January 1, 2013 is rapidly approaching. This is the date by which HIPAA covered entities must implement the Department of Health and Human Services (HHS) Eligibility and Claim Status Operating Rules mandated under the Affordable Care Act. The Eligibility and Claim Status Operating Rules that HHS adopted by regulation in 2011 comprise the majority of those required for CAQH CORE’s voluntary Phase I and II certification. Emdeon became CORE Phase II certified in 2010, so Emdeon was in a strong position of readiness when HHS adopted these operating rules.
Emdeon has completed a thorough gap analysis in order to be ready by the compliance date. We are now concluding our remediation of any identified gaps.
Trading Partner Support
Emdeon is dedicated to help our clients complete this important transition successfully. We have already initiated testing with health plans that are ready to test their operating rule conformance.
In addition, we are actively engaging health plans who utilize our Eligibility and Claim Status Hosted Data Services (HDS). These health plans must:
• Migrate to version 3 of HDS if they are not on that version already; migration efforts for clients on prior versions are actively underway.
• Provide the proper data content in their eligibility files. (There are no data content requirements for the Claim Status transaction)
HIPAA Simplified
Our HIPAA Simplified website, www.hipaasimplified.com, remains the primary resource for information regarding the operating rules and other HIPAA and ACA regulations.
On the Operating Rules pages, you will find the newly updated Operating Rules Playbook. This publication is full of valuable information, including our operating rule program management structure, roles and responsibilities, educational material on the rules themselves and a new section specific to the upcoming ERA/EFT Operating Rules.
HIPAA Simplified is updated regularly, so check back often!
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Eligibility and Claim Status Operating Rules Update
From the Desk of Chris Meffe
Welcome and thank you for taking time to read the Emdeon Current newsletter!
First, I would like to introduce myself. I’m Chris Meffe, Senior VP of Emdeon’s Strategic Partner Group. Though I’ve been with Emdeon for nearly 13 years, I have just recently taken the helm of this segment of our company. In my new role, I am focused solely on leading our group to meet the needs of you, our channel partners. It is my job to make certain that we are about the business of making your business run smoother, offering greater value to your customers and helping you be more profitable than ever before.
We have restructured our approach to create absolute and critical focus on your business priorities, all with the goal of responding in the most customized, holistic manner possible. I am leading our team to connect with you one-to-one—more personally and directly—to get a greater understanding of what’s really going on with your business. That is what it is going to take for us to continuously develop better solutions and support to drive results all around.
To help launch this pinpoint approach, we recently conducted a study in partnership with a third party research firm to learn what you and your colleagues are most concerned about in the market today. We collected measurable insights about the hot button issues and business needs you are prioritizing now and in the coming year, and we are already putting that knowledge to work in the form of tailored solutions you can offer to your client base (read all about it by clicking here).
Knowing you as well as we already do, we understand that you also strive to take a personalized, client-centric approach with your customers. Now as we get to know you even better, we are excited about the possibilities to help you become an even greater resource for your clients—to take your business further.
This newsletter has always been about providing a useful source of information and ideas and we will continue to make sure it provides that insight. Please share your questions and suggestions so we can