Emdeon Compass

Are You the 43%?

2011-12-02T14:25:00.003-06:00

There’s much mention of percentages in today’s headlines: “the 1%,” “the 99%” and so on. For those of us in the healthcare industry, let’s hope we’re part of “the 43%.”

According to the U.S. Healthcare Efficiency Index^© (USHEI), business efficiency in healthcare stands at 43% based on the most recently collected data. That means 57% of the industry has not transitioned from a paper-based system to an electronic one leaving nearly $30 billion in annual savings unrealized. If you’re part of the 43%, you’re on the leading edge of technology and smart solutions, managing your organization’s business with simplified, standard-setting efficiency that’s not reliant on costly paper processes.

Since 2009, USHEI has been shining a spotlight on the need for greater efficiencies for the business of healthcare. Established under the purview of Emdeon, USHEI is a national, non-affiliated, industry wide measuring tool guided by a team of respected advisors from relevant disciplines. The Index calculates data on electronic-versus-paper transactions for claims, eligibility, payments and remittance to determine percentage of electronic transactions and potential annual savings. Additionally, environmental impact is assessed. USHEI Phase 1 findings revealed the aforementioned 43% efficiencies and pointed to areas for future improvement.

It was recently announced that ownership of the Index is transferring from Emdeon to the Council for Affordable Quality Healthcare (CAQH), heralding the initial steps of Phase 2 for this increasingly important industry reference. As Emdeon’s Senior VP of Clinical Services, Miriam Paramore stated, the CAQH is a “perfect strategic home for the USHEI” for the long term. CAQH plans to add aggregated outcomes data from other CAQH sponsored initiatives, including the Committee on Operating Rules for Information Exchange (CORE), to offer a more comprehensive analysis of the progress.

What does this all mean to you?

As provider organizations like yours face new transaction standards and operating rules contained in the healthcare reform law, you can turn to USHEI for helpful information, inspiration and affirmation. Track USHEI regularly for:
- insights into simplification solutions that are proven effective based on quantifiable results
- supporting data to guide your staff and patients’ comfort levels and acceptance of the electronic transition
- useful stats regarding industry-wide savings that can be used in context to support your organization-specific data
- compelling information regarding the environmental impact of paper-based transactions and the green benefits of going electronic
- ongoing awareness of key issues in the business of healthcare
- a reliable measuring stick to gauge your organization’s progress
- source material for your own internal communications and external Public Relations as you introduce more sweeping electronic solutions for your organization

Learn more about USHEI online at ushealthcareindex.com. There you’ll find details on Phase 1 findings, the USHEI advisory committee and more. Keep visiting the site in the days ahead to be part of the taking “the 43%” to 100% efficiency.

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HIPAA Simplified Update (Institutional)

2011-12-02T14:15:00.003-06:00

Emdeon continues to guide our customers successfully through the migration to the X12 5010 and NCPDP D.0 versions of the HIPAA transaction standards. We have enhanced our 5010 systems and solutions to support the Errata versions of HIPAA transactions. The Errata versions of the gap analysis documents are available at the HIPAA Simplified website under the ‘Downloads’ section.

We strive to provide you with the most updated and accurate information regarding our readiness for HIPAA 5010. Please see below for answers to the most commonly asked questions regarding HIPAA 5010.

What is Emdeon’s current state and plans for HIPAA 5010 testing?
Emdeon is currently testing and implementing 5010 with submitters and payers while already in production with some payers and submitters. The late release of the Errata changes to the 5010 transaction standards further constricted the already narrow 5010 testing and conversion window. Nevertheless, as you can see in the list below, Emdeon has initiated submitter and payer testing on all 5010 transactions.

Errata testing/production in process:

• 837 Professional claims
• 837 Institutional claims
• 837 Dental claims
• 835 ERAs
• 270/271 Eligibility verification

Emdeon is also testing and implementing the Final Rule version with submitters and payers for the HIPAA X12 transactions that were not included in the Errata revisions:

• 276/277 Claim Status
• 278 Referral/Authorization

What Emdeon solutions are impacted by 5010?
5010 impacts eligibility, claim, claim status and remittance transactions. The associated Emdeon solutions impacted by 5010 include our clearinghouse, as well as:

• Emdeon Assistant
• Emdeon Receivables Analytics (RA)
• Emdeon Claim Master®
• Emdeon Payment Manager
• Emdeon AccuPost

Please select links above to view the HIPAA 5010 factsheets for these products.

Note: HBS and Legacy Claim Master products are NOT being modified to be 5010 compliant. Clients on these products are already being migrated to the latest release of Emdeon Claim Master to meet 5010 requirements. These migrations are targeted to be completed by December 31, 2011*

How will my organization be notified of any product updates if required?
Emdeon has created a global communications plan for our clients. In addition, HIPAA 5010 Product fact sheets are available and being distributed for each product line. Remember to frequently visit Emdeon’s hipaasimplified.com website which has been recently updated and reorganized to contain new valuable content like product fact sheets and product specific testing information.

What is the timeline(s) of events?
The compliance date of HIPAA 5010 conversion is January 1st, 2012*. All Emdeon products and services have been remediated for 5010; we are in testing phase with many submitters and payers while already in production with some submitters and payers.

Is 5010 delayed until March 2012?
No, the compliance date for 5010 standards remains January 1, 2012, however on November 17th , 2011, CMS announced that the Office of E-Health Standards and Services (OESS) would not initiate enforcement action until March 31, 2012. Emdeon strongly encourages its clients to meet the January 1 compliance deadline if possible. Customers should not view this announcement as a 90 day extension of the compliance date and should continue testing earnestly with their trading partners to meet the end of the year deadline. http://www.cms.gov/ICD10/Downloads/CMSStatement5010EnforcementDiscretion111711.pdf

Did Emdeon participate in the CMS National version 5010 Testing Days?
Yes, Emdeon did participate in the CMS National version 5010 testing day on June 14th and also in the subsequent testing week (August 22nd to August 26th). Emdeon sent test files to all Medicare Administrative Contractors (MACs) during both these testing periods.

Where can I obtain additional information about HIPAA 5010?
Emdeon created a valuable web resource available to all industry stakeholders titled HIPAA Simplified, which may be found at hipaasimplified.com. HIPAA Simplified is a one-stop online resource that features gap analysis, business level documentation, webinars, timelines for the transition and testing information for our customers.

Thank you for trusting Emdeon as your source for HIPAA readiness. We work diligently to deliver solutions that enable our customers to seamlessly meet these industry regulatory requirements.

*The compliance date for 5010 standards remains January 1, 2012, however on November 17th, 2011, CMS announced that the Office of E-Health Standards and Services (OESS) would not initiate enforcement action until March 31, 2012. Emdeon strongly encourages its clients to meet the January 1, 2012 compliance deadline if possible.

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What’s the Big Deal About Emdeon Payment Automation?

