Emdeon Assistant Achieves HFMA Peer Review Designation

Industry experts honor Emdeon's automated patient eligibility and information verification solution
On June 23 it was announced that Emdeon Assistant, after intensive review, has earned the Peer Reviewed designation of the Healthcare Financial Management Association (HFMA). The HFMA Peer Review designation puts Emdeon Assistant in a short list of prestigious solutions that have been proven to be beneficial by industry expert volunteers and independent HFMA staff.

An automated solution
Emdeon Assistant automates key patient registration processes and delivers real-time eligibility and benefit verifications to save time while increasing revenue. Emdeon Assistant easily interfaces with most existing registration systems and channels efficient search requests to Emdeon contracted carriers with responses generally returned in seconds. By accessing a wide range of information from available payers and credit bureaus, Emdeon Assistant helps providers create a clear, non-discriminatory picture of a patient's ability to pay in an easy-to-read format.

Customers agree
Emdeon customer Carol Plato Nicosia of Martin Memorial Health Systems in Florida concurs with the HFMA Peer Reviewed findings. "Emdeon Assistant really helped us to automate our workflows and instantly retrieves critical patient registration information," Ms. Nicosia states. "Not only is this application easy to use, but it has also allowed us to become much more efficient within the patient registration process because it automatically populates our billing system with eligibility information."

Simplifying the Business of Healthcare
"We understand that consumer-directed healthcare and other trends in healthcare are putting pressures on the front end of the revenue cycle," said Philip Hardin, Executive Vice President of Emdeon Business Services. "We are working with the hospitals to provide them with the tools they need to identify insurance eligibility and benefits, the sources of funds and determine the patient's ability to pay self-pay balances prior to or at the point of care."

By simplifying patient registration and giving providers the ability to store, search and sort key points of information, Emdeon Assistant helps to reduce painful write-offs and the errors that can lead to them. Automatic verification of addresses and key demographic information helps providers maintain contact with patients after they leave the office.

To learn more about the HFMA Peer Review designation and what Emdeon Assistant can do for your healthcare business, call us today at 877.EMDEON.6 (877.363.3666), or visit us online.

Preparing for the Aging Population

As the Baby Boomers hit retirement age and beyond, new demands will be put on providers
Whether most of us realized it or not, 2006 was a momentous year for the future of the healthcare industry in America: the first of the Baby Boomers (Americans born between 1946 and 1964) turned 60 years old. That point was the beginning of what may be the most important shift in modern healthcare because from that moment on, the rate of Americans over 60 began to skyrocket. The National Association of Area Agencies on Aging (n4a) found in a 2006 report that "when the trend peaks in 2030, the number of people over age 65 will soar to 71.5 million -- one in every five Americans." This will literally double the number of elderly people per capita from its 2000 levels.

This trend is not an American phenomenon either. The U.S. Department of Health and Human Services' Administration on Aging recently reported a staggering set of world population statistics: "In 2000, approximately 605 million people were 60 years or older. By 2050, that number is expected to be close to 2 billion. At that time, seniors will outnumber children 14 and under for the first time in history."

Dramatic effect on healthcare providers’ workload
This change in patient demographic is sure to represent an enormous increase in the number of visits most healthcare providers will see. Not only will these patients need more care than they did before, they will require more preventative and proactive procedures such as screenings, blood work and general check-ups. Even the healthiest people of the entire Baby Boomer generation will see their physician several more times a year than they have been previously.

More geriatric patients making more visits means there will be a premium on bringing in excellent staff, training them and keeping them in place. Unless something is done, high turnover rate among staff members who have the most contact with patients will make it even more difficult for physicians to care for a higher volume of patients. Providers across the industry must place more emphasis on retaining staff and keeping them well trained.

Difficulties collecting payment
In 2011 the first Baby Boomers will qualify for Medicare. This rapid influx of Medicare recipients will make the already complicated process of collecting payments even more burdensome. Providers must be prepared for not just the delivery of care, but also the complex billing issues that will ensue. Failing to do so could cause the provider side of the healthcare system to be pushed beyond the limits of its infrastructure and severely hindered by lost revenue in the billing and payment process.

Healthcare providers who rely on manual or dated methods to handle key revenue cycle tasks like patient registration, eligibility checks, claiming, payment receipt, denial management or payment posting could lose revenue due to write-offs and underpayments. Automated electronic solutions will prove vital in making this increasingly burdensome process more efficient and more profitable.

