Sticker Shock Absorber

Patient Responsibility Estimation Takes the "Gasp" Out of Healthcare Pricing

The era of consumer-driven healthcare is in forward motion. Today, patients may be as inclined to ask their physicians “what’s this going to cost me?” as they are “what’s my prognosis?”

No question about it, recipients of care are increasingly being handed or are taking the reins and responsibility for portions of payment. Patients need to know potential costs and payment options to make informed decisions—as purchasers of healthcare services. In the simplest iteration, trips to the doctor need to work more like trips to the store; costs should be stated and payment alternatives clearly expressed to ensure those who receive care can most adeptly pay those who have rendered it.

There must be an answer to the question “what’s this going to cost me?,” and that answer begins with patient responsibility estimation.

Patient responsibility estimation is the responsive “supply” to the market’s “demand” for information. In this newly consumer-driven model, technologies and services are being developed to accommodate the shifting paradigm. Innovative tools and communication methods are equipping providers to be able to inform patients of anticipated expenditures and guide the payment process.

“A knowledgeable patient is an empowered consumer,” states Ed Caldwell, Senior Vice President of Provider Services and Sales for Emdeon. Emdeon, a leader in revenue cycle management solutions, has created an interactive, web-based estimator tool for use in provider settings. “In any purchasing decision, consumers deserve to know the scope of treatment and costs in order to make intelligent choices. Healthcare is an industry that has not traditionally delivered this level of transparency to its consumer until after the service has been rendered.”

Patient responsibility estimation is an essential solution for a population that’s grown up with—and an industry that evolved from—third-party payment systems involving high indemnity, managed care and co-payment scenarios. In the past, patients had little need to know cost details and participated only minimally in the adjudication process. With such distance between the consumer and payment (coupled with the innately complex, unpredictable nature of healthcare), patients have long deemed medical care to be exorbitant and exclusionary—so complicated and costly that the idea of being more deeply entrenched in the payment process is daunting if not totally overwhelming.

Patient responsibility estimation is helping to lower the veil, bringing patient-consumers in direct contact with the facts about their healthcare costs. In pre-encounter estimations, providers must thoroughly approximate procedures and calculate associated costs transparently. The summation of anticipated activity and expenses is output in retail-style estimates and bills that can be easily explained by providers’ frontline employees and understood by patients. Up-front pricing, even in speculative form, along with pre-determined payment options, are the keys to revolutionizing the evolution to a consumer-based healthcare system.

Of course, the healthcare industry’s reputation as costly and complicated is based on truisms. Any point of care—be the encounter small or involved—is no “trip to the store.” Each contact with a healthcare provider encompasses many layers of costs and adjudication. Thus, the ability to create fully accurate or unalterable estimates is rarely possible. Even still, estimating is immensely effective in giving ballpark costs, educating patients on the aspects of care and initiating discussion about payment alternatives. Though specifics may change throughout the encounter or episodes of care, patient-consumers are better informed and prepared for their financial responsibilities.

The benefits of patient responsibility estimation are far greater than just the enhancement of the retail-oriented process. When patients are knowledgeable about the costs and are prepared for payment, they make better choices and are more proactive about their own health. Uninformed patients may avoid seeking care, even if there’s notable need, simply out of fear of being unable to pay, and such avoidance could exacerbate medical problems and ultimately increase costs down the road.

Furthermore, informed patients are more likely to pay in total and to do so promptly. That’s good for the entire system, as providers must receive compensation in order to continue their services. To that end, providers are now coupling pre-encounter estimations with opportunities to pre-pay as well. This approach is proving very effective, as patients are often able to cover out-of-pocket costs up-front.

“Thorough estimates are the foundation of patient-friendly billing,” Caldwell summarizes. “For too many people, one of the most painful aspects of their care has nothing to do with their physical condition; it is the shock of unexpected costs that hurts the most. By setting the proper expectation prior to treatment, consumer estimates alleviate patients’ concerns around costs and make the entire system healthier and more efficient.”

Clearly, when patient-consumers have answers to the question of “what’s this going to cost me,” the prognosis for the entire health system is improved.

To find out more about patient responsibility estimation or see how Emdeon is simplifying the business of healthcare contact us today at 877.EMDEON.6 (877.363.3666) or visit us online.



