HIPAA Simplified Update for Channel Partners

Anatomy of a patient-friendly bill

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 solidifies Emdeon’s commitment to ensure compliance with HIPAA 5010.

Emdeon’s commitment is to guide our channel partners 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 we have enhanced our 5010 systems and products to support the modified HIPAA transactions. The Errata versions of the gap analysis documents are available at the HIPAA simplified website under downloads.

Testing with Emdeon:
Emdeon began testing for the original 5010 Final Rule version in the 3rd quarter of 2010, ahead of the January 1, 2010 HHS guidance date. During the June 2010 X12 meeting several Errata revisions were approved and these Errata versions were adopted by HHS as the 5010 standard in October 2010. However, as HHS did not move out the January 1, 2012 5010 compliance date, this late release of the Errata versions further constricts the already narrow testing and conversion window. As you can see in the list below, Emdeon has initiated submitter and payer beta testing on the Errata versions, in advance of the CMS April 1, 2011 date to begin Medicare Errata testing.
ERRATA Beta Testing in process:

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

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

Emdeon Pharmacy Update
An NCPDP D.0 gap analysis is also available at the HIPAA simplified website under downloads. To help our clients with HIPAA readiness, Emdeon is continuously updating gap analysis documentation. Like all our other documentation, this gap analysis is available to download for free. Visitors only need to provide their email addresses and they will be able to download documents from our vast library. Emdeon is also currently testing in NCPDP D.O.

Take advantage of Emdeon’s HIPAA simplified website that not only communicates important 5010 updates but also keeps you aware of any industry news that will impact you and your providers. To date, the HIPAA simplified website has received 30,000 visits and over 20,000 downloads of resource materials.

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Increasing Your 'App'titude

Anatomy of a patient-friendly bill
Trends & tips for going mobile in healthcare

We’re rapidly becoming a nation powered by mobile devices. Nearly 80% of Americans have mobile phones1, and more than a quarter of those users have opted for smartphone devices over traditional cell phones.2 Predictions are that more than half of all mobile phone users will go “smart” over “cell” by November of this year. 3

Healthcare providers are adopting mobile technology even faster. Almost three-quarters of physicians already use smartphones, and that number is poised to exceed 80% by 2012.4

8 out of 10 physicians will have smart phones by 2012.

Smartphones—essentially cell phones with computer-like operating systems—enable users to be online nearly all the time. That means that the importance of the voice function is minimized as data and content features take center stage. For physicians, the unlimited access to Internet is a strong driver for their interest in mobile market. Within 3 years, U.S. physicians will likely make no distinction between accessing the Web via smartphone or personal computer, according to findings by Manhattan Research, LLC.4

What does this mean for the healthcare industry, and what do we do with this knowledge?

The short answer to those questions is “go mobile.”

For any business centered on customer service, it’s impossible to ignore the power of mobile technology. For healthcare—motivated by patient-centric service and communications, this is particularly true. Here are some practical ways that you and your organization can “Go Mobile.”

• Use mobile devices:
If you’ve not yet done so, incorporate the use of smartphones and/or tablet devices into your daily life. The best way to understand how to make the most of the computing capabilities of these ultra-portable devices is to make use of them on a regular basis. Consider unifying the kind of products used throughout your organization to ensure seamless communications and simplify updates and maintenance of operating systems and equipment. If you are conflicted about choosing between iPhone®, Android™ or BlackBerry®, bear in mind the market penetration of each option. iPhone is highly established with loyal followings. Android devices have quickly gained market share, exceeding Blackberry and iPhone usage as of January of this year.5

• Create a mobile-friendly web presence:
Because more and more people are accessing the Internet through mobile devices, it’s essential that websites be formatted for the most optimal viewing on these smaller screens. If you are updating or creating a primary website, be sure to incorporate viewing standards that are conducive to mobile viewing. Through “mobile detect,” websites can discern if they’re being accessed via mobile or standard browsers and display the proper versions accordingly. Mobile friendly sites are built with awareness of the constraints of mobile viewing, in order to better accommodate those unique needs.

