One of the major discussions this summer has revolved around the Errata for some of the HIPAA 5010 Implementation Guides (TR3s). X12N released the Errata for publication on August 5, and they are now being considered for adoption as a part of a standard by Centers for Medicare and Medicaid Services (CMS). Even though the Errata have not yet been adopted by the Department of Health and Human Services (HHS), many Covered Entities are nonetheless preparing to update their gap analyses accordingly if and when the Errata are adopted.
In simple terms, the Errata are supplemental information that contain modifications to some of the TR3s. Not only must senders adopt the Errata, but so also must receivers if they are to perform a successful exchange of information.
To help our clients with HIPAA readiness, Emdeon is publishing updated gap analyses for the transaction code sets to reflect the Errata once they are adopted by CMS. Like all of our other documentation on HIPAA Simplified, these updated gap analyses will be available to download for free. Visitors only need to type in their email addresses, and they’ll be able to pick from our vast library of documentation.
For visitors who search for new documentation on HIPAA Simplified, we have good news: we’re currently updating our Frequently Asked Questions (FAQ) to incorporate new questions we’ve answered since publishing the first FAQ.
Additionally, our Pharmacy team has been working on new NCPDP D.0 gap analyses. As always, we’ll update our Downloads page to highlight the new or updated documentation for quick access and easy download.
We’re also excited to announce that Emdeon will be launching a new regulatory e-newsletter later this year, which we’ll use not only to communicate updates to HIPAA Simplified, but also to keep our clients up-to-date on industry news that will impact them. We’ll also use the e-newsletter to announce the publication of new documentation. Check HIPAA Simplified over the next few weeks as we share more information about how to stay in the loop concerning the ongoing transition to HIPAA 5010.
HIPAA Simplified Update
Employ the View, Tame the Claims: Rejections Become the Exception with Emdeon Vision for Claim Management
Nobody likes rejection.
That’s especially true for those in the business of providing healthcare. For providers, rejection —in the form of returned claims— means payment for services rendered will be delayed or, worse yet, denied. Every claim that must be corrected and resubmitted costs providers valuable time and money.
Your business strives to help providers get paid in a fast and efficient manner so they can focus on providing best care for their patients. To serve that purpose, thankfully, Emdeon shares your vision.
Emdeon Vision for Claim Management is a robust, online claims management reporting tool—with specially tailored versions for providers, channel partners, payers and Emdeon support. Utilizing today’s leading information and communications technologies, Emdeon Vision organizes and translates digital data about claims into understandable, actionable information. You can readily access details regarding all your customers’ claims, and manage their claims in a quick, efficient manner with Vision’s 20/20 insights and 360° perspectives.
Get the unobstructed view of customer claims.
We understand you need clear, unveiled information to better serve your customers. That’s why we made customizable alert reporting a core offering of Emdeon Vision. We’ve made it simple to set preferred criteria for searches. Query by customer, claims or dollars rejected (amount or percentage) and generate online reports (no need for printing) to identify struggling providers and address their most common rejection issues.
Additionally, you can track provider usage of Emdeon Vision, noting frequency of use and reports generated. Emdeon’s recent market research proves that providers who regularly utilize Emdeon Vision reduce rejected claims, experience measurable gains and are able to resolve many support issues internally. Thus, your knowledge of use will help pinpoint and respond to areas of opportunities within your customer base, instead of fielding productivity-inhibiting support calls.
Emdeon Vision for Vendors features
• claims search options: quantity rejection or dollar amount percentage
• alert reporting: quick view of claims issues requiring action
• utilization reporting: detailed insights into usage by customer
A clear view lets providers become insiders
Providers directly benefit from the transparent view offered by Emdeon Vision. This tool takes providers from the ‘outside looking in’ to the ‘inside looking out,’ giving them timely intelligence and empowering them to substantively improve the claims process. As one provider recently stated, Emdeon Vision is like having “...a snapshot of the health of the practice.”