2011-12-02T14:08:00.004-06:00

Would you consider the capability to get paid faster and more completely while also reducing manual processes and the need for full-time staff to be a big deal? Of course you would. The evolving healthcare landscape demands that providers of all sizes find solutions to not only collect more revenue, but be more efficient in doing so. Any alternative that results in greater reimbursement and staff efficiencies is, simply put, a big deal.

That’s where Emdeon Payment Automation comes in. Providers nationwide are reaping the revenue from automated solutions for processing paper Remittance Advice (RA) and Explanation of Benefits (EOBs) for one streamlined workflow. We’re empowering providers to eliminate burdensome, manual processes related to paper with automation to post commercial insurance payments promptly and accurately.

Rather than just tell you of Emdeon Payment Automation’s powerful impact from our vantage point, we’d prefer to show you its benefits through a recently-released case study featuring a prominent medium-sized organization’s surprisingly simple and quick journey to big time benefits.

Download this compelling case-in-point to discover:

- the shortcomings of a bank’s EOB processing system and lockbox services
- how long it took and how many people were needed to post payments and correct Electronic Remittance Advice (ERA) errors for this provider organization
- the many, measurable ways Emdeon Payment Automation improved the situation
- an executive’s firsthand account of Emdeon’s implementation process and support
- how long it took for the provider organization to break even on its investment in Emdeon’s solution

While this Emdeon Customer Success Story is a relevant read for any organization seeking a practical, simple-to-implement payment automation solution, it’s particularly fitting for providers that are:

- still using an inordinately large dedicated staff to handle manual commercial payer payment processes
- currently tied to a bank for payment process and lockbox support
- struggling with posting errors and subsequent revisiting of items posted
- in need of higher first-pass yield, reduction of denials and all-around better data accuracy
- looking for a simple-to-integrate, automated solution that will enhance efficiencies and bring big deal results

With Emdeon, achieving those big deal results can be a relatively small feat. We cover all the details to get you up and running with automated payment solutions promptly and offer integration to make workflows as seamless as possible.

Click here to download the case study and learn more!

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Customer Support Around the Clock

2011-12-02T14:05:00.002-06:00

Access Emdeon’s web-based, secure support system 24 hours a day, seven days a week! Emdeon ON24/7 enables you to easily submit service requests for most Emdeon Revenue Cycle Management Solutions whenever you need. Helping you stay up-to-date on the current status of any request, ON24/7 sends confirmation emails when requests are received and ongoing progress reports. In addition, you can rest assured that your service requests are being handled by Emdeon’s team of experienced professionals who know your systems.

Enroll Today! Call 800.819.7965 and select Option 1 today to enroll in ON24/7 and start accessing support and communication tools via the Internet 24 hours a day, seven days a week.

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Emdeon Adds New Payer Transactions

2011-12-02T14:01:00.002-06:00

The largest healthcare revenue and payment cycle network continues to grow!

Emdeon connects you and 340,000 other providers to 1,200 payers, the nation’s largest healthcare revenue and payment cycle network. We’re constantly adding new payers and new transactions to this network, giving you even greater reach for real-time eligibility and benefits verification and electronic claims submission. View our complete payer list to make sure you’re taking advantage of Emdeon’s connectivity for all available transactions today. 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’ve recently added the following payer transactions:

• AmeriChoice of New Jersey, Inc. (Medicaid NJ) - Claims
• Bay Area Automotive Group - Claims
• Benefit Management Administrators - Claims
• Bridgestone/Firestone - ERA
• CA Home Health & Hospice - Claims
• Cardiovascular Care Providers - Claims
• CBHNP – HealthChoices - Claims
• Christian Brothers Services - Claims
• Crescent PPO, Inc.- Claims
• Delaware Physicians Care, Inc. - ERA
• Dental Management Administrators - ERA
• Fidelio Dental Insurance Company - Claims
• Florida Hospital Waterman - ERA
• Global Excel Management - Claims
• Good Shepherd Hospice Inc. - Claims
• Harrington Health Non-EPO - Claims
• HealthEdge Administrators - Claims
• InterCare Health Plans Inc. - Claims
• Life Pittsburgh - Claims
• LifePath Hospice Inc. - Claims
• MHNET - ERA
• MMSI - ERA
• Mutual Assurance Administrators - Claims
• New Avenues, Inc. - Claims
• Ohio PPO Connect - Claims
• PacificSource Medicare - Claims
• Partners Benefit Group - Claims
• Sendero Health - Claims

Don’t miss out! View our complete payer list online today. Put in your Emdeon ON24/7 request to map to any new payers or transactions available to take advantage of Emdeon’s connectivity!

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Complimentary Case Study Download: Baptist Health Systems Sees the Pay-off of Online Patient Payment Solutions

2011-12-02T13:37:00.003-06:00

Offering patients the ability to pay online aids in collecting revenue more promptly and fully, with less drain on staff time and resources. When Baptist Health Systems (BHS) in Jackson, Mississippi implemented Emdeon Patient Pay Online in March 2010, the organization was in a revenue optimization mode, making the efficiencies associated with implementing an online payment collection portal incredibly appealing and necessary.

More than a year after launch, Angie Buckley, Director of Business Services, reports that the system has performed as anticipated in aiding collections. In addition to helping BHS reduce costs by automating the collection of patient payments, the most positive result for BHS has been the empowerment and satisfaction of patients.

Download this complimentary Emdeon customer success story and Listen Now at no charge to a recent Emdeon podcast “Online Patient Billing: Provider and Patient Benefits” to hear more online patient payment solutions and tips.

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Emdeon Does it Again: Three Emdeon Revenue Cycle Management Solutions Achieve HFMA Peer Reviewed Designation

2011-08-30T16:01:00.007-05:00

Emdeon recently announced three of its revenue cycle management solutions have earned the Peer Peer Reviewed designation of the Healthcare Financial Management Association (HFMA). The HFMA Peer Reviewed designation places these Emdeon solutions on a short list of prestigious products and services that have been proven effective by industry expert volunteers, product customers and independent HFMA staff.

Emdeon^® Assistant, an automated patient eligibility and benefits verification tool, was awarded the designation for the fourth year in a row. And for the second straight year, both Emdeon Claim Master^®, a web-based claims management solution, and Emdeon Payment Integrity Services, which provides accounts receivable audit and recovery services for healthcare providers, were selected for Peer Reviewed status. All products presented for the certification must meet predetermined standards as established by HFMA in areas such as product effectiveness, quality, overall value and customer support to earn the "Peer Reviewed by HFMA" designation.

"By helping providers better manage the complexities of the revenue and payment cycle, Emdeon's solutions allow our customers to be more efficient from the initial patient encounter through third-party reimbursement and final payment," said George Lazenby, chief executive officer for Emdeon. "We are pleased to receive corroboration from our customers and peers that Emdeon's solutions are effectively addressing healthcare market needs."

Emdeon Assistant simplifies patient registration through real-time automation of patient eligibility and information verification tasks and interfaces with most existing registration systems. Emdeon Assistant accesses a wide range of information from available government and commercial payers including insurance eligibility, referrals, pre-authorizations and claim status. Emdeon Assistant also has the ability to perform address verification, payment prediction, charity screening and discount assessment.