In our Estimation: Tools for Patient Financial Responsibility Estimation

Electronic calculators: web-based estimating systems that compute anticipated patient out-of-pocket costs; often created to work in real-time; calculates totals in context of patients' health plan verifications and third-party coverage

Patient-friendly billing statements: retail-like invoices and follow-up documentation, created for ease of reading by patient-consumers

Frontline training/patient relations: advanced training to give frontline personnel skills and tactics to communicate financial responsibility and payment options at the point of access into the system; more consumer-focused methodology and counseling techniques

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Congress Returns to Resume Critical Healthcare Reform Debate

September marks the return of Congress to Washington and the continuation of a historical debate on healthcare reform. As healthcare annual spending tops $2.4 trillion, the stakes are high as Congress faces conflicting pressures to expand coverage and curtail spiraling costs. Controlling these costs is a top priority for President Obama and Congress and will be a key driver of economic stability and growth.

What began as a civilized debate turned into a full-scale political showdown during the August recess– playing out in raucous town hall meetings across the country. A majority of Americans want healthcare reform, but their views vary widely on the approach and funding of reform. Five different Congressional Committees are debating the issue, and three comprehensive bills have been released, including the long-anticipated Senate Finance bill. The question remains– can consensus be reached in a Congress that remains sharply divided on the details of reform?


President Obama Takes a Stand

Action on reform started early as Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee released a high level framework for reform just after Congress reconvened. That news was quickly overshadowed by President Obama’s speech to the joint session on September 9th. The speech was meant to reset the debate and clear up any confusion resulting from political posturing during the town hall meetings and debates during the recess.

The President delivered an emotional and eloquent speech that invoked the memory of Senator Ted Kennedy and attempted to refocus the debate on the merits of his vision for health care reform.

Key components of the President’s plan include:
•Ending pre-existing condition limits
•Limiting premium differences based on gender and age
•Eliminating loss of coverage due to health status
•Capping out-of pocket expenses
•Protecting Medicare
•Eliminating the "donut-hole" gap in Medicare Part D coverage for prescription drugs
•Creating a new health insurance exchange
•Providing new tax credits to help people buy insurance
•Providing small businesses with tax credits and affordable options for covering employees
•Offering a public health insurance option to assist the uninsured and those who cannot find affordable coverage
•Immediately offering new, low-cost coverage through a national "high risk" pool to protect people with pre-existing conditions until the new Exchange is in place

In an effort to reach across the aisle, President Obama did address the need for malpractice reform to help bend the cost curve. He also gave a “read my lips” pledge to make the reform deficit neutral. While a remarkable speech, the most concrete framework for reform emerged from the Senate Finance Committee as it began its long-awaited mark-up this month.

The Three Key Bills

Senate Finance Chairman Baucus released the Chairman’s Mark of the Committee’s bill on September 16th. Senate Majority Leader Harry Reid (D-NV) set a goal to get a bill to the floor for a full Senate vote by the end of September, but the Committee must still finalize the actual language that will appear in the bill. Expect intense philosophical and political debate addressing several of the more contentious provisions in the bill.Here is an overview of the proposed Senate Finance Bill:
•Cost projected to be $856 billion over 10 years
•Creates health care affordability tax credits to help low and middle income families purchase insurance in the private market
•Provides tax credits for small businesses to help them offer insurance to their employees
•Allows people who like the coverage they have today the choice to keep it
•Reforms the insurance market to end limits on pre‐existing conditions and health status
•Eliminates yearly and lifetime limits on coverage
•Creates web‐based insurance exchanges that would standardize health plan
premiums and coverage information to make purchasing insurance easier
•Gives consumers the choice of non‐profit, consumer owned and oriented plans(CO-OP)
•Standardizes Medicaid coverage for everyone under 133 percent of the federal poverty level
•Requires adoption of standardized electronic administrative transactions to drive efficiency, reduce errors and lower costs

While the Senate Finance Committee bill is considered most likely to advance, two other bills have already been approved in key Committees– the Senate Committee on Health, Education, Labor, & Pensions (HELP) and the House Tri-Committee bill passed by the Committees on Energy and Commerce, Ways and Means, and Education and Labor. Those bills will need to be reconciled with the final version of the Senate Finance bill.

