Stuck in a River of Denials?

See Fewer Denials and More Revenue in 5 Easy Steps

For many healthcare businesses, denials remain a constant flow of lost revenue and lost time. Few other elements related to the business of healthcare have generated as much buzz and frustration as denial management over the past decade. The topic has been scrutinized, and the results have produced scores of promising electronic solutions that can help slow the current of lost revenue. But, the already complex tasks involved in healthcare payment are growing more complex, creating potential pitfalls in processes that used to be efficient.

Hospitals and healthcare groups are in a difficult situation when it comes to decreasing the financial and time losses created by denials. Increased regulatory demands, fluctuations in coverage by payers and staff turnover are often the biggest obstacles in improving denial management. Fixing these issues requires administrators and staff at all levels to coordinate set procedures and create the safeguards that catch mistakes before they cause a problem. To help, here are 5 easy steps you can implement to help reduce the occurrence and the impact of denials on your healthcare business:

1. Take no coverage for granted.
Always check a patient's health plan to verify eligibility and benefits before every procedure. Health plans change constantly these days, so care that may have been covered a few months ago could be dropped from the plan by today. The most efficient method is to use real-time electronic solutions that can connect to all of your payers from one system. If you don’t have that option, you can still pick up the phone or surf to multiple payer websites. Any way you can verify eligibility, this ounce of prevention up front is one of the most effective ways to minimize denials downstream.

2. Check for secondary coverage.
Secondary and supplemental insurance plans have become more common with the popularity of Consumer-Directed Health Plans. As a result your staff should be diligent during the registration process so that they collect relevant information on all available payment options.

3. Do everything reasonable to prevent staff turnover.
No matter how thorough a staff member's training, the intricate details of correcting and properly resubmitting a denied claim take time to learn. The longer an employee is with your organization the more productive they will probably be in many areas, including registration and denial management.

4. Consider creating an incentivized department specifically for denials.
This department can vary significantly in size depending upon the scale of your organization, but when dedicated staff work on resolving denied claims on a daily basis, they develop nuanced skills and understanding that normal business office staff wouldn't have the time to cultivate. Having a dedicated denial management department can also help you spot over-arching trends and take pro-active measures to reduce future denials.

5. Investigate automated solutions.
Automated denial management solutions can connect with your claim management to create automated checks that quickly identify errors while accurately accounting denied and adjusted amounts. Automated denial management solutions can simplify the entire process so that your organization gets the greatest mix of revenue and efficiency.

These 5 easy steps will help get your healthcare organization flowing in a strong current of better denial management, but they're only the beginning. Every organization contains different people and different procedures, so it's incredibly important that you implement the changes that are best for your situation. Make sure your staff and any other impacted parties are on board with prospective changes and keep the lines of communication healthy. If everyone is paddling in unison towards the same goal you may be surprised by how much time and money you'll save with improved denial management in your healthcare organization.

To find out more information and see how Emdeon can assist you in your denial management process, call 877.EMDEON.6 (877.363.3666) or visit us online.

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Emdeon Asks the $30 Billion Question

Introducing the U.S. Healthcare Efficiency Index™

“What would you do with $30 billion?” This question sparked a groundswell of intrigue at the recent Healthcare 2.0 conference in San Diego. Purveyed on buttons and business cards at the event, this hypothetical inquiry alludes to the dollar value assigned to the cost of the healthcare industry’s voluminous inefficiencies as it lumbers toward becoming electronically-based. A guerrilla website—www.save30billion.com—supplemented the messaging, concurrently touting the $30 billion question to curious participants and putting a spotlight on a must-address issue for the industry.

For those of us who’ve worked in healthcare any length of time, it may be hard to fathom there’s $30 billion (with a “b”!) of business inefficiencies in our industry. Of course, we know the transition is far from complete, and there’s always room for improvement...but $30 billion worth? Aren’t we ceaselessly implementing technology or upgrading systems to accommodate a new mandate, fulfill a market demand or streamline revenue cycles?

And if there’s still a $30 billion chasm—even after all the electronic evolutions, solutions and changes, how can we ever be sure we’re making real progress?

Enter the U.S. Healthcare Efficiency Index™.

The U.S. Healthcare Efficiency Index is “an industry forum for monitoring the business efficiency in healthcare.” The Index, already online at www.ushealthcareindex.com, is poised to be the singular source for tracking the transition of our system from paper to electronic transactions.