• Increase your “app-titude”:
Mobile applications provide direct, quick-access to select information and functionality. It seems no matter what we want to know or what we need to do, there truly is “an app for that.” The most effective and widely used applications are very audience-focused—developed to answer the interests and needs of those who will access the app. In healthcare, apps can offer a multitude of interactions and information options, especially as the industry enters the era of the Electronic Health Record. As health information goes digital, it’s a natural evolution to incorporate mobile apps as tools to connect patients and providers alike to key data. Healthcare-related apps keep lines of communication and information open 24/7, 365 days a year and are increasingly popular. At present, of the approximately 6,000 mobile apps available for download in the iTunes® App Store, 73% are targeted to consumers, with 27% designated for healthcare professionals for example iPrescribe, iCD9 and iPharmacy.6

• “Go with” mobile technology:
An interesting and often liberating aspect of our increasingly mobile society is the ability to be closely in touch without being geographically near. From texting and “Facetime” on the iPhone to Skype™ and distance video conferencing, we no longer have to be in the same place to stay on the same page. Mobile devices bring us together even when we’re apart, and this fluidity of communications has taken hold at the root systems of our work and personal lives. For younger demographics, these communications options are fundamental to life experience, while for others, they are still perceived as new innovations. Nonetheless, our modes of sharing information are forever altered across the board thanks to mobile technology.

With awareness of the shift to mobile communications, Emdeon has responded to the challenge with practical solutions. Here are a few examples:

When accessing www.emdeon.com on a mobile smart phone, you’ll find the site automatically loads for optimized mobile viewing. The interface of the website is formatted specifically for smartphone screens, with simplified navigation and easily viewable content.

Emdeon VisionSM Mobile is a mobile website that functions as an extension of the Emdeon Vision web-based application designed to give healthcare providers quick access to the claim management side of their practices. Through this website, providers can securely and conveniently view key metrics of their practices.

We’ve integrated these mobile solutions as part of our corporate commitment to customer connectivity. The motivation to “go mobile” stems from the priority placed on meeting customers where they are...be that in the field, online or on the go—with smartphones in hand.

1- http://www.emarketer.com/Article.aspx?R=1007927
2- http://www.pcmag.com/article2/0,2817,2371907,00.asp
3- http://blog.nielsen.com/nielsenwire/consumer/smartphones-to-overtake-feature-phones-in-u-s-by-2011/
4- http://mobihealthnews.com/7505/72-percent-of-us-physicians-use-smartphones/
5- http://mashable.com/2011/03/08/android-smartphone-platform-report/
6- http://www.closerlook.com/thinking/physician-patient-mobile-marketing/

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What's Good for Them is Good for You: Discover How Your Organization Stands to Gain from Patient Friendly Billing Practices

Anatomy of a patient-friendly bill
Call it good business, or simply good karma. Healthcare organizations that commit to putting their providers and patients first in financial communications can improve patient satisfaction and providers’ bottom line along with theirs. Here’s a look at why these investments lead to better financial outcomes.

Investment: Patient-friendly statements
Outcome: Fewer customer service calls

Historically, financial communications in this industry have been provider and payer centric, meaning the language and structure of statements and documentation were geared toward trade audiences. Little consideration was given to patients who might need to review and interpret payment-related materials in order to take action.

Today, more patients are directly responsible for at least a portion of the payments required for their care. By improving billing statements so patients can make sense of costs and payment requirements, providers eliminate barriers to collect. Patients who understand what they owe and what they’re paying for are more likely to pay promptly and in full. Likewise, they’re also less likely to require customer service support, reducing providers’ staff workload and ultimately increasing your revenue.