Emdeon Vision for Providers features
- landing page metrics: top items requiring attention, including rejected or unworked claims and a File Summary Status matrix
- flexible work flow options: multiple search options and filters
- dashboard analytics: easy-to-read views for trend and issue identification
- mobile option: essential information formatted for smartphone viewing
Results from a recent user poll reveal the effectiveness of Emdeon Vision in practical application. The majority of respondents indicated that use of Vision has reduced outstanding accounts receivable. Most noted they no longer require text-based reports thanks to the immediate results of the online reporting tool. Likewise, many providers have reduced or ceased calls for support regarding claim status, as Vision provides direct access to that essential information. Nearly 90% of the respondents indicated that Emdeon Vision exceeds their expectations.
Even with overall satisfaction so high, Emdeon continues to improve Emdeon Vision. Recently Emdeon Vision added the Emdeon payer list to the portal, integration of ERAs, as well as Customer Service alerts from Emdeon ON24/7. In the near future, this innovative tool will be enhanced with fee-based add-on features such as payment management, advanced claiming (auto and work comp), comparative community reporting and in-system refiling capabilities. We’ll offer real-time eligibility and claim status within Vision soon, as well.
Ready to improve the view for your customers and gain insights on their claims? Contact us to get started.
Adding Value to Emdeon ExpressBill Services
The IntelliJet™ Printing System
Emdeon is pleased to announce the arrival of the next generation in printing technology, which will expand and improve the capabilities of Emdeon ExpressBill Services to accelerate patient statement printing and provide more communication opportunities, all with an exceptional level of system reliability and accuracy.
Maximize communication opportunities with custom statement messaging
Save money by communicating with your patients directly through their statements instead of paying extra for separate mailings. With this sophisticated printing technology, Emdeon can print statements that include customized messages at the batch, group or individual statement level.
Greater statement design flexibility
With this new printing system, statement information such as standard legal disclaimers or letterhead design can be quickly updated to accommodate your needs. This added flexibility in statement design also provides cost savings by eliminating the additional fees for destroying unused preprinted paper stock.
Advanced print quality for razor sharp, vibrant patient statements
The Pitney Bowes®IntelliJet™ Printing System prints full-color statements in a high resolution (1200 x 600 dpi resolution) which produces sharp logos and imagery with crystal clear text. Emdeon will also be able to accommodate nearly any request for adding four-color printing to either side of the statement to produce eye-catching patient statements.
Accelerate patient payments with expedited insertion into the mailstream
Emdeon will be able to get statements into the mailstream more quickly. Since the IntelliJet™ Printing System integrates with advanced presorting software and eliminates the need for preprinted forms, statement printing, processing and delivery is accelerated.
Closed loop processing for greater print and mail precision
The IntelliJet™ Printing System offers an unmatched level of system integrity and process control. A closed-loop workflow monitors the entire process from beginning to end, to help ensure statement accuracy. With this advanced printing system, you can also get peace of mind knowing your patient statement printing and mailing can seamlessly continue to function with enhanced reliability using our secure network of redundant back-up servers.
Emdeon Achieves CAQH CORE Phase II Compliance
Emdeon has achieved compliance with the CAQH® Committee on Operating Rules for Information Exchange (CORE) Phase II rules. CAQH, a nonprofit alliance of health plans and trade associations, is a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers. Emdeon achieved CORE Phase I compliance in March 2007.
CORE Phase II sets industry-wide standards that improve electronic administrative information exchange between health plans and providers. Both CORE Phase I and Phase II were designed by CAQH to resolve communication disparities created by original Health Information Portability and Accountability Act (HIPAA) regulations. Persistent ambiguity in language and code sets from payer to payer has perpetuated healthcare IT inefficiencies and made adoption of electronic solutions especially challenging, labor intensive and expensive for providers that must interact with multiple payers.
As a leading provider of electronic healthcare transaction processing, Emdeon has long provided technology solutions to manage the flow of information between healthcare payers and providers and bridged the gaps caused by disparate rules for data exchange. In achieving CORE Phase II compliance, Emdeon furthers its position as an industry leader committed to healthcare efficiency and broadens its capabilities to transact information in accordance with industry standards.
"Our CORE Phase II compliance is not only good news for the thousands of providers and payers we interact with daily, it ultimately benefits patients whose care may be improved as their healthcare providers and payers can more easily exchange essential electronic information," explains Damien Creavin, chief information officer of Emdeon.