This innovative forum—and the intriguing $30 billion question that was its precursor—are the brainchildren of Emdeon’s leadership team. Though the Index was born of Emdeon’s unwavering commitment to electronic efficiency, it is established, guided and advised by some of the nation’s most respected, authoritative experts from the healthcare industry and beyond. The charter advisory council includes the likes of Former House Speaker Newt Gingrich, founder of the Center for Health Transformation. Renowned statisticians Dr. Fritz Scheuren and Dr. Patrick Baier are creating processes for data gathering, analysis and reporting for the Index.

Emdeon’s Senior Vice President of Corporate Strategy Miriam Paramore serves on the Index’s advisory council and is a passionate advocate of the need for awareness and action.

“So many business leaders and policy makers assume that billing and payment related transactions have been ‘fixed’ and are fully automated, but that’s not so.” Paramore explains. “For example, when we tell people that medical payment transactions alone could create $11 billion in annual savings through direct deposit, they’re blown away. They had no idea there was such need for improvement.”

The Index is launching in phases to accommodate increased specificity over time. Phase 1 is focused on the potential savings for medical claims-related transactions. Future phases will address pharmacy, dental, vision and Worker’s Compensation. In addition to the tracking of financial data, the Index also follows environmental impact as the industry moves away from paper usage to electronic transactions. Information will be updated quarterly.

Log on and sign up. Visit the "Get Involved" page of the website to sign up for regular updates and opportunities to participate.

Advisory Council Roster (to date)
Fritz Scheuren, Ph.D.
Scheuren–Ruffner

Patrick Baier, D.Phil.
Milliman, Inc.

John L. Phelan, Ph.D.
Milliman, Inc.

Andrew Naugle, MBA
Milliman, Inc.

Jane Sarasohn-Kahn, MA, MHSA
THINK-Health
Health Economist and Author

Newt Gingrich
Center for Health Transformation

Erik Swanson
WellPoint

Dave Garets
HIMSS Analytics

Stanley Nachimson
Nachimson Advisors, LLC

Miriam Paramore
Emdeon

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Adding Value to Emdeon Claim Master with Complete Claim Life Cycle Monitoring

by Todd Thomas, Director of Provider Product Management

“SHOW ME THE MONEY!” More than a decade later the phrase made famous in the 1996 movie “Jerry Maguire”, can still be heard daily in healthcare business offices throughout America. It is the battle cry of the CFO. It is the “nails on the chalkboard” for the business office director. It is the challenge facing revenue cycle professionals everywhere. Where is the cash? Emdeon Claim Master has a new feature that just made the answer to that question a whole lot easier.

Emdeon Claim Master is a web-based billing management solution that can save time and money by providing one interface for managing claims for virtually all government and commercial payers from start to finish. Claim Master now has a new feature that enables unrivaled visibility into every stage of the claim life cycle. From the time a newly billed claim begins its journey to when the final payment is received and posted, Claim Master now has the capability to monitor every claim, every step of the way. This new feature not only illustrates the status of the entire claims inventory with dashboard-style charts and graphs, but it also reveals daily processing trends while shining a spotlight on potential processing issues. Providers can then select any data point on any chart to drill down to the payer, batch or even to the claim level.

Part of this new Claim Master capability includes configurable email alerts that instantly notify managers of potential issues that may delay processing, and ultimately payment of claims. Instead of searching through daily reports looking for “processing anomalies”, now Claim Master can send alerts via email to appropriate parties. Once alerted, providers can take advantage of the drill-down feature to get all the way down to the claim level, enabling them to identify and expose the root cause of any processing problem.

Emdeon Claim Master is also now able to monitor the claim life cycle in conjunction with existing end-to-end Revenue Cycle Management Solutions. If Emdeon Payment Manager is used for electronic remittance processing, Claim Master will now automatically monitor ERA processing, with charts and graphs that show payments trended by date and by payer. If Emdeon Denial Manager is used to identify and correct denials, Claim Master will also automatically monitor the count and amount of denials by date and by payer, with drill down capability to reveal denial reason, right down to the claim level.

With the new functionality recently added, Emdeon Claim Master now offers visibility into the claims life cycle illustrating the status of the entire claims inventory with dashboard-style charts and graphs. So, the next time you think “SHOW ME THE MONEY”, Emdeon Claim Master is the perfect solution for you- literally!

Todd Thomas is the director of provider product management at Emdeon. Have a question or interested in learning more about where the industry is headed with Claims Management? Email him at tothomas@emdeon.com.