Preparation is key
By working to increase staff retention and automate key revenue cycle processes, healthcare providers can prepare themselves for the rapid changes this increase in older patients will create. Automating the intake, storage and exchange of data with easy-to-use electronic solutions can save time while reducing many of the delays and lost revenue associated with manual processes. Implementing standardized processes across offices as well as health care systems can also help increase efficiencies. Preparation will allow providers to keep their primary focus on what's really important: taking care of patients, not paperwork.

A Place at the National Podium

Emdeon’s Senior V.P. Miriam Paramore Addressed Delegates, Officials & Notable Guests, Shared in National Dialogue at a DNC Healthcare Reform Forum

Amidst the feverish excitement of the recent Democratic National Convention in Denver, Emdeon Business Services participated in an event—in a national dialogue, really—that soberly transcended party lines or affiliations to address a topic relevant to all Americans: healthcare reform.

The public Health Policy Forum, of which Emdeon was a corporate sponsor for an opening VIP reception, brought together a host of influential figures to discuss the present and future of our nation’s healthcare system. Emdeon’s Senior Vice President of Corporate Strategy, Miriam Paramore, herself a recognized thought leader in the industry, offered opening remarks for the reception, representing Emdeon in welcoming the likes of Congresswoman Allyson Schwartz, author of the E-MEDS Bill which requires e-prescribing for Medicare, columnist Arianna Huffington, and Kansas Governor Kathleen Sebelius.

“Emdeon is in the conversation,” Paramore says, recapping her experience at the event. “I’m thrilled to represent a company that’s doing the right thing...participating in the dialogue on the healthcare crisis that affects us all...to help in real, material way.”

Paramore came away energized not only by Emdeon’s role in the national discussion, but in how the company plays a substantive role in “moving the needle” by digitizing the industry and using information technology to turn raw data into usable information. Effective information exchange is essential to the functioning of the entire healthcare system, especially as that system is in a constant state of evolution.

“Our mission is to simplify the business of healthcare,” Paramore explains. “That’s why we are part of discussions on public policy and regulation, to stay on the forefront and influence direction changes that impact the electronic exchange of healthcare information. We are often the connecting point that keeps our customers prepared and ready. ”

Now more than ever, Emdeon is the “glue for the industry when changes occur that impact health information exchange.” By staying close to the regulatory machination, Emdeon is consistently ahead of the game, investing to accommodate altering governmental and industry standards/requirements long before business partners will be affected.

From pay-for-performance issues to handling unfunded mandates and quality initiatives, Emdeon aggressively seeks ways to use technology to make data accurate, expedient and readily accessible for payers, providers, and pharmacies. By improving eligibility transactions and applying business intelligence to EDI, Emdeon is helping reduce the $150 billion of inefficiencies related to insurance and billing activities that burden the healthcare system each year.

“Of course, this is our business, and our customers are our priority. Yet as we better serve our customers, we are improving the system as a whole. We’re motivated to step up our corporate responsibility to make a difference. We are not on the sidelines, in the quest for true reforms” Paramore summarizes. “We encourage our business partners to do the same.”

What does all this mean to you? Here are a few key ‘take aways’ Paramore shares with you from her DNC Health Reform Forum experience.

• Join the conversation. What individuals in your organization are committed to knowing issues, defining goals and finding solutions? Whether you begin simply by staying more informed or you choose to participate more prominently, you must be in the mix; your voice is vital to reform.

• Start your own conversation. Create ways to communicate with constituencies within your organization about key issues, to gain perspective from all angles. Start dialogue, and ensure communication is two-way so that questions, ideas and information can be shared effectively.

• You can count on Emdeon to help connect the dots. As you join in discussion and generate conversation from within, you can count on Emdeon to help filter and share information throughout the industry. Connect with your Emdeon account manager, call 877.EMDEON.6 (877.363.3666) or visit us online at www.emdeon.com and we will always do our best to accurately represent your ideas, questions and concerns to the associations and industry and governmental groups in which we participate.

Address Patient Responsibility with Clarity and Compassion

The following is an important excerpt from the recent HFMA report:

Calculating and Communicating Patient Financial Responsibility.
How can point-of-service collection be considered a success if you don’t collect? Just ask Lorraine Schnelle, executive vice president, Bridgefront, whose organization provides online training in revenue cycle management, among other training topics for healthcare providers.

To Schnelle, a POS collection encounter can be successful even if you don’t get a dollar, “as long as the patient walks away from the registration desk understanding why he or she owes that $200 and thinking about how to pay it. You can still feel that you’ve done your job simply by educating customers about their financial responsibility.”

It’s not that the money isn’t important. It’s that, at this particular historical juncture, as consumerism takes hold in health care and individuals are being asked to shoulder a greater portion of the financial burden—including rising deductibles and copayments—the conversation about the money is almost equally so.