Creavin continued, "Emdeon is dedicated to reducing costs involved in the claim lifecycle and simplifying the business of healthcare— with the goal of making the system more efficient and affordable."
CAQH launched CORE to promote interoperability between healthcare payers and providers and to improve provider access to administrative information. The CORE rules are being developed by over 115 participating organizations, representing providers, vendors, health plans, the Center for Medicare and Medicaid Services, state and federal government agencies, associations, standard-setting organizations and other healthcare organizations. More than 20 leading health plans, large provider groups and technology vendors committed to completing Phase II rules certification on or before the end of March 2010. Emdeon is among these organizations.
"The CORE Phase II rules represent a transparent, consensus-based national approach to an expanded set of operating rules for electronic administrative transactions among providers, health plans and vendors," said Robin Thomashauer, CAQH executive director. "By completing CORE Phase II certification, Emdeon is making it easier for everyone to exchange real-time administrative transactions more effectively, thereby improving efficiency and freeing up time for physicians to focus on their patients."
To learn more about Emdeon, call 877.EMDEON.6 or visit us online.
Emdeon webinar series
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
» HIPAA 5010 for Software Vendors & Channel Partners
New Payer Transactions
The Emdeon network of payers continues to grow. New payers 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
• TRIHEALTH PHYSICIAN SOLUTIONS- Claims, Payer ID: 31144
• 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
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
HIPAA Simplified
On January 16, 2009, the U.S. Department of Health and Human Services (HHS) published rules that require updated versions of the standards for electronic transactions under the authority of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These updated standards (Versions 5010 and D.0) are designed to replace the current standards (Versions 4010/4010A1 and 5.1) and are designed to promote greater efficiency in electronic transactions. Compliance with the new HIPAA 5010 and NCPDP D.0 standards is required by January 1, 2012.
This transition poses a number of challenges for covered entities which are defined as businesses that are required to achieve compliance in large part because these changes affect all healthcare segments: hospitals, physicians, dentists, pharmacies, PBMs, payers and vendors.
In December 2009, Emdeon Senior Vice President of Corporate Strategy and Government Services, Miriam Paramore, testified before the National Committee on Vital and Health Statistics (NCVHS). During her testimony, Paramore said, “Emdeon is committed to supporting our customers and leading the industry in compliance and adoption of the new standards and code sets.” She continued, “Our goal is to be ready in advance of the government mandated deadlines to ensure a smooth and successful transition.”
On January 22, 2010, Emdeon launched HIPAA Simplified to be a one-stop resource for the information that covered entities needed for HIPAA readiness. HIPAA Simplified will be a communications focal point as Emdeon helps its customers adopt the 5010 and D.0 standards prior to 2012. The website offers technical gap analyses, simplified business-level downloads, trading partner transition strategy information, frequently asked questions and testing tools.
Additionally, HIPAA Simplified is divided by business units across the entire healthcare industry, eliminating the need for complex web navigation or surfing multiple sites. Visitors simply select their line of business and all available resources are located on the page to browse and download. For free.
What really sets HIPAA Simplified apart from other resources, however, is its analytical tools that are designed to propel the transition strategies of covered entities. Only HIPAA Simplified offers informational and analytical tools, from high-level FAQs, to documents that explain the transition in business-level language, to in-depth technical analyses.
As the nation’s largest health information network, Emdeon is the healthcare industry’s most comprehensive source for HIPAA readiness. Just as with HIPAA 4010 and the National Provider Identifier (NPI), Emdeon is working diligently to deliver solutions that enable its customers to seamlessly meet the new requirements for HIPAA 5010, NCPDP D.0, and ICD-10.
Make sure to spread the word and bookmark www.hipaasimplified.com– it will be updated often as the compliance deadline approaches.
Emdeon recommends secure interim solutions to avert delays in the implementation of ePrescribing of controlled substances
Emdeon Submits Comments to DEA on Interim Final Rule
NASHVILLE, Tenn., May 27 /PRNewswire-FirstCall/ -- Emdeon Inc. (NYSE: EM), a leading provider of healthcare revenue and payment cycle management solutions, today submitted formal comments to the U.S. Drug Enforcement Administration (DEA) in response to the agency's request for comments on the Interim Final Rule enabling electronic prescribing (ePrescribing) of controlled substances. Emdeon's comments reiterate its support for the proposed security standards and recommend the DEA consider interim solutions to permit implementation as soon as possible after the Final Rule becomes effective on June 1, 2010.