Emdeon Claim Master's innovative and easy-to-use web-based interface allows hospitals, health systems and provider practices to manage their entire billing process across all facilities. Emdeon Claim Master utilizes unique tools to aid decision support, provide dashboard snapshots of claims inventory, manage workflow and prioritize resources. In addition, Emdeon Claim Master provides trending analytics at the patient level while illustrating the claim lifecycle, enabling the user to monitor the end-to-end experience of individual claims in the claims management process.

"Emdeon Claim Master is one of the most important revenue cycle tools we have installed at Martha Jefferson Hospital," said Albert Payne, revenue cycle manager at Martha Jefferson Hospital in Charlottesville, Va. "This claim management solution automates the import of bills from our patient accounting system and sends clean claims to Emdeon without any staff intervention."

Emdeon Payment Integrity Services consists of professional services and technology solutions that enable healthcare providers to transform previously written-off government managed care and commercial payer underpayments into realized revenue. Coupling industry expertise with sophisticated tools to work with providers, Emdeon Payment Integrity Services focuses on key areas of the revenue cycle where providers traditionally lack the in-house resources to address payer underpayments including accuracy of payments and collection issues.

To learn more about Emdeon’s Peer Reviewed by HFMA Revenue Cycle Management Solutions, visit us online or call 877.EMDEON.6 (877.363.3666) today!

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HIPAA 5010/HIPAA Simplified Update for Institutional

2011-08-30T15:43:00.005-05:00

We are pleased to announce that Emdeon has received notification that we have met the requirements of the EHNAC 5010 Readiness Assessment Program. Emdeon received a score of 100%, which further evidences Emdeon’s commitment to ensure compliance with HIPAA 5010.

In addition to this industry recognition, Emdeon continues to guide our customers successfully through the migration to the X12 5010 and NCPDP D.0 versions of the HIPAA transaction standards. We have updated our gap analysis documents to include the recent 5010 Errata changes and enhanced our 5010 systems and solutions to support the Errata versions of HIPAA transactions. The Errata versions of the gap analysis documents are available at the HIPAA Simplified website under the ‘Downloads’ section.

We strive to provide you with the most updated and accurate information regarding our readiness for HIPAA 5010. Please see below for answers to the most commonly asked questions regarding HIPAA 5010.

What is Emdeon’s current state and plans for HIPAA 5010 testing?
Emdeon is currently testing and implementing 5010 with submitters and payers. The late release of the Errata changes to the 5010 transaction standards further constricted the already narrow 5010 testing and conversion window. Nevertheless, as you can see in the list below, Emdeon has initiated submitter and payer testing on all 5010 transactions.

Errata Beta testing in process:

• 837 Institutional claims
• 837 Professional claims
• 835 ERAs
• 270/271 Eligibility verification
• 837 Dental claims
Emdeon is also testing the Final Rule version with submitters and payers for the HIPAA X12 transactions that were not included in the Errata revisions:
• 276/277 Claim Status
• 278 Referral/Authorization

What Emdeon solutions are impacted by 5010?
5010 impacts eligibility, claim, claim status and remittance transactions. The associated Emdeon solutions impacted by 5010 include our clearinghouse, as well as:

• Emdeon Assistant
• Emdeon Receivables Analytics
• Emdeon Claim Master^®
• Emdeon Payment Manager
• Emdeon AccuPost
• Emdeon Office

Note: HBS and Legacy Claim Master products are NOT being modified to be 5010 compliant. Clients on these products are already being migrated to the latest release of Emdeon Claim Master to meet 5010 requirements. These migrations will be complete no later than December 31, 2011.

How will my organization be notified of any updates if required?
Emdeon is actively finalizing a global plan which will provide various communications to our clients throughout the year. In addition, fact sheets are available for each solution at the HIPAA Simplified website.

What is the timeline(s) of events?
Emdeon is committed to be fully compliant prior to the HIPAA 5010 January 1st, 2012 compliance date, however this will vary based on solution, transaction, payer readiness and client readiness. Our goal is to have all Emdeon solutions modified and testing complete by the end of the year in order to be ready for the January 1st compliance date.

Where can I obtain additional information about HIPAA 5010?
Emdeon created a valuable web resource available to all industry stakeholders titled HIPAA Simplified, which may be found at hipaasimplified.com. HIPAA Simplified is a one-stop online resource that features gap analysis, business level documentation, webinars, timelines for the transition and testing information for our customers.

Thank you for trusting Emdeon as your source for HIPAA readiness. We work diligently to deliver solutions that enable our customers to seamlessly meet these industry regulatory requirements.

Read More >>

Staking Your Claim: Podcast Gives Practical Solutions for Overcoming Common Claims Management Challenges

2011-08-30T15:29:00.005-05:00

For all too many hospitals and healthcare institutions, “claims management” is an oxymoron. Claims often elude management efforts amidst the layered, third-party payment structure of the industry. Government and commercial payers have varying rules and standards, while providers use disparate technology to process and transmit claims. Add to those incongruences the fact that healthcare charges are innately complex and detailed, and it’s clear why claims management is so, well, unclear.

In the business world, it’s often said “you can’t manage what you don’t measure.” By making a practical assessment of common challenges in claims management, hospitals can begin to better stake the claims as they come. With our vast payer and provider networks and literally hundreds of thousands of claims transmissions in process at any given time, Emdeon is keenly aware of claims management problems and have culled a representative list of common issues.

Do any of these scenarios sound familiar to you and your hospital staff?

- Lost in Transmission: Claims can easily get lost in transmission, especially when multiple vendors must interact with claims between provider and payer. The longer the journey, the more chance for a claim to get lost.
- A Catch in the Batch: An entire batch of claims may be rejected by a payer due to just a single error on a solitary claim. When this occurs, the payer will likely not provide explanation, leaving the provider to sift through the entire batch in search of the error.
- The Paper Chase: Paper claims continue to be used throughout the healthcare system. These hard copy claims require more manual effort, and, thus, are more susceptible to human error and/or loss within the system. Obviously, lost paper claims are very hard to find and track, offering little hope of recovery to meet timely filing requirements.
- Off-Track Tracking: Though electronic claims are much more easily tracked than paper ones, providers must put the mechanisms in place in order to infuse tracking into the process. This is a provider-driven priority that requires effort to put into action.
- Internal Differences: Health systems that are geographically diverse and large in scope often run on disparate billing procedures and technology, making it incredibly difficult to establish efficient protocols and coordinate claims management systemwide.

With a spotlight on these common challenges, we’re reminded of key tactics for effective claims management. For example, it’s essential to submit the cleanest claims possible, automate processes whenever circumstances (and budget) allow and infuse tracking throughout the system. Of course, advanced technology exists to improve overall claims management and identify internal patterns of problems that can then be addressed and eliminated. However, many providers do not yet have such solutions at their disposal. In those instances, proactive manual claim reviews, scrubbing and tracking (even if more people power is required) will make a far more positive impact than a reactive response after 30 or more AR days have accumulated.