For more information related to the new capability in Emdeon Claim Master, existing Emdeon Claim Master customers call 877.271.0054. For those interested in learning more about Emdeon Claim Master, call 877.EMDEON.6 (877.363.3666) or visit us online.

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Discovering Opportunities for Keeping Bad Debt in Check

The following is an important excerpt from the recent HFMA Educational Report: Strategies for Reducing Bad Debt.

If the state of affairs in health care is bleak now, then the future does not appear to be any brighter. In 2007, an estimated 25 million people between ages 19 and 64 lacked adequate insurance—a 60 percent increase since 2003. At the same time, census figures show 45.7 million people lacked health insurance altogether. Into this mix throw in rising unemployment, lower earnings, and a worsening economy. The result: As more patients are becoming responsible for their healthcare costs, it’s becoming increasingly difficult for them to afford care and, in turn, for hospitals to collect from them when they do seek care.

For many hospitals, this perfect storm of eroding health benefits, increasing patient financial responsibility, and economic woes has led to a rise in bad debt. According to the American Hospital Association, the cost of uncompensated care (including bad debt and charity) for the country’s 4,897 registered community hospitals grew to $34 billion in 2007.

Stemming the Flow
Given this worsening environment and the related mounting bad debt, hospital executives may feel there is little that can be done. Fortunately, this isn’t the truth. By leveraging innovative technologies and rethinking or evolving processes, many healthcare providers are discovering opportunities for keeping bad debt in check.

One key strategy hospitals can employ is to improve efforts to differentiate between patients who are able but unwilling to pay and those who truly are unable to pay. Stronger efforts should then be undertaken for those patients without payment ability not only to assist in determining eligibility for financial assistance or charity care but also to aid in the enrollment process. Individuals with an ability to pay can be best served with efforts that help them understand the obligation and processes that help facilitate payment.

Of course, pursuing such an approach can be challenging. Providers may find themselves reengineering processes, retooling with new technology, and retraining employees. Also, underlying any self-pay strategy should be the realization that a delicate balance must be maintained between a high-tech tool that increases efficiency and a personal touch that recognizes the importance of treating all patients with respect.

Shifts in Revenue Cycle Focus
Not so very long ago, discussion of payment and payment options took place in some cases long after the hospital service was rendered. For example, a patient had surgery and a bill was then sent followed perhaps by a collections letter or two. If payment wasn’t received promptly, only then did discussion about payment options begin.

In today’s environment of patients’ increased financial responsibility, the discussion of payment and payment options after the delivery of nonemergency care is not well-suited. Instead of focusing on payment after healthcare services are rendered by the hospital, the discussion of financial responsibility often must shift to the front of the revenue cycle.

Like many providers, Martin Memorial Health Systems, a 344-bed, two-hospital organization based in Stuart, FL, has changed its payment processes to promote earlier discussion about financial responsibility and up-front collections practices. Rather than the day before the patient is admitted to the hospital for elective procedures, the eligibility process at MMHS begins several days before the patient is admitted, says Carol Plato Nicosia, administrative director of corporate business services for MMHS. If registration staff determines that an uninsured patient scheduling services does have the means to pay, then the hospital requests an up-front payment before the patient is admitted. Uninsured patients pay a steeply discounted rate, which helps patients’ ability to pay in many cases, she adds.

Starting eligibility verification early in the process allows the patient time to come up with the down payment, if needed. Patients appreciate the up-front communication, Plato Nicosia says. “They are not faced with an unexpected responsibility for a large dollar amount the day before the procedure.”

The process change not only has been welcomed by patients, but also has been a welcome relief to the bottom line. Since implementing the change three years ago, MMHS has been able to slow the rate of increase of its bad debt by about 1 percent, says Plato Nicosia.

To find out more about Strategies for Reducing Bad Debt, click here to read this report in its entirety.

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New Payers On Board

The Emdeon network of payers continues to grow

Emdeon connects you and 300,000 other providers to 1,200 payers, the nation’s largest network. We’re constantly adding new payers to this network, giving you even greater reach for real-time eligibility and benefit verification and electronic claims submission. The more payer connections you access through our network, the quicker you can begin receiving accurate reimbursements, reducing write-offs, and improving first pass acceptance rates.