As the only ePrescribing network with market-based experience, Emdeon through its eRx Network is already demonstrating the achievability of ePrescribing of controlled substances and its potential impact on healthcare. Emdeon is participating in a multi-year research project with the Massachusetts Department of Public Health (MDPH) for ePrescribing of controlled substances. The project began in 2007 and Emdeon believes the lessons learned can assist in developing implementation guidelines for the Final Rule within existing workflows, standards, certifications and technology changes.
"ePrescribing in general, and specifically ePrescribing of controlled substances, can bring several benefits to physicians, pharmacists, patients and the health system as a whole," said George Lazenby, chief executive officer of Emdeon. "Emdeon wants to do everything we can to support nationwide implementation of ePrescribing of controlled substances as soon as possible."
ePrescribing of controlled substances is expected to help overcome the last major barrier preventing certain physicians from ePrescribing as they will no longer have to maintain both paper and electronic workflows. Emdeon believes another benefit of ePrescribing of controlled substances to pharmacies, hospitals and practitioners will be the added level of security for controlled substance prescriptions that come with the new DEA regulations.
Emdeon's comments, which are both supportive and constructive, focus on the provisions that require a secure transmission of electronic prescriptions, including provisions relating to digital signature indicators and digital signatures; signing and transmitting prescriptions; content alteration and two-factor authentication. Emdeon's comments note that it believes the industry will take a significant amount of time to adopt and implement formal standards that address all parts of the Final Rule and suggests the DEA consider interim guidelines to support adoption variances. Emdeon believes such variances would permit quicker adoption while allowing the industry sufficient time to develop and implement long-term infrastructure to meet the minimum requirements of the Interim Final Rule.
"Security and data integrity are the most important factors driving the future success of ePrescribing of controlled substances," said Rick Sage, Emdeon's vice president of clinical services and the manager of Emdeon's participation in the MDPH research project. "Working in conjunction with our partners in the MDPH project, we successfully implemented a workable solution for electronic data transmission security. While the Interim Final Rule mandates some specific requirements that differ from the MDPH project, there are certainly enough similarities that will enable Emdeon to readily assist our partners in implementing and complying with the Final Rule."
Emdeon estimates only approximately 18% of all prescriptions are currently transmitted electronically. According to the Centers for Medicare and Medicaid Services, adoption of ePrescribing can enable improvements in patient safety, quality of care and cost effectiveness. ePrescribing can reduce the need to retype medication and dosage information, helps to eliminate the need for interpretation of prescriber handwriting and potentially reduces the amount of labor required to approve and fill any given prescription.
Emdeon's secure and interoperable network is the largest financial and administrative healthcare information exchange in the nation. Clinical exchange volumes among Emdeon's suite of solutions are increasing with a current annual run rate of 100 million ePrescriptions and 30 million clinical messages per year. In total, Emdeon currently facilitates over 5 billion healthcare information exchanges each year through its network which reaches approximately 500,000 physicians, 81,000 dentists, 55,000 pharmacies, 5,000 hospitals and 1,200 payers.
About Emdeon
Emdeon is a leading provider of revenue and payment cycle management solutions, connecting payers, providers and patients in the U.S. healthcare system. Emdeon's product and service offerings integrate and automate key business and administrative functions of its payer and provider customers throughout the patient encounter. Through the use of Emdeon's comprehensive suite of products and services, which are designed to easily integrate with existing technology infrastructures, its customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle process. For more information, visit www.emdeon.com.