No doubt, these things are definitely easier said than done. They require lots of strategy, organization-wide support and investment in resources. Listen Now at no charge to a recent HFMA podcast on “Strategies for Avoiding the Claims Black Hole to Accelerate and Maximize Payment” to hear more claims management tips and solutions. This podcast takes an in depth, practical look at this all-important topic. Through firsthand accounts of industry pros, this program gives insight into real-life, relatable struggles and offers ideas and solutions to overcome them.

To learn more about Emdeon Claims Management Solutions, visit us online or call 877.EMDEON.6 (877.363.3663) today!

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Getting to Know Emdeon Better, Learning How to Get Paid More, Faster

2011-08-30T15:20:00.006-05:00

Attendees at the Healthcare Financial Management Association (HFMA) Annual National Institute (ANI) held June 26th-29th in Orlando recently got to know Emdeon better and as a result, learned how to accelerate their revenue cycle to get paid more, faster. Attendees walked away with ideas, tools and results that can help their organization increase financial and operational results. A few lucky attendees even walked away with an Apple iPad 2^® by attending our in-booth speaking events!

Are You Ready for HIPAA 5010?
Presented by Debbi Meisner, Vice President of Regulatory Compliance at Emdeon

“Epic” Integration of Eligibility & Benefits Verification
Presented by Lyman Sornberger, Executive Director of Revenue Cycle Management at Cleveland Clinic

A special congratulations to our Apple iPad 2 winners:

• Paul Sassaman, Financial Manager, Geisinger
• Troy Walker, Director Revenue, Health Systems Management
• Tera Carter, Chief Medical Officer, Finance Patient Services, USA
• Larry Appel, Controller, Northwest Community Hospital
• Wendy Sassman, Geisinger
• Kelly Knorr, Financial Manager, Geisinger
• John Doyle, CFO, Mountain States Health Alliance
• Pat Owens, PFS Project Manager, Memorial Medical Center

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Get to Know Emdeon Better at a Tradeshow Near You

2011-08-30T15:05:00.007-05:00

Want to get to know Emdeon a little better? Emdeon exhibits at many tradeshows throughout the year where you can learn more about our full suite of Revenue and Payment Cycle Management Solutions, as well as new products, and features on the horizon. Stop by and visit us at the following upcoming tradeshows:

September
• CO HFMA Annual Fall Conference September 21-23; Glenwood Springs, Co
• Northern & Southern CA HFMA September 25-27; Lincoln, CA
• HIMSS Summit of the SE September 28-29; Nashville, TN

October
• TN HFMA October 12-14; Gatlinburg, TN
• Region 2 HFMA October 5-7; Verona, NY
• WRUG October 13–14; San Francisco, CA
• TAHAM Southeast Regional Conference October 21-22; Gatlinburg, TN
• MGMA October 23-26; Las Vegas, NV
• HFMA MAP Conference October 26-28; Miami, FL

November
• KS Hospital Association November 16-17; Wichita, KS

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HFMA Webinar: "Stop Misdiagnosing Undiscovered Eligibility as Self-Pay: Strategies for Optimizing Patient Access"

2011-08-30T11:46:00.027-05:00

Attend an HFMA Webinar to Learn More

This program will explore resources available to help proactive and forward-thinking hospitals address the reimbursement risk associated with their uninsured patient population. By optimizing processes and leveraging technology and professional services to discover funding sources through federal, state and community benefit programs, providers can become advocates for the uninsured in their communities.

In this session, Sentara will share their experiences and strategies for optimizing eligibility verification and enrollment for qualified patients to improve the providers’ bottom line.

Register now to attend an HFMA Webinar September 14th 3:00 to 4:30 pm EST to hear more about this topic!

Speakers:
Brenda Loper
Director of Patient Registration Services
Sentara Healthcare

Steve Kilguss
Vice President of Product Management
Emdeon

After This Webinar You Will Be Able To:

• Identify the common short-falls and limitations of home-grown eligibility determination programs

• Describe why most patients who are qualified for government and charity care won’t ever apply without your help cutting through the red-tape

• Discuss how to put technology and workflow processes in place to assist indigent patients in qualifying for public assistance programs

• Develop a strategy for managing your uninsured patient base to generate meaningful incremental cash flow

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Emdeon Adds New Payer Transactions

2011-08-30T11:42:00.002-05:00

The largest healthcare revenue and payment cycle network continues to grow!

Emdeon connects you and 340,000 other providers to 1,200 payers, the nation’s largest healthcare revenue and payment cycle network. We’re constantly adding new payers and new transactions to this network, giving you even greater reach for real-time eligibility and benefits verification and electronic claims submission. View our complete payer list to make sure you’re taking advantage of Emdeon’s connectivity for all available transactions today. 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’ve recently added the following payer transactions:

• AIG - Claims
• America First - Claims
• American Medical Security, Inc. – ERA
• AmeriChoice of New Jersey, Inc. (Medicaid) – Claims
• Bay Area Delivery Drivers – Claims
• BMI HEALTH PLANS – ERA
• Bravo Health Inc – Claims
• CA Healthy Families – Claims
• Cedars Sinai Medical Cente – Claims
• ClaimsBridge MidAtlantic – Claims
• ClaimsBridge North – Claims
• ClaimsBridge NW – Claims
• ClaimsBridge South – Claims
• Commerce Benefits Group – Claims
• Dreyer Health – Claims
• Encara – Claims
• Federated – Claims
• Hartford – Claims
• Integral Quality Care – Claims
• InterCare Health Plans Inc. – Claims
• Liberty Mutual – Claims
• Liberty Mutual – ERA
• MedSolutions, Inc – Claims
• Mid America Benefits – Claims
• MMSI – Claims
• North American Benefits Network (Cleveland, OH) - Claims
• Ohio PPO Connect – Claims
• Samaritan Health Plans – Claims
• Secura – Claims
• Summit America Insurance Services, Inc. - Claims
• Travelers - Claims
• Vantage Medical Group - Claims
• VT Medicare Part A (J14 - NHIC) - ERA
• WTC Health Plan - Claims

Don’t miss out! View our complete payer list online today. Put in your Emdeon ON24/7 request to map to any new payers or transactions available to take advantage of Emdeon’s connectivity!

Read More>>

Get to Know Emdeon Better to Get Paid More, Faster

2011-06-15T13:25:00.001-05:00

Find out more at HFMA's 2011 ANI

Did you know that Emdeon offers about 30 solutions that simplify the revenue cycle and save providers like you loads of time and money? Visit booth 821 during HFMA’s 2011 ANI in Orlando June 26th – 29th to get to know Emdeon better and find out how we can help you. Attend our client in-booth presentations below for your chance to win one of eight Apple iPad 2s^®!

