In what circumstances is real-time adjudication (RTA) typically employed?

Real-time adjudication (RTA) is employed in circumstances where reimbursement decisions are made in the presence of the patient. During RTA, the provider submits a claim while the patient is present for services rendered, allowing for immediate verification of benefits and upfront cost determination. This process ensures that patients are informed of their financial responsibility right away, potentially streamlining the payment process and reducing the likelihood of outstanding patient balances.

In contrast, submitting insurance claims for patients not present does not provide the necessary immediate feedback on claims, making RTA irrelevant in that context. Patient follow-up care generally involves ongoing monitoring and support rather than the immediate financial resolution that RTA provides. Record-keeping compliance focuses on maintaining accurate and thorough documentation rather than real-time processes concerning patient billing and reimbursement. Hence, the nature of RTA and its focus on immediate financial decision-making in the presence of the patient makes this scenario the most fitting context for its use.