Statements made in this press release that express Emdeon's or management's intentions, plans, beliefs, expectations or predictions of future events are forward-looking statements, which Emdeon intends to be covered by the safe harbor provisions for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995. These statements often include words such as "may," "will," "should," "believe," "expect," "anticipate," "intend," "plan," "estimate" or similar expressions. Forward-looking statements may include information concerning Emdeon's possible or assumed future results of operations, including descriptions of Emdeon's revenues, profitability and outlook and its overall business strategy. You should not place undue reliance on these statements because they are subject to numerous uncertainties and factors relating to Emdeon's operations and business environment, all of which are difficult to predict and many of which are beyond Emdeon's control. Although Emdeon believes that these forward-looking statements are based on reasonable assumptions, you should be aware that many factors could affect Emdeon's actual financial results or results of operations and could cause actual results to differ materially from those in the forward-looking statements, including the risks discussed in the "Risk Factors" and "Management's Discussion and Analysis of Financial Condition and Results of Operations" sections and elsewhere in Emdeon's Annual Report of Form 10-K for the year ended December 31, 2009, as well as Emdeon's periodic and other reports, filed with the Securities and Exchange Commission.
You should keep in mind that any forward-looking statement made by Emdeon herein, or elsewhere, speaks only as of the date on which made. Emdeon expressly disclaims any intent, obligation or undertaking to update or revise any forward-looking statements made herein to reflect any change in Emdeon's expectations with regard thereto or any change in events, conditions or circumstances on which any such statements are based.
SOURCE Emdeon Inc.
Emdeon acquires FutureVision Technologies to enable full automation of healthcare payments
Acquisition combines Emdeon's broad connectivity network and revenue cycle management solutions with FVTech's innovative suite of payment transformation solutions
Emdeon announced January 26th the acquisition of FutureVision Technologies ("FVTech"), a premier provider of outsourced services specializing in electronic data conversion and information management solutions. By combining FVTech's innovative document conversion technology with Emdeon's broad connectivity network and revenue cycle management solutions, Emdeon will now have the ability to electronically process virtually all patient and third-party healthcare payments regardless of the format in which the payments are submitted.
Commenting on the strategic benefit of the acquisition, George Lazenby, chief executive officer of Emdeon said, "Today, roughly 90% of payments in healthcare are conducted via paper. At Emdeon, we are committed to changing this fact. FVTech's technology, when combined with our industry-leading all-payer network, will position Emdeon to help our customers overcome many of the barriers that prevent automation of these payments. With FVTech's capabilities, Emdeon can now automate 100% of the posting for both paper and electronic payments for our provider customers. These capabilities will allow Emdeon to create immediate savings for our customers through automation and help reduce costly errors that commonly occur through manual processes."
Brad Banyai, chief executive officer for FVTech, stated, "As a result of our acquisition by Emdeon, we can properly leverage our technology and experience with Emdeon's vast connectivity in the marketplace and make real inroads to processing healthcare payment transactions electronically. For more than ten years, FVTech has focused on creating electronic document solutions for the healthcare industry and we are excited about layering our solutions into the Emdeon network."
Emdeon currently distributes payments and remittance data to more than 500,000 healthcare providers. 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 to electronic data. FVTech's documentation conversion technology, when coupled with Emdeon's consumer payment processing services, will provide a comprehensive payment solution for providers. The new capabilities acquired as a result of the FVTech acquisition will also allow Emdeon to automate the posting of payments from its network along with other payer payments to automate this historically labor-intensive process. This 360 degree view of payments will offer healthcare providers the ability to manage 100% of their third party payer and consumer payments from one vendor, as well as automated reconciliation and posting capabilities.
To view the full press release or learn more about how Emdeon is Simplifying the Business of Healthcare, visit our website or call 877.EMDEON.6 (877.363.3666).
Read More >>
National Progress Report on healthcare efficiency: Introduction/ Executive Summary
The National Progress Report on Healthcare Efficiency is the first annual report on the findings from the primary research phase of the U.S. Healthcare Efficiency Index® (USHEI). The USHEI was launched in 2008 to raise awareness of the potential cost savings associated with adoption of basic electronic transactions in healthcare. In its first year, several important milestones were achieved including successful engagement with policy makers on the practical benefits of administrative simplification. The initial findings announced during the launch of the USHEI were based on a thorough analysis of available industry data. Phase 1 of the Index estimated total potential savings to be nearly $30 billion per year for medical claims-related transactions.