Revenue Recovery & Optimization
Presented by Gladys Baxley, MBA, Director of Managed Care at Lakeland Regional Medical Center
Monday, June 27th, 1:00 pm Eastern
The complexities of payer contract management and underpayment revenue recovery have the potential to pose true challenges for providers and their staff. Attend this session to find out how Lakeland Regional Medical Center transformed previously written-off Government Managed Care and Commercial payer underpayments into realized revenue.

Are You Ready for HIPAA 5010?
Presented by Debbi Meisner, Vice President of Regulatory Compliance at Emdeon
Monday, June 27th, 4:30 pm Eastern
Planning for upcoming 5010 requirements can help protect cash flow by reducing the risk of late or denied claims payment. In this session, we will discuss critical strategies and lessons learned to help providers prepare for 5010 regulatory changes.

Eligibility Coverage using Both Technology & Professional Services
Presented by Brenda Loper, Director of Patient Registration Services at Sentara
Tuesday, June 28th, 1:00 pm Eastern
What happens when a provider needs eligibility coverage for both insurance benefit verification and the screening and enrollment of patients into Government, charity and community benefit programs? Attend this session to learn how Sentara not only streamlined eligibility and benefits verification processes, but also how they lowered their incidence of uncompensated care using both technology and professional services.

“Epic” Integration of Eligibility & Benefits Verification
Presented by Lyman Sornberger, Executive Director Revenue Cycle Management at Cleveland Clinic
Tuesday, June 28th, 4:30 pm Eastern
Is it possible to integrate 13 different platforms for eligibility and benefits verification into one solution directly within Epic? Find out how Cleveland Clinic overcame administrative inconsistencies by partnering with Emdeon for direct integration of real-time and batch eligibility and benefits verification within Epic.

For more information, visit us online.

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Get Social with Emdeon

2011-06-15T13:24:00.002-05:00

Discover new ways to simplify your business when you connect with Emdeon online. Follow Emdeon on Facebook and Twitter to learn about innovative new solutions and special offers or to provide feedback on Emdeon products and services you use. Emdeon regularly posts updates and offers valuable resources to keep you on top of industry trends and current information, including healthcare reform, emerging technology, best practices and more. Use your computer or mobile device to receive Emdeon updates on free webinars, new product launches, important news articles and upcoming tradeshows. You can also visit our YouTube channel to watch inspiring customer testimonials and insightful product videos, or join Emdeon on LinkedIn to connect with colleagues. Click the icons below and get social with Emdeon today!

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Tips to Use Pre-Admission Patient Financial Profiles for Increased Payments and Improved Patient Encounters

2011-06-15T13:24:00.001-05:00

While some say success is all about who you know, in the business of healthcare, success is more about how much you know about who you know. When providers have more detailed, accurate information about their patients, they are more likely to collect payment promptly and in full. If they get to know those details before patients arrive for treatment, the likelihood of successful collections can increase exponentially.

This timely topic is the feature of a recent Healthcare Financial Management Association (HFMA) webinar entitled “Creating a Patient Financial Profile Prior to Patient Arrival” and offers insights for hospitals and health systems regarding the power of pre-arrival profiles to aid in bad debt reduction and pre-admission collections. Though the movement toward pre-admission patient financial profiles is taking hold throughout the industry, providers nationwide are in varying stages of adoption. This webinar gives practical and tactical advice to help providers of all types, sizes and degrees of readiness get a game plan in place for acquisition of patient details before encounters occur.

Obtaining profiles before arrival is a common sense approach with far reaching results and mutual benefits for providers and patients alike. Rather than try to gather pertinent financial details in the midst of a patient arrival for care, providers are opting to take care of that task beforehand, ultimately making the process better for everyone involved.

In the pre-arrival scenario, providers have obtained patient information proactively such as an estimate of payment responsibilities, coverage and benefits and payment alternatives. Providers can then use the arrival of their patients to confirm any details in a more relaxed manner. The proactive profile can even compel patients to be better prepared for the financial aspects of their care making for more positive interactions and experiences all around.

Providers are greatly empowered by having all the patient financial details in advance of the point-of-service. With a full patient picture on hand, they are able to avoid potential roadblocks to claims reimbursement, identify those who are eligible for charity care and, in many instances, collect at least a portion of payment upfront and frequently reduce the risk of bad debt post-care. Clearly, getting to know more about patients earlier in the process can quite literally pay off.

How can providers effectively implement pre-arrival financial profiles? What data points should be included in those profiles? What results can providers anticipate from this approach? Our webinar podcast answers all these questions and more. Listen now to hear James DeFrancisco, Manager, Admissions/ER Registration at Lakeland HealthCare talk about how they made pre-arrival profiles part of standard admission procedures.

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Revenue Cycle Strategies for Upfront Collection

2011-06-15T13:23:00.001-05:00

The following is an important excerpt from a recent Emdeon sponsored HFMA Executive Roundtable titled Strategies for Upfront Collection.

The key to effective revenue cycle performance is collecting patient payment early in the revenue cycle, when payment responsibility is top of mind to the patient and cost to collect is lowest. Yet calculating and communicating financial obligation up front is often a challenge. With this in mind, revenue cycle leaders discuss ways they structure the financial clearance prior to service, metrics for performance improvement, and key strategies for developing a culture of collection.

How is your organization working to provide financial clearance prior to service?

Leslie Richard: We pre-register scheduled patients, obtain patients’ benefits information, and use a price estimator solution to capture patients’ financial responsibility prior to service. We make attempts to notify the patient of the financial obligation prior to service. If a patient is not able to pay in full, then we ask for 50 percent payment. If a patient is unable to pay that amount, then we try to secure a good faith deposit.

Carol Plato Nicosia: We ask for payment of the patient’s responsibility for elective services prior to admission. For years, we have been using software that helps us put in a CPT code or a description of the service and arrive at a pretty close price estimate. We give an automatic 50 percent discount to any uninsured patient, and if the patient is not able to meet even that 50 percent obligation, then we run a credit check to determine the propensity to pay. We offer long-term payment plans for those with payment difficulty. We also provide charity care to patients who cannot meet their financial obligations.

Katie Davis: We make every attempt to let patients know their financial responsibility based on their coverage before they come in. We currently communicate this financial obligation through phone calls. We are not 100 percent successful in reaching all patients prior to service. However, we give all information pertaining to the financial obligation to front-line registrars at the point-of-service, so they can answer patients’ questions and explain how out-of-pocket amounts were calculated when the patient arrives for care.

What are some of the most common sources of error when determining patients’ out-of-pocket expense?

Davis: Our most common source of errors comes from insurance companies not having updated databases. We look to see if patients are eligible for coverage anywhere from two days to two weeks ahead of service. Insurance companies may list patients as eligible in their databases. But by the time a patient comes in, has the service, and the bill drops, the insurer may have removed the patient from its database because coverage no longer applies.

Philip Hardin: We find the best practice for providers is to check eligibility multiple times, during the preregistration process and during admission for the actual treatment, to minimize the impact of any change in eligibility or any of those accumulators, such as deductibles or co-pays.