These days, hospitals must be prepared not just to deliver accurate and timely information about a consumer’s benefits on the spot (itself no easy trick), but also to explain that information in terms that make sense to the consumer, to listen to the consumer’s response and react appropriately, and then to bring the conversation to a close that satisfies both parties.


Multiple challenges
Providing real-time estimates of out-of-pocket expenses—and experts agree that’s what patients really want, that hospital charges are not as important—is a highly complex business. It requires hospitals to pull together into one figure information from distinct databases on patients, payers, and providers, including the interaction of insurance contracts, individual benefits, specific medical conditions, expected treatments, physician preferences, and discount policies. Copayments are pretty cut-and-dried by now, notes Schnelle. “Generally the information is either right on the insurance card or you can access it with an online tool.” Co-insurance and deductibles pose more of a challenge because the information is more fluid, and this is where many hospitals are struggling right now. Then there’s the balance due from past visits, which some hospitals throw into the mix and others don’t.

Technology can go a long way to help find and fit the different pieces together. Automated tools can enable hospitals to track and match benefit information—including coverage, rules, exclusions, limitations, copays, and employment status—identify eligibility for financial assistance, and calculate charges. But technology is not a panacea.

“There’s no one-stop shopping yet—no tool that can access every third-party payer database without the need for workarounds,” observes Schnelle. “Even with HIPAA [Health Insurance Portability and Acountability Act of 1996], the consistency and uniformity of transactions haven’t spread to all payers. Depending on the market, finding a workable solution can be very resource intensive. And some smaller hospitals may not be in a position to invest in the tools that are available.”

The complexity of information exchanged external to the hospital also presents its difficulties, as Schnelle notes. “Is communication between the employer and the third-party payer timely, so that you know who actually is eligible for benefits at a given moment? How fast are other providers submitting claims on that patient’s coverage? What is the effect of the adjudication process? These will all affect the quality of information the hospital is working with,” she says.

On the people side of the equation, the challenges are almost as daunting. Typically, hospital employees in positions of direct contact with patients about financial expectations are considered entry-level, have only a high school education, and are paid relatively low wages (for example, making between $9 and $12 an hour in the Phoenix area). As a result, turnover is often high and communication skills low among scheduling and preregistration staff. Turning this situation around—attracting, training, and keeping better qualified people—is a costly undertaking.

It’s natural to wonder: Is it worth all of the expense and effort required to provide cost estimates, to ask consumers to pay what they owe up front, and to educate them about healthcare finance?

To find out more, read the report in its entirety here.

Simplify and Improve Your Up-front Collections

Tips for generating more revenue and easing the self-pay burden
Patients are carrying more and more of the fiscal burden for delivery of care every day. Self-pay patients can be a source of financial pain for many providers because they are more likely to generate a write-off that results in lost revenue. Making sure your staff knows how to considerately collect money before the delivery of care is a key way to generate more revenue and make it clear to the patient what their financial responsibilities are after they leave your office.

............................................................................................
• Make your patient registration as accurate as possible because it's your best chance to maintain contact with the patient throughout the process. Many write-offs occur because of inaccurate information during this stage. Automated solutions such as Emdeon Assistant can check and verify key information to ensure accuracy and eliminate painful errors.

• Utilize electronic eligibility and benefits verification to create an accurate accounting of what the patient will have to pay after and third party or payer contributions. An automated solution such as Emdeon Assistant can integrate this into your daily patient registration to give your staff the most information possible.

• Be timely and accurate with your billing and make sure your up-front costs are as clear as possible to the patient. When a patient is confused about what they are actually paying for it can create mistrust. Make sure your billing documents are detailed, but still as readable as possible to people with no medical training.

• Work with your staff to make sure they can politely and competently explain the benefits of paying for care up-front, rather than after the fact. They should remain polite and not make the patient feel uncomfortable when discussing their financial responsibilities.

• Have a clear, consistent payment policy that you give to the patient before the delivery of care. It should define the terms and payment schedule to expect from the patient. This eliminates confusion for any financial responsibility they may carry after any procedure.

• Reduce staff turnover so that you are not constantly training new registration personnel. Mistakes made in the initial process are a primary cause for future billing and payment problems.

............................................................................................

These tips will help you and your staff collect payments up-front and ensure you have the most accurate information available to reduce the chance that you have to write-off revenue. By preventing financial losses and ensuring accuracy from the beginning you can save time and money across your entire revenue cycle and simplify your work on multiple levels.

To learn more about how Emdeon can help simplify your revenue cycle, call us today at 877.EMDEON.6 (877.363.3666), or visit us online.