Over the course of the year that followed, the Advisory Council for the USHEI oversaw the development of a detailed methodology, a secure data collection infrastructure and a formal data collection process that is now yielding an initial set of data. This report places the findings in the context of the recently enacted healthcare reform legislation, as well as the HITECH Act, passed as part of the American Reinvestment and Recovery Act (ARRA). It assesses the landscape and suggests a set of trends likely to impact the healthcare industry in the months and years to come. Here is a summary of the key findings that will be discussed in this report:
1. The industry is making progress on adoption of electronic claims. The data shows a current rate of 85%, which represents a 10% increase over the Phase 1 findings.
2. Adoption of electronic remittance advice transactions is also higher. Data shows a current rate of 46% as compared to 26% in Phase 1.
3. Calculating the costs and potential savings associated with automation in healthcare has become increasingly complex, particularly as the lines get blurred between electronic and paper-driven offices.
4. Cost savings must be addressed at the system level. Approaching the problem as a systemic issue is critical to help avoid the continual cost shift that has plagued healthcare for so long.
5. Meaningful Use requirements are expected to drive further adoption of claims and eligibility transactions, assuming the requirements remain intact in the final rules. In general, the inclusion of revenue cycle transactions as a part of Meaningful Use illustrates the convergence of clinical and financial information which is an important trend in health information exchange.
6. The recent passage of landmark healthcare reform legislation brings significant gains in the area of administrative simplification by adding covered transactions like e-payment and requiring greater standardization and operating rules. This new policy will play an important role in eliminating many of the old barriers to adoption.
7. Implementation of healthcare reform will be a long and complex process. It will be important for all stakeholders to stay involved and ensure that their needs and concerns are reflected in the rules and regulations to be written in coming years.
8. Change is hard, but for the nation’s healthcare system, not changing will be much harder. With Medicare Trust Fund Reserves expected to be exhausted in less than 10 years (2017) and 41 states facing midyear budget shortfalls, it is critical to capture tangible savings today wherever possible.
Medicare
Based on its most recent report in 2009, Medicare's Hospital Insurance (HI) Trust Fund is expected to pay out more in hospital benefits and other expenditures than it received in taxes and other dedicated revenues. Growing annual deficits are projected to exhaust reserves in 2017.
(From the SUMMARY OF THE 2009 ANNUAL REPORTS, Social Security and Medicare Boards of Trustees)
Medicaid
Mid-way through state fiscal year 2010, the effects of the economic recession (rising unemployment, sharp declines in revenues, higher demands for public programs, including Medicaid) continue to plague states… 41 states are facing
mid-year budget shortfalls for fiscal year 2010 that could total $35 billion. Looking to 2011, states estimate a budget gap of $102 billion but could grow to $180 billion as revenues continue to decline.
(From the Kaiser Commission on Medicaid & the Uninsured, Feb. 2010)
New and exciting enhancements to Emdeon Vision for Providers
Emdeon Vision(SM)for Claim Management is a real-time, web-based application for tracking and monitoring all claims submitted through Emdeon. Emdeon Vision gives you and your providers access to 15 months of historical claim data instantly at your fingertips. We’ve recently updated the provider-facing version of Emdeon Vision to improve workflow for your providers.
New enhancements include:
• Drop-down lists and improved navigation
• “My Practice” landing page presenting a summary snapshot of claims that may require your attention
• ERA linking to the claim, where available by payer (may require additional contracting)
• Emdeon payer list quick link within Emdeon Vision
• View all customer communications from payers and/or Emdeon for the last 30 days
• And more!
View the Release Notes and FAQ for more details!
If your providers haven’t signed up for Emdeon Vision, it’s not too late! Emdeon Vision is available at no extra charge as a standard part of our service! Providers can sign up at www.emdeon.com/signup.
Emdeon webinar series
Emdeon offers informative webinars that will keep you in the loop regarding the latest news, views and issues related to reform legislation and your business.
June
Healthcare Policy Reform have you stumped?