Richard: Another common challenge is when a physician orders a test and the radiologist expands it. For example, while providing a scheduled abdominal ultrasound, a radiologist may determine need for a pelvic ultrasound as well. As such, an estimate for the pelvic portion of service wouldn’t have been included. To improve accuracy, we’re asking radiologists when they most commonly will add on an exam. If, for example, a pelvic scan is included 90 percent of the time when providing an abdominal ultrasound, then we will know to work the account differently from the beginning.

Michael Taylor: The most common sources of error when determining patient out-of-pocket expenses are related to the more challenging PPO co-pay estimates. It’s the complexity, with the combined analysis of the estimated cost of service, the contractual language and rates, and then the overlay of the benefits on top of that.

We had a cumbersome process for making PPO estimates. We went into our system, created some queries, and added the ICD-9 procedure codes. We weren’t able to search by narrative. We developed estimates for a few of our top contracts, but it was just in a readable format, so there was a lot of interpretation involved, and somebody had to do the calculation manually. In January 2011, we implemented a tool that does all of these functions. We’re hoping this will produce productivity savings.

What metrics are most useful for improvement?

Richard: We monitor POS collection as a percentage of net patient revenue as well as a price per patient target, and the number of price estimates we complete for scheduled patients. Those are a few of the things we monitor to see if we’re improving the collection target.

Also, we include patient access performance in the monthly report of key financial indicators for the organization. Doing so supports visibility of overall performance and serves as a foundation for conversations with our hospital CFOs about where strategies and opportunities lie.

Lisa Grodevant: If we want to drill down in our performance, we look at payer mix or use benchmarking. We benchmark across our hospitals, facility to facility, outpatient area to outpatient area. We use national benchmarks on a limited basis, such as the percentage of net revenue collected, but we don’t do benchmark comparisons on a monthly basis like we do with productivity standards.

Taylor: We want to trend our up-front cash collection at 15 percent of total private pay cash collection on an annual basis, so our target for the staff each month is somewhere around 15 percent. We’re measuringpr-eregistration credit card phone collection separately, and we’re targeting these areas for the month at 33 percent of our up-front cash collection. For eligibility and verification, our metric for financially secure scheduled service is 100 percent. There’s no movement from the financially secured standpoint. We measure the number of patients we actually got in touch with before they arrived for service, and that’s an 80 percent target. Our pre-admission rate for surgeries is 80 percent, and for ancillary services, such as radiology, it’s 60 percent— because we have a high walk-in volume.

We drill down the measurements to staff level by facility and the type of service performed. Some of our larger facilities (over 100 beds) have a large surgery service, especially outpatient surgery, and we would expect a higher collection percentage from those facilities than for a rural facility that has a small surgery population.

Read this HFMA Educational Report in its entirety to learn about more revenue cycle strategies for addressing upfront collections. Also, discover how Emdeon can help you with this today with our Patient Access Management Solutions! Call us at 877.EMDEON.6 (877.363.3666).

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Turn Third-Party Payers into Major Players with Payment Automation Strategies

2011-06-15T13:22:00.001-05:00

Automated patient payment works great for providers. When patients pay electronically, they experience convenient, real-time access to account information and ease of payment. In tandem, providers benefit from accelerated cash flow, reduced errors and simplified reconciliation. Why shouldn’t payments received from Government and Commercial payers be any different?

At last, the healthcare industry is awakening to the transformative value of automated payments from third-party payers. There’s almost a collective “what took us so long?” sigh as solutions are introduced to accommodate Electronic Remittance Advice (ERA) from payers. After all, Government and Commercial payments account for a large percentage of healthcare reimbursement dollars. When that large volume of payment is distributed by payers electronically, providers, as well as the healthcare industry as a whole, reap the benefits of the automation. According to a November 2009 report by Celent, there could be as much as $11 billion in annual savings realized in the U.S. alone by converting paper checks and Explanation of Benefits (EOBs) to electronic data.

While $11 billion in savings and improved cash flow are compelling, the reality is that much of the industry is still mired in the paper shuffle. Though they want to transition to automated third-party payments, providers linger on the familiar path of paper transactions due to concerns about cost, lack of resources to manage individual enrollments in Electronic Funds Transfer (EFT) with individual payers as well as antiquated or disparate financial management systems. While these are real hurdles, the undeniable advantages of automated payments, and the surprising ease with which they can be implemented into an organization, will ultimately compel the shift.

As a leader in electronic transmittance of financial data, Emdeon has already paved the way for providers to streamline the payment cycle to receive, process and post third-party payments electronically regardless of payer participation in EFT. What is presently considered an innovation will likely become the accepted standard for the industry in the near future.

“Remittance & Payment Management Best Practices,” a recent podcast available via Healthcare Technology Online puts a spotlight on the topic and offers information and tips for providers taking the early steps toward automated payments. In this session, Tom Turi, Senior Vice President of Financial Services at Emdeon, reveals the latest payment management tips for receiving, processing and posting payments electronically.

No matter where your organization stands between the paper-filled past and the automated future, this podcast will aid in making decisions about your present practices and policies to ensure your readiness for payment automation innovations. Listen to the podcast now.

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HFMA Webinar: Strategies for Increasing Patient Adoption of Online Payment

2011-06-15T13:21:00.000-05:00

Attend an HFMA Webinar to Learn More

Hospitals risk paying the hidden costs associated with inefficient manual processes when using traditional outbound patient billing and inbound payment collection methods.

Traditionally speaking, patients were limited to two payment options—either paying in person or mailing their check to the provider. Unfortunately, the “paperwork prison” (the excessive administrative costs and hassle associated with collecting paper-based patient payments such as sorting and opening mail, posting patient payments, creating deposit tickets and making trips to the bank) actually reduces the net amount that providers get to keep.

Proactive providers are now including online payment options to avoid the “paperwork prison” while empowering patients with payment flexibility.

Register now to attend an HFMA Webinar July 7th 3:00 to 4:30 pm Eastern to hear more about this topic! In this session, Baptist Health Systems will share strategies for increasing patient adoption of online payment for patient-owed amounts.

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New Payer Transactions on Board!

2011-06-15T13:20:00.000-05:00

The largest healthcare revenue and payment cycle network continues to grow!