In July, the Senate HELP Committee, chaired by the late Senator Kennedy, became the first Congressional committee to approve meaningful healthcare legislation when it passed the Affordable Health Choices Act. Originally, the Congressional Budget Office (CBO) estimated the bill to cost less than $615 billion over 10 years, but this month the CBO confirmed in a letter to Senator Enzi the bill would increase the deficit by over $1 trillion and would lead to an increase in national health care spending.

Key provisions include:
• State health insurance exchanges
• Government-run, public health insurance option to compete with private insurers to drive costs down
• Individual insurance mandate, with some exceptions for those who cannot afford coverage
• Employers with 25 or fewer employees also exempt from penalties
• Prohibiting insurers from denying coverage based on their health status
• Promoting quality through financial incentives for providers
• Coverage of preventive health services
• Extending coverage for dependent adults until age 26
• No lifetime or annual limits on individual or group health insurance policies

The House Tri-Committee approved its own healthcare reform bill before leaving for the August recess. This bill known as H.R. 3200 was much more hotly debated and was approved in a much closer vote than the HELP Committee’s bill. It seemed unlikely that the bill would pass until several concessions were made to Blue Dog Democrats who had crossed party lines to protest certain provisions in the legislation.

Basic components include:
• Creation of a public insurance option
• Expanding access to health insurance
• Standardized benefits packages
• Provisions to end premium increases or coverage denials for "pre-existing"
conditions
• Eliminating co-pays for preventive care
• "Affordability credits" to make premiums affordable
• Caps on out-of-pocket expenses
• Employer mandate - pay or play
• Guaranteed catastrophic coverage

The Senate Finance Committee was widely viewed as the key to passing meaningful bi-partisan legislation this year. However, after three months of negotiations between the “Gang of Six”– the three Democratic Senators and three Republican Senators who helped craft the legislation– no Republican Senators would publicly support the Chairman’s Mark of the bill. Several key Democrats from both the House and the Senate have publicly stated their disapproval of the legislation in its current form as well. Senator Kennedy’s absence not only leaves Democrats without a statesman that could potentially bridge the partisan divide, but also leaves Senate Democrats one vote short of the sixty needed for a filibuster-proof majority when the debate advances to the floor.

If talks continue to deteriorate between the two parties, Senate Democrats might be willing to pursue the budget reconciliation process which would allow the legislation to pass the Senate with a simple majority instead of 60 votes. Earlier this year, the Senate agreed to a deal that would allow the process if a bill has not passed by October 15th.

Expect the debate to escalate in the days ahead as the Senate Finance legislation advances towards the floor. With Republicans stating the bill goes too far and Democrats criticizing the bill for not going far enough, Congress will need a near herculean effort to bridge the divide and pass meaningful bi-partisan health care reform this year.

Emdeon Supports Sensible Policies, Practical Solutions

Emdeon supports and promotes sensible public polices and practical solutions that make healthcare efficient. Our goal has been to help reframe the healthcare reform debate and focus on actions we can take today to take costs out of the system. Key areas like administrative simplification, program integrity/fraud and abuse, third party liability cost avoidance and public beneficiary management offer billions in potential annual savings.

The U.S. Healthcare Efficiency Index™, launched by Emdeon in 2008, identified $300 billion in savings over 10 years from automating the most basic healthcare administrative transactions. Emdeon has worked to raise awareness of these potential savings that can free up dollars to pay for delivery of care or offset costs of longer term reforms. Currently all three major bills include provisions in these key areas.

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Emdeon Partners with Susan G. Komen for the Cure®

Emdeon Partners with Susan G. Komen for the Cure® for Unprecedented Education & Awareness Campaign

Thanks to Emdeon real-time technology and the real-life information of the Susan G. Komen for the Cure®, healthcare providers across the country will be able to print out practical, useful information for patients during appointments, potentially empowering thousands of people with deeper knowledge about how to detect and respond to risk factors, face challenges and get help.

Emdeon and Susan G. Komen for the Cure are partnering to revolutionize in-office, teachable moments by making breast health literature readily available to patients through their healthcare providers. The printable materials include topics such as “Breast Cancer Risk Factors”, “When You Discover A Lump”, and “Sexuality and Intimacy” in both English and Spanish formats. There is no limit on the number of times the providers may print the disease prevention and wellness materials.

These materials are currently available through the web-based software solution, Emdeon Office™, a solution that enables healthcare providers to conduct everyday administrative transactions, including patient eligibility/benefits verification, claim submission, referrals, authorizations and pre-certifications for care. It is currently in use in professional offices representing nearly 100,000 healthcare professionals across the country.



In addition to exposing thousands of healthcare providers to readily accessible, print-quality downloads, Emdeon is engaging in another campaign to turn America’s mailboxes “pink” this October. During the month, Emdeon’s print and mail facilities will print outgoing consumer healthcare statement envelopes with a hot pink awareness message that reads, “Are you Inspired to Save a Life? Find out how at www.komen.org/inspire.” Since Emdeon sends millions of consumer statements each month, millions of people will be thinking pink this October.

For more information on this partnership, visit www.emdeon.com.




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New Payers on Board

The largest health information network continues to grow

Emdeon connects you and 340,000 other providers to 1,200 payers, the nation’s largest health information network. We’re constantly adding new payers to this network, giving you even greater reach for real-time eligibility and benefits verification and electronic claims submission. View our complete payer list online to make sure you’re taking advantage of Emdeon’s connectivity. 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.

We have recently added the following payers:

•Advantek Benefit Administrators- Claims
•Affordable Benefit Administrators, Inc- Claims
•American Family Medicare Supplemental Administered by Am Rep- Eligibility
•Americhoice of San Diego- Claims
•Arrowhead Administrators- Claims
•Atlantic Medical Insurance- Claims
•Bankers Life & Casualty- Claims
•BritCay- Claims
•Carilion Clinic Medicare Health Plan- Claims
•CeltiCare- Claims
•Cenpatico Massachusetts- Claims
•Conseco Services LLC- Claims
•Consolidated Health Plans- Claims
•Contractors Laborers Teamsters & Engineers- Claims
•Custody Medical Services- Claims
•Delaware Medicare Part A- Claims
•Elmcare, LLC- Claims
•Health Choice Arizona- Eligibility
•Health Choice Generations- Eligibility
•Health Options of Illinois- Claims
•Healthfirst of Austin- Claims
•Healthsmart Accel- Claims
•Hinsdale Physician Healthcare- Claims
•HMA Administrators, LLC- Claims
•Holy Cross Health Partners- Claims
•Hometown Health Providers- Claims
•Ingalls Provider Group- Claims
•Maine Medicare A- Eligibility
•Medicaid Wisconsin HIP- Claims
•Medicaid New York- Claims
•Medical Partners of America- Claims
•Mississippi Medicaid- Claims
•Molina Healthcare- Claims
•MPA-Custom Provider Network- Claims
•Northwest Community Health Partners- Claims
•Oak West Primary Physician Association- Claims
•OMNI/Medicare HP- Claims
•Paragon Benefits, Inc- Claims
•Personal Insurance Administrators, Inc- Claims
•QuikTrip- Claims
•Santa Clara Family Health Plan- Claims
•Sante Health System and Affiliates- Claims
•Senior Care Partners- Claims
•Seven Corners- Claims
•Sheet Metal Workers Local 104 Health Care Plan- Claims
•Silver Cross Managed Care Organization- Claims
•South Dakota Medicaid- Eligibility
•State Auto Insurance Companies- Claims
•Swedish Covenant Hospital- Claims
•Tehtys Health Ventures- Claims
•Trihealth Physician Solutions- Claims
•University of Illinois at Chicago, Div of Specialized Care for Children- Claims
•ValueOptions/MBHP- Claims
•Verdugo Hills Medical Group- Claims
•Wenatchee Valley Medical Center- Claims
•West Covina Medical Group- Claims
•Wisconsin Department of Corrections- Claims
•Young Life- Claims


Don't miss out! View our complete payer list online today to take advantage of Emdeon's connectivity.

See the full list of new payers>>

Get a Lock on Patient Payments

Introducing Emdeon Patient Lockbox, a Solution You Can Bank On

There are a few givens in the healthcare equation. One of those givens is our overall system runs better for everyone when providers receive prompt payment. Another given is that providers are perpetually challenged to handle patient payment processing and posting, ultimately affecting their own cash flow and revenue cycles. As increased consumerism and digital technology converge in the healthcare sector, it’s also a given that the way providers receive, handle and interact with patients and payments evolve. As the industry is slowly incorporating electronic payments, there remains a deluge of paper payments to process. Thus, it’s a challenge for providers to prepare for the digital future while still handling--literally--the paper-filled present.To that end, Emdeon has expanded its Patient Billing & Payment Solutions offering to introduce Emdeon Patient Lockbox, a gap-bridging alternative ready for immediate application in provider practices.

Emdeon Patient Lockbox is a progressive interpretation of a longstanding tool of the banking and finance world. Designed expressly for the healthcare industry with specific functionality for providers seeking payments from patients, used in conjunction with Emdeon ExpressBill Services for statement printing and mailing, Emdeon Patient Lockbox easily integrates with providers’ existing processes and procedures to expedite deposits, posting and management of patient payments.

According to Lyle Beasley, Emdeon‘s Vice President of Patient Billing & Payment, Emdeon Patient Lockbox is a truly unique solution for providers seeking to proactively improve their payment processing. “Emdeon Patient Lockbox was built specifically for healthcare providers marrying the best components of the financial industry lockbox model with the healthcare data processing expertise of Emdeon” Mr. Beasley explains. “The result is an elegant solution that automates the process of accepting inbound patient payments. Emdeon Patient Lockbox automates mail processing and handling, provides state-of-the-art image archival, delivers enhanced workflow and exception management, and enables electronic payment posting. The results are lower labor costs, reduced exceptions, expedited payment, and more timely and accurate posting.”

Emdeon Patient Lockbox funnels paper communications and payments to a strategically located and secured facility, where the information received--be it change of address notifications or patient payments--is immediately processed, channeled and handled on behalf of providers. Deposits are posted directly to providers’ existing banking institutions. The result is the mass of paper and mailed correspondence that circumvents providers’ offices is no longer a burden to already busy staff members. Additionally, Emdeon Patient Lockbox incorporates automated exceptions handling, making any special posts very simple and manageable for providers. This focused system streamlines the process and reduces potential for error all around.

Because providers are in the business of caring for patients--not patient collections, Emdeon Patient Lockbox is an excellent tool for all providers to direct more energy on their priorities while at the same time enhancing the patient collections process. Even as providers benefit from highly efficient deposits and payment processing, patients also receive benefits as they are assured of payment receipt including a more up-to-date view of account status and any correspondence sent receives faster, more accurate attention.

“The financial relationship between providers and patients continues to gain in importance, as patients are increasingly responsible for directly paying for the care they receive,” Mr. Beasley summarizes. “With Emdeon Patient Lockbox, providers can focus on patient care, while Emdeon focuses on simplifying the business of healthcare.”

Emdeon Patient Lockbox is available in conjunction with Emdeon ExpressBill Services immediately as part of the company’s integrated Patient Billing & Payment Solution, Emdeon Patient Connect. To find out more about a healthcare specific lockbox solution contact us today at 877.EMDEON.6 (877.363.3666) or visit us online.

A Proficient Partner to Handle your Posts: Emdeon Patient Lockbox efficiently and effectively captures and processes payments received--for the fastest, most accurate posting.

A Lock on the Needs of the Healthcare Industry: Emdeon Patient Lockbox incorporates core components of institutional banking lockboxes, yet customizes the functionality for targeted needs of healthcare providers including working with existing software and posting to existing bank(s) accounts.

Provider Friendly, Patient Ready: Emdeon Patient Lockbox is easily integrated with Emdeon Patient Connect, making patient billing and payment simpler and less labor-intensive while ensuring patients get the payment acknowledgements they deserve.

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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:

October
• NJ HFMA: October 14-17 in Atlantic City, NJ
• TAHAM Southeast Regional Conference: October 15-17 in Pigeon Forge, TN
• Northeast NAHAM: October 19-20 in Stamford, CT
• TN Hospital Association: October 28-29 in Nashville, TN

November
• HFMA Fall Revenue Cycle Strategies Conference: November 5-7 in Chicago, IL
• APHSA/NASMD: November 9-11 in Arlington, VA
• OK Hospital Association: Oklahoma City, OK
• KS Hospital Association: November 12-13 in Wichita, KS
• HFMA Region 9: November 15-17 in New Orleans, LA

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

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