Live event June 16, 2010 at 11:00am Central/ 12:00pm Eastern
Ideal for Practice Management and EMR vendors: Programmers, Compliance Officers, CEO, COO, EDI managers, Organizational leaders
July
Reducing support issues while increasing customer satisfaction
Live event July 29, 2010 at 11:00am Central/ 12:00pm Eastern
Ideal for Practice Management and EMR vendors: EDI managers, financial officers, account managers, sales managers
August
Industry hot topics: Meaningful Use, ePrescribing and Electronic Funds Transfer (EFT)
Live event August 17, 2010 at 11:00am Central/ 12:00pm Eastern
Ideal for Practice Management and EMR vendors: CFO, CEO, COO, EDI managers, financial officers, account managers, sales managers
September
HIPAA 5010 solutions that work for you
Live event September 23, 2010 at 11:00am Central/ 12:00pm Eastern
Ideal for Practice Management and EMR vendors: Programmers,compliance officers, CEO, COO, EDI managers, organizational leaders
New payers on board
The Emdeon network of payers continues to grow
New payers added recently:
•Aetna Better Health- PA Medicaid- Claims
•AETNA ENCOUNTERS- Claims
•AFFINITY MEDICAL GROUP- Claims
•American National Ins. Co. (ANICO)- ERA
•American National Property and Casualty Company (ANPAC)- Claims
•Americas 1st Choice Health Plans of North Carolina, Inc.- Claims
•AmeriChoice of New Jersey, Inc. (Medicaid NJ)- Claims
•Auto Club Insurance Association- Claims
•Blue Cross Blue Shield of Kansas City MO- Claims
•Blue Cross Blue Shield of Kansas City MO- ERA
•Blue Cross Blue Shield of Louisiana- ERA
•Blue Cross of Nebraska- ERA
•C&O Employees Hospital Association- Claims
•CAP Management Systems- Claims
•Carolina Crescent Health Plan Inc.- ERA
•Carpenters Health and Welfare Fund of Philadelphia- Claims
•CeltiCare- ERA
•Cenpatico Massachuetts- ERA
•CIGNA ENCOUNTERS- Claims
•Claims Management Services- ERA
•Community Health Electronic Claims/CHEC/webTPA- ERA
•Contractors Laborers Teamsters & Engineers- Claims
•Correctional Medical Services- Claims
•CT Medicare Part A (J13- NGS)- ERA
•Delta Dental of Arizona- ERA
•Delta Dental of Illinois- ERA
•Deseret Mutual- ERA
•DiaTri, LLC- Claims
•District of Columbia Medicaid- ERA
•Edwards Claim Administration- Claims
•FIRST ADMINISTRATORS, INC- Claims
•Great American (GAFRI)- Claims
•Guardian Life Insurance Company of America- ERA
•HARPETH IPA/SRRIPA- Claims
•Health Partners of Minnesota- Commercial- ERA
•Health Partners of Minnesota- Medicaid- ERA
•Health Right- Claims
•Independence Medical Group- Tulare- Claims
•Integral Quality Care- Claims
•InterCare Health Plans Inc.- Claims
•J1 MAC Medicare Part A (CA,HI,NV)- ERA
•Louisiana Medicaid- ERA
•MI Medicare Part A (J8)- ERA
•Mississippi Medicaid- ERA
•MMSI- ERA
•Molina Healthcare of New Mexico- Salud- Claims
•Motion Pictures Industry- Claims
•NC Medicare Part A (J11)- ERA
•Nebraska Medicaid- ERA
•New Hampshire Medicaid- ERA
•New York State Insurance Fund (NYSIF)- Claims
•NJ Medicare Part A (J12- Highmark)- ERA
•North American Benefits Network (Cleveland, OH)- Claims
•North Dakota Medicaid (Hospital)- Claims
•NYS DOH UCP- Claims
•Physicians Care Repricing- Claims
•Premera Blue Cross- ERA
•QuikTrip- ERA
•Sanford Health Plan- ERA
•SCAN ENCOUNTERS- Claims
•SelectHealth- ERA
•Southeast Dental Associates- Claims
•State Farm (Casualty & Property Claims)- Claims
•Sun Life and Health Insurance Company (U.S.) (formerly GLHIC)- ERA
•Touchstone Health PSO- ERA
•Triple-S, Inc.- ERA
•UCARE of Minnesota- ERA
•United Health Plan Encounters- Claims
•Utah Medicaid- Claims
•VI Medicare Part B (J9- First Coast)- ERA
•WEA Insurance Group- Claims
•WPS Tricare TriWest- ERA
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