Investment: Automated, third-party billing distribution solutions
Outcome: Faster collections process, reduced busy work for staff

With the overwhelming volume of outbound billing statements, the traditional ‘print, fold, stuff and stamp’ mailing process can become a burden to staff and a barrier to prompt payment collection. Proactive healthcare organizations that are focused on improving the revenue cycle are no longer in the mailroom business; instead, they partner with vendors that can quickly and accurately disseminate billing statements.

Today’s third-party billing solutions easily alleviate the tasks of statement mailing. These state-of-the-art bill printing and distribution services absorb all the conventional, time-consuming tasks associated with mailings, eliminating the need for internal staff to handle the paper shuffle. These services receive billing data electronically from hospital systems and, using modern automation, print and mail statements expediently. This means patients get statements more quickly, aiding in faster turnaround time for collections.

Investment: Address scrubbing solutions
Outcome: Minimized staff labor & better patient communications

Outdated mailing addresses— and manual processes for handling undeliverable mail— can become real impediments to collecting payments.

Providers investing in patient friendly practices integrate address correction services into the core of their statement mailing processes. By outsourcing these services to a qualified third-party vendor that integrates address cleansing technology, providers automatically collect and correct more bad addresses greatly improving the accuracy of patient address lists. When patients receive billing statements promptly, they are able to pay and more quickly interact with their providers as needed.

Ready to do right by your providers, patients and your bottom line? Look to Emdeon ExpressBill Services as the single source for your providers’ billing needs.

Emdeon ExpressBill Services provides comprehensive solutions to better manage the patient billing process. From the creation of easy-to-read patient statements to the integration of automation throughout the billing process, Emdeon ExpressBill Services streamlines all aspects of patient billing, making it friendlier for patients and easier for you.

Ready to improve cash flow by automating your outbound statement printing and mailing? Call 877.EMDEON.6 (877.363.3666) or visit us online to learn how Emdeon ExpressBill Services can improve cash flow through prompt, easy-to-understand billing.

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ePrescribing Essential for Physicians in 2011

Anatomy of a patient-friendly bill
This year, ePrescribing will present physicians with both opportunity and risk. ePrescribing activity during 2011 will be the basis for 2012 and 2013 ePrescribing Medicare penalties under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). According to CMS, providers who do not begin ePrescribing and document their activity in their claims submissions using the appropriate G-codes prior to June 30, 2011 may be subject to a -1% payment adjustment on all of their Medicare Part B reimbursements for 2012. CMS is also offering electronic prescribing incentives but it is important to realize that if your providers don’t meet the June 30th deadline, the 1% penalty may also apply.

For timing and payment impact information, please refer to the following CMS document:http://www.cms.gov/ERxIncentive/Downloads/2011eRxIncentiveProgramUpdatefor2012PaymentAdjustment.pdf

For procedures around claim coding using the G-code procedures, please refer to:http://www.cms.gov/ERxIncentive/Downloads/Claims-BasedReportingPrinciplesforeRx122209.pdf

In addition, 2011 is the first year that physicians can demonstrate Meaningful Use of a certified electronic health record (EHR) under the American Recovery and Reinvestment Act of 2009 (ARRA). It is also the first year in which eligible professionals who meet Meaningful Use can begin to receive up to $44,000 from Medicare or up to $64,000 from Medicaid over five years. Providers cannot qualify for both Medicare Meaningful Use incentives and electronic prescribing MIPPA incentives.

Emdeon offers a quick to market EHR Lite solution that includes ePrescribing functionality as well as electronic lab orders and reports management. Emdeon Clinician, part of the Emdeon Office Suite, is also a certified EHR Lite that meets Stage 1 Meaningful Use criteria and can help eligible providers qualify for government incentives.* This solution is available to Emdeon channel partners to co-brand or implement into their existing software offering. Visit Emdeon’s Meaningful use topic center to view a short video about Meaningful Use and Emdeon Clinician.

To read more about the importance of ePrescribing visit the EMR and HIPAA website. Other MIPPA and Meaningful Use information can be found on the CMS website.