Emdeon connects you and 340,000 other providers to 1,200 payers, the nation’s largest healthcare revenue and payment cycle network. We’re constantly adding new payers and new transactions to this network, giving you even greater reach for real-time eligibility and benefits verification and electronic claims submission. View our complete payer list to make sure you’re taking advantage of Emdeon’s connectivity for all available transactions today. 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’ve recently added the following payer transactions:

• Aetna-IL Medciad- Claims
• AFLAC- Claims
• Alta Bates Medical Group- ERA
• Arizona Medicaid- ERA
• AvMed, Inc- ERA
• Blue Choice Medicaid Managed Care-ERA
• CAP Management- Claims
• Celtic Insurance- Claims
• Claimsbridge West-Claims
• Compsych- Claims
• CTI Administrators, Inc- Claims
• ES Beveridge and Associates- Claims
• HealthSpan Network Repricing- Claims
• ILCBH- Claims
• IlliniCare- Claims
• J12 Medicare Part A Legacy WPS (DC, DE, MD, NJ and PA)- ERA
• Kentucky Health Administrators, Inc- Claims
• MacNeal Health Providers – CHS- ERA
• MedSolutions, Inc- Claims
• MedStar Family Choice- Claims
• Memorial PSN/CMS- Claims
• MHCC/CoreSource- ERA
• Mills Peninsula Health Services- Claims
• Monarch IPA- Claims
• Omnicare Medical Group (OMNI)- Claims
• Premier Eye Care- Claims
• Providence of Oregon Health Plan- Claims
• Quality HealthPlans, Inc- Claims
• Simply Healthcare- Claims
• Sterling Medicare Advantage- Claims
• United Physicians Network- Claims
• University Health Alliance- ERA
• VNS Choice Medicare- ERA
• WellNet Health Plans- Claims
• Wyoming Medicaid- ERA

Don’t miss out! View our complete payer list online today. Put in your Emdeon ON24/7 request to map to any new payers or transactions available to take advantage of Emdeon’s connectivity!

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Make a Statement When Sending Statements

2011-06-15T13:19:00.006-05:00

Maximize Your Messaging with Versatile, Affordable Patient Statement Inserts

When it comes to keeping patients informed, there’s no such thing as “too much communication,” especially regarding billing and payment. That’s why it’s important for providers to use every point of patient contact as an opportunity to meaningfully connect.

Did you know that patient statements can offer frequent and cost effective opportunities to communicate with your patients? Every patient receives them; every patient is compelled to open, read and keep them. With the inclusion of informational inserts, letters or brochures, your patient statement mailings can become more than a basic communication of financial status and expectation. They can become effective communication tools that reach an attentive audience.

Here are just a few of the many ways hospitals can use statement inserts to maximize patient friendly communications.

• Highlight key points about the statement itself. Inserts provide a convenient way to explain updates or changes to patient statements. When a statement format changes, patients often need guidance to understand their new bill. By creating a “Guide to Understanding Your Bill” that includes a picture of the newly designed sample statement with a brief explanation of where to find key pieces of information, you can cut down on the number of phone calls from patients asking "how to read" their new statement.

• Announce new financial services, policies or procedures. Inserts can also be used to convey important news regarding services, policies or procedures relevant to patient billing. Adding new bill payment options for patients to pay over the phone or online? Adding an insert in your patient statements highlighting the relevant phone number and bill payment website can help drive adoption of these new services.

• Share updates or reminders about hospital events, locations or programs. Inserts can announce news regarding the opening of new facilities or clinic locations or the launch of expanded services. In addition, they can also help remind recipients of previously announced news, reinforcing overall patient communications campaigns.

• Offer patients the chance to submit input. Inserts can be used to collect input or information from recipients. You can create a quick survey to get feedback or encourage recipients to submit current contact or insurance information. The completed form can simply be included when payments are mailed back.

Another compelling reason to use inserts? They’re cost effective. Rather than sending separate mailings to announce important news and information, hospitals can power-pack updates into their patient statements. For only the cost of printing, inserts maximize the usefulness of statement mailings exponentially.

Also, statement inserts support the HFMA’s PATIENT FRIENDLY BILLING® initiatives. Patient friendly billing practices advocate making information accessible while reaching patients frequently and directly with pertinent updates.

Make a positive statement about your commitment to patient friendly billing practices. Call 877.EMDEON.6 (877.363.3666) or visit us online to discover how Emdeon Patient Communications can provide companion print and mail services to keep your patients informed.

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The Integrity Test: Emdeon Payment Integrity Services Earns Peer Reviewed Designation from HFMA

2011-03-11T10:30:00.004-06:00

The Results are In, and It’s Good News

Through a rigorous, 11-step screening process, it has been determined that Emdeon Payment Integrity Services has the integrity it takes to hold the Healthcare Financial Management Association (HFMA) Peer Reviewed designation.

This means that a panel of current customers, prospects who have not purchased the service and expert HFMA Peer Review Board members found that Emdeon Payment Integrity Services meets or exceeds performance claims regarding the following stringent criteria:
• Effectiveness
• Quality and usability
• Price
• Value
• Customer and technical support

This unique Emdeon solution now holds a coveted spot on a short and prestigious list of products and services that have earned Peer Reviewed designation.

Emdeon Payment Integrity Services’ dual-pronged approach offers both professional and technology support to customers looking to minimize Government Managed Care and Commercial payer underpayments and write-offs. This offering helps providers overcome common revenue cycle issues such as:
• Payer underpayments including accuracy of payments and collection issues
• Contractual underpayments, authorization issues and medical denials
• Coordination of Benefits (COB) discrepancies, charge bundling and timely filing denials
• Current Procedural Terminology (CPT) coding conflicts to even disparate claim systems

In light of the earned Peer Reviewed designation, Emdeon has market affirmation of the ability to identify what’s missing from your Government Managed Care and Commercial payer revenue bottom line and transform it into realized revenue. That’s industry validation with real integrity.

Ready to review Emdeon Payment Integrity Services for yourself? Discover our full offering online.

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The Latest on CMS System Performance Issues: What You Need to Know

2011-03-10T16:22:00.005-06:00

Emdeon Continues Leadership Role in Addressing Outages with CMS & Testing New Solutions

Since last fall, providers nationwide have dealt with Medicare Part A & B processing issues during eligibility and benefits verification. The toll on time and productivity is significant. From moment one of the dilemma, Emdeon has been on the case, acting as an advocate of the provider community to seek resolution with the Centers for Medicare & Medicaid Services (CMS).

Here’s the latest news on this important issue with a recap of action to date since the last edition of our eNewsletter.

Where We Stand Today
CMS has announced that the revised application will be deployed in April. Until that time, they are focusing efforts and resources on thoroughly developing and testing the revised HETS 270/271 application that will alleviate the Medicare Part A & B processing issues during eligibility and benefits verification. Progress has been made but more time is required for completion.

CMS shared its progress on 5010 via a conference call on March 3, 2011. For assistance with the current HETS 270/271 application or to share comments with CMS, you can reach them directly through their Medicare Customer Assistance Regarding Eligibility (MCARE) Help Desk at 866.324.7315.

Previous Activity
Last fall, Emdeon CEO, George Lazenby, met with CMS in Washington, D.C. to directly address the processing issues affecting the provider community, as well as to offer aid. At that time, the CMS team confirmed they were working to create technology to eliminate these issues, and Lazenby solidified Emdeon’s role in testing any revised application prior to systemwide launch as needed.

Unfortunately, the CMS’s early December release of the revised application did not function properly upon deployment (though initial testing had proven effective) and was quickly replaced by the original application. Since that time, CMS has continued development, working with a cloned version of the system to conduct active testing. Emdeon has been involved in this testing and has seen significant reduction in timed out or lost Medicare Part A & B transactions due to delayed CMS response.