• 360 Alliance Gilsbar- Claims
• Aetna Better Health Connecticut Medicaid- Claims
• Blue Cross Blue Shield of South Dakota (Sioux Falls)- Eligibility
• Blue Cross Blue Shield of Alabama- Eligibility
• Blue Cross of Idaho Health Services, Inc- Eligibility
• Blue Grass Family Health/SRRIPA- Claims
• CBH Florida- Claims
• Cincinnati Financial Corporation- Claims
• Community Claims Administration- Claims
• Coventry Health Care Nevada- Claims
• HealthSpring- Claims
• Midwest Security of WI- Eligibility
• Molina Healthcare of Florida- Claims
• National Health Benefits Corporation NHBC02- Claims
• National Health Benefits Corporation NHBC03- Claims
• National Health Benefits Corporation NHBC04- Claims
• Network Health Insurance Corp Medicare- Claims
• North Suburban Associated Physicians- Claims
• OK State Employees & Educators (EDS)- Claims
• Phoenix Health Plan- Claims
• Physician Associates of the Greater San Gabriel Valley- Claims
• Prestige Health Choice- Claims
• Sunshine State Health Plan- Claims
• TRLHN/AU- Claims
• TRLHN/EB- Claims
• Upper Peninsula Health Plan- Claims
• Virginia Premier Gold- Claims
• Washington Labor & Industry- Eligibility
• Wellmark Blue Cross and Blue Shield of Iowa (IASD)- Eligibility
• Western Health Advantage- Claims

See the full list >>

Don't miss out! View our complete payer list online to make sure you're taking advantage of Emdeon's connectivity.

Stay Connected with your Patients through Informative Statement Inserts

Take full advantage of your patient communications

Looking for an economical and easy way to improve the connection with your patients? Our patient statement inserts are a personal, effective and economical method to keep in touch. In most cases, no additional postage is required because the inserts are included with documents that are already going to the patients. Simply contact Emdeon with the details you want to communicate, and we can create a custom insert just for you. Or, you may choose from any of our existing stock inserts, and we’ll customize it with your logo.

What are some of the ways inserts can help you connect?

• Announcement of New Physician
• Announcement of New Office or Location
• Change of Address Notice
• Changes in the Billing Cycle
• Promotion of Online Patient Billing and Payment Feature
• Promotion of a New Product or Service
• Instructions on Reading a Redesigned Patient Statement
• Promotion of National Health Awareness Observances
• Education on Important Health Topics

Any message you need to communicate to your patients can be executed effectively and economically with a timely statement insert. To learn more about Emdeon Patient Communications or to add an insert to your next round of statements, call 800.537.7563 ext. 73151 or visit us online.



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Visit Emdeon at a tradeshow near you

Emdeon attends many tradeshows throughout the year where you can learn more about our full suite of Revenue Cycle Management Solutions and new products and features on the horizon. Come visit us at the following tradeshows:

March
• AMGA: March 2-4 in Las Vegas, NV
• SEHAM: March 4-6 in Tunica, MS
• VA AAHAM: March 6 in Charlottesville, VA
• HFMA Executive Summit: March 8-10 in Phoenix, AZ
• MN MGMA: March 9-11 in St. Paul, MN
• St. Louis MGMA: March 11 in St. Louis, MO
• NC HFMA: March 11-13 in Durham, NC
• Southern IL HFMA March Extravaganza Vendor Fair: March 19 in Fairview Heights, IL
• NJ MGMA: March 19-20 in Atlantic City, NJ
• KY HFMA: March 19-20 in Lexington, KY
• AZ HFMA: March 27 in Phoenix, AZ
• TX HFMA State Conference: March 29-31 in Austin, TX

April
• AROC (Atlantic Regional Osteopathic Conference): April 1-4 in Atlantic City, NJ
• HIMSS: April 4-8 in Chicago, IL
• FL MGMA: April 8-10 in Orlando, FL
• MedAssets: April 13 in Las Vegas, NV
• TORCH (TX Conference of Rural and Community Hospitals): April 15-17 in Addison, TX
• MT HFMA: April 15-17 in Bozeman, MT
• HFMA Leadership Training Conference: April 19-21 in Ft. Lauderdale, FL
• HI HFMA: April 22-23 in Honolulu, HI
• CO HFMA: April 22-24 in Colorado Springs, CO
• FMS MGMA: April 26-28 in Boston, MA
• IN HFMA: April 28-29 in Indianapolis, IN
• MS HFMA: April 28-30 in Biloxi, MS

For more information and to view our full list of upcoming scheduled tradeshows, please visit us online.

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