*This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. Emdeon Inc, 10/22/10, Emdeon Clinician 7.4, 1014201030691,NQF0064/PQRI128, NQF0041/PQRI110, NQF0024, NQF0028, NQF0038, NQF0059/PQRI1,NQF0064/PQRI2, NQF0061/PQRI3.
Emdeon Clinician is not currently certified for Stages 2 and 3 and we do not promise that users will qualify for any particular amount of enhanced payments.

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Emdeon webinar series

Anatomy of a patient-friendly bill
New upcoming Emdeon webinar
"HIPAA 5010: Critical strategies for readiness and lessons learned"

Jim Mechan, Senior Vice President of Corporate Compliance with Emdeon will discuss lessons learned and industry updates for HIPAA 5010. He will also speak to key findings during early testing, HIPAA 5010 readiness and how Emdeon can help our software channel partners gain compliance.

Who should participate?
This webinar is ideal for CFO, CEO, COO, EDI managers, Financial officers, account managers, sales managers and Organizational leaders of Practice Management and EMR vendors who want to learn more HIPAA 5010 compliance and how Emdeon can help.

Emdeon offers informative webinars that will keep you in the loop regarding the latest news, views and issues related to your business. The following recorded webinars are available for you to view via the webinar section of our Resource Library from anywhere on Emdeon.com.

From Practice Management to Meaningful Use August, 2010
HIPAA 5010 for Software Vendors & Channel Partners September, 2010

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New Payer Transactions

New payers. Take a look at the new list
The Emdeon network of payers continues to grow. New transactions added recently:

•ADVANTICA BENEFITS- Claims, Payer ID: 59374
•Alta Bates Medical Group- Claims, Payer ID: A0701
•American Family Medicare Supplemental Administered by Am Rep - Claims, Payer ID: 56071
•AmeriChoice of New Jersey, Inc. (Medicaid NJ) - Claims, Payer ID: 86047
•ATA-FL - Claims, Payer ID: 65064
•BCBS LA - Claims, Payer ID: 23740
•Benefit & Risk Management Services - Claims, Payer ID: 99320
•Benefit Administrative Systems - ERA, Payer ID: 36149
•Blue Cross Blue Shield of Montana - ERA, Payer ID: CBMT1
•Coventry Health Care - ERA, Payer ID: 25133
•Empire Omnipro (BC NY City) - ERA, Payer ID: 12B36
•Employee Benefit Systems - Claims, Payer ID: 42149
•Employers Insurance Group - Claims, Payer ID: J1232
•Florida Health Care Plan - Claims, Payer ID: 59322
•Freedom First - Claims, Payer ID: 31313
•Healthtran - Claims, Payer ID: 31172
•Hometown Health Plan Nevada - ERA, Payer ID: 88023
•InterCare Health Plans Inc. - Claims, Payer ID: 37227
•JMH Medicare Advantage - Claims, Payer ID: 59171
•MAMSI Life and Health Insurance Co. (MLH) - ERA, Payer ID: 52148
•MBA Benefit Administrators, Inc. - Claims, Payer ID: 83028
•MD Medicare Part A (J12 - Highmark) - ERA, Payer ID: 12010
•Medicaid Hawaii Waivers - Claims, Payer ID: 77059
•Medical Services Initiative - Claims, Payer ID: 12057
•Medicare Blue Private - Claims, Payer ID: SX262
•MetroPlus Health Plan - ERA, Payer ID: 13265
•Metropolitan Transit Athority - Claims, Payer ID: J1238
•MidCoast IPA - Claims, Payer ID: 77012
•National Health Insurance Company - ERA, Payer ID: 75275
•Nebraska Medicaid - ERA, Payer ID: 12K19
•New Era Employee Welfare Benefit Plan Trust - ERA, Payer ID: 76031
•NHI BILLING SERVICES, INC - Claims, Payer ID: 14043
•North American Benefits Network ((Cleveland, OH) - Claims, Payer ID: 34159
•Optum Specialty Svcs / Americhoice of NJ - Claims, Payer ID: GP133
•PEHP (Public Employees Health Program) - ERA, Payer ID: CX080
•Pennsylvania Medicaid - ERA, Payer ID: 12008
•Providence PPO - Claims, Payer ID: SX187
•Regence UT BCBS - ERA, Payer ID: CBUT1
•Regence UT BCBS FEP - ERA, Payer ID: CBUTF
•San Louis Obispo Select - Claims, Payer ID: 33072
•Sheffield, Olson, & McQueen, Inc - ERA, Payer ID: 41143
•Southwest Airlines - Claims, Payer ID: J1233
•SRS Hilton Worldwide, Inc - Claims, Payer ID: J1237
•SuperiorSTAR Pregnant Women - Claims, Payer ID: CPPSW
•Surency Life and Health - Claims, Payer ID: CX088
•Surency Life and Health - ERA, Payer ID: CX088
•The Beacon Mutal Ins Co - Claims, Payer ID: J1234
•Tower Life Insurance Co. - ERA, Payer ID: 69493
•United American Liberty National - Claims, Payer ID: 55821
•United Healthcare Ovations Insurance Solutions (AARP) - ERA, Payer ID: 36273
•University Family Care - ERA, Payer ID: 09830
•University Family Care - Healthcare Group - ERA, Payer ID: 07503
•University Family Care - Maricopa Health Plan - ERA, Payer ID: 09908
•UTICA (C1027) - Claims, Payer ID: C1027
•Valley Mental Health - Claims, Payer ID: 94293
•Wellmark BCBS - Medicare COB - Claims, Payer ID: 12B92
•Wellmark BCBS - Medicare COB - Claims, Payer ID: SB645
•Wyoming Blue Cross - ERA, Payer ID: 12B30
•Antares Management Solutions - Eligibility Inquiry and Response, Payer ID: ANTAR
•CeltiCare - Eligibility Inquiry and Response, Payer ID: CELTI
•Cenpatico - Massachusetts - Eligibility Inquiry and Response, Payer ID: CBHMA
•Cenpatico Behavioral Health - Eligibility Inquiry and Response, Payer ID: CBHMA
•Fallon Community Health Plan - Eligibility Inquiry and Response, Payer ID: FALLN
•Fallon Health Plan - Eligibility Inquiry and Response, Payer ID: 272
•Group Health Plan - CMR - Eligibility Inquiry and Response, Payer ID: 184
•Health America Inc./Health Assurance/Advantra - Eligibility Inquiry and Response, Payer ID: 148
•HealthEZ - Eligibility Inquiry and Response, Payer ID: AMTPA
•HealthEase (WellCare of Florida) - Eligibility Inquiry and Response, Payer ID: WCHEA
•HealthEase Kids (WellCare of Florida) - Eligibility Inquiry and Response, Payer ID: WCHEK
•Healthcare USA - Eligibility Inquiry and Response, Payer ID: 186
•Omnicare - A Coventry Health Plan - Eligibility Inquiry and Response, Payer ID: 413
•PersonalCare/Coventry Health of Illinois - Eligibility Inquiry and Response, Payer ID: 179
•Southern Health Services Inc. - Eligibility Inquiry and Response, Payer ID: 156
•Standard Life and Accident Insurance Company - Eligibility Inquiry and Response, Payer ID: SLAIC
•StayWell - Eligibility Inquiry and Response, Payer ID: WCSWA
•StayWell Kids - Eligibility Inquiry and Response, Payer ID: WCSWK
•WellCare Health Plans (WellCare of FL GA NY CT NJ LA OH TX) - Eligibility Inquiry and Response, Payer ID: WCHP
•Wellpath - Eligibility Inquiry and Response, Payer ID: 164
•Blue Cross Blue Shield of Alabama - Eligibility Inquiry and Response, Payer ID: BCALC
•Sterling Life Insurance - EFT, Payer ID: 67829

For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/

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