the health of the nation while transforming the way patients receive medications in America. Contact 5040 NW 155th Street, First Floor Miami Lakes, Florida 33016 1.888.926.0069 www.scriptdispense.com
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Glossary Pharmacy Benefit Manager (PBM) A third-‐party administrator of prescription drug programs primarily responsible for processing and paying prescription drug claims as well as developing and maintaining formularies, contracting with pharmacies, processing claims and other functions relating to paying for pharmaceuticals. National Council for Prescription Drug Programs (NCPDP) Founded in 1977 as the extension of a Drug Ad Hoc Committee that made recommendations for the US National Drug Code (NDC). Over-the-Counter medications (OTC) Medications that are available without a prescription. Bank identification number (BIN) A six-‐digit number that health plans can use to process electronic pharmacy claims if they do not use pharmacy benefit cards with a magnetic stripe. Electronic prescribing or e-prescribing (e-Rx) Electronic (computer-‐based) generation, transmission and filling of a medical prescription. Paper and faxed prescriptions can be replaced by e-‐Rx which allows physicians to electronically transmit a new prescription or renewal authorization pharmacies. Co-Payment (Co-Pay) The amount of out-‐of-‐pocket expenses for prescription drugs a patient pays at the time the prescription is dispensed, with the payer paying the remaining cost to the pharmacy.
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Surescripts The nation's largest e-‐prescription network which supports a rapidly-‐expanding ecosystem of health care organizations nationwide. Surescripts certifies software used by prescribers, pharmacies and payers/PBMs for access to three main services: Prescription Benefit, Medication History and Prescription Routing. Reimbursement The amount of money a payer pays a pharmacy or dispensary for a claim. Electronic Medical Records (EMRs) A digital version of the paper charts in a medical office. An EMR contains the medical and treatment history of the patients in one practice. Electronic Health records (EHRs) These systems perform all the functions of an EMR and more. EHRs focus on the total health of the patient going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. Health Level Seven International (HL7) The global authority on standards for interoperability of health information technology which enables the seamless, real-‐time interfacing of medical software systems. Live Adjudication The processing of a claim in real time and providing approval or rejection in only a few seconds. Once approved, the reimbursement is paid directly to the medical practice.
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References: 1 2011 Florida Statutes: http://www.flsenate.gov/laws/statutes/2011/465.0276 2 2011 Florida Statutes: http://www.flsenate.gov/laws/statutes/2011/465.0276 3 Health Level Seven International: http://www.hl7.org/about/index.cfm?ref=nav 4 Annals of Internal Medicine: http://annals.org/article.aspx?articleid=1357338 5 2011 Florida Statutes: http://www.flsenate.gov/laws/statutes/2011/465.0276 6 Missouri Department of Social Services: http://dss.mo.gov/mhd/participants/pages/medtrans.htm 7 Annals of Internal Medicine: http://annals.org/article.aspx?articleid=1357338 8 American Medical Association Opinion 8.06: http://www.ama-‐assn.org/ama/pub/physician-‐resources/medical-‐ethics/code-‐medical-‐ethics/opinion806.page?