As your advocate to the CMS, we are in regular communication with the development team and are integrally involved in further testing. Because we greatly understand the impact of these issues on your productivity and performance, we factor your priorities and standards into all points of contact and testing occasions accordingly.

Of course, Emdeon will keep you posted regarding this important issue through resolution. Stay tuned for more update emails and information in the Summer edition of the Emdeon Compass.

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HFMA Webinar: "Creating a Patient Financial Profile Prior to Patient Arrival to Increase Up-Front Payments and Reduce Bad Debt"

2011-03-10T16:07:00.003-06:00

Attend an HFMA Webinar to Learn More

As patients bear more responsibility for direct payment of their healthcare costs, there is an increased financial risk that hospital systems may not be fully compensated for services they provide.

Traditional revenue cycle management strategies typically triage this balance sheet issue mid-way through or after the patient encounter. Unfortunately, this approach limits the options available to providers to maximize payment and reimbursement.

In this session, Lakeland Healthcare will explore a new strategy for optimizing the financial health of provider organizations. Using a Patient Financial Profile System, providers can reduce their risk of denied claims, underpayments, bad debt and more easily identify and forecast charity care cases before the patient even receives medical treatment.

Providers will learn how to create a comprehensive Patient Financial Profile System using the following data points:
• Address verification
• Commercial insurance and managed care eligibility and benefits verification
• Patient financial responsibility estimation
• Credit Score
• Healthcare Risk Score
• Income
• Hospital Payment history
• Federal Poverty Guidelines

After this webinar you will:
• Understand how to create a Patient Financial Profile System for your organization
• Learn how to maximize revenue from claim reimbursements and patient payments

Using the Patient Financial Profile System, you will discover how to optimize your pre-admission workflow by creating three categories: Patient Payment, Charity Predicted and Medicaid Eligible.

Register now to attend an HFMA Webinar March 16th 3:00 to 4:30 pm EST to hear more about this topic! Lakeland HealthCare will share best practices and recommendations for using the Patient Financial Profile System.

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Revenue Cycle Strategies to Address Explosive Medicaid Eligibles Anticipated with the Affordable Care Act

2011-03-10T14:34:00.002-06:00

The following is an important excerpt from a recent Emdeon sponsored HFMA Educational Report titled Preparing for shifts in Medicaid Coverage.

The Affordable Care Act has made it possible for roughly half of the country’s uninsured patients to become eligible for healthcare coverage under state Medicaid programs. That could mean as many as 23 million people will be added to Medicaid rolls.

The explosive growth in the Medicaid population may have a positive benefit on hospitals as they stand to receive at least some payment for services instead of absorbing the costs of bad debt and charity care for the indigent.
There is the danger, however, that the rising numbers of Medicaid patients will threaten margins.

Although subsidies from the federal government will ease the transition to Medicaid coverage in the first few years of reform, at some point states will have to assume full financial responsibility for Medicaid beneficiaries, and it is not clear how state governments will be able to do so. State budgets most likely will not increase, so while treating the increasing numbers of Medicaid patients will raise costs for hospitals, the costs may not be balanced by increases in payment. Hospitals therefore may have to make do with lower per-procedure or per-patient Medicaid payments.

Most of the money to reimburse hospitals for treating Medicaid patients may end up coming from other sources of payment that are already slated for hospitals. As a result, safety net and teaching hospitals may face reductions in disproportionate share and graduate medical education funding.

The growth of the Medicaid population also may negatively affect the revenue cycle. Medicaid programs characteristically are slow to pay, and in most states they follow a complicated, manual, and elongated application procedure that can interrupt the revenue stream.

As hospitals take steps to ensure that they identify and qualify as many patients as possible for Medicaid coverage or financial assistance, they are also streamlining administrative, revenue cycle, and operational processes to mitigate the adverse effects that the influx of Medicaid patients may exert on margin and cash flow.

In particular, many providers are identifying and readying for potential effects on eligibility screening processes, financial assistance counseling and enrollment, and near-term financial strategy.

Eligibility Screening
When it comes to reviewing registration processes most likely to be affected by shifts in coverage, hospital leaders are focusing on enhancing ways to identify third-party payer sources, paying particular attention to the emergency department (ED) and opportunities to incorporate workflow tools.

Natural Order
Communication is visual, and the layout and design of a statement does matter when conveying patient-specific information. Work with your patient billing vendor to adjust the placement of key data and text on the page. Reordering content will aid in drawing the eyes of recipients to key information first.

Accelerating third-party payer identification
Halifax Health, the largest healthcare provider in east central Florida, is preparing for the expansion in Medicaid by strengthening its registration methods, particularly screening for third-party payment eligibility.

A member of Florida’s Safety Net Hospital Alliance, Halifax Health is one of about 20hospitals that care for nearly 60 percent of the state’s Medicaid enrollees. The system has a tertiary and community hospital with 944 beds and more than 500 physicians on its medical staff. It also provides psychiatric services and has four designated cancer treatment centers as well as centers of excellence in cardiology, orthopedics, and the neurosciences.

“We already have a very active program for identifying any patients who would have any type of third-party coverage, whether through a local charity or victim’s compensation fund, Social Security, disability, or Medicaid,” says Arvin Lewis, chief revenue officer for Halifax Health. Now, the health system is focused on building this program, which in 2008 shifted $34 million in charges from self-pay to Medicaid and in 2009 raised that number to $46 million.

“Many patients, even those who qualify for Medicaid, do not sign up for all of the third-party payment programs that are available to them,” says Lewis. “So we are continuing to try to assist in identifying these opportunities. It’s good for patients, it’s good for the hospital, and it’s good for the community. After all, whatever programs we can identify that people are qualified to receive will ultimately improve payment. And payment is necessary for the hospital to continue to support its mission of care.”

Halifax Health is combining internal and external resources to strengthen third-party payment eligibility screening. Its revenue cycle team works side by side with clinical staff, social services professionals, and government program specialists to uncover new and existing eligibility, complete and submit applications, and track cases from inception to resolution. “We have to balance the ledger, so we plan to aggressively enroll patients in third-party payer programs as well as Medicaid,” Lewis says.

Halifax Health also is accelerating eligibility decisions. The health system partnered with an outside vendor about three years ago to speed its processes. “By the end of the first inpatient day, we want to have a clear view of the patient from a financial standpoint: Does the patient have coverage? If not, what are the programs the patient may qualify for, and how can we assist in securing qualification? The patient may not be able to participate in this process on day one, but we are doing the background, working with the family, and getting forms completed to be able to move forward,” he says.

Read this HFMA Educational Report in its entirety to learn about more revenue cycle strategies for addressing the explosive Medicaid population anticipated with the Affordable Care Act. Also, discover how Emdeon can help you with this today with our Patient Access Management Solutions! Call us at 877.EMDEON.6 (877.363.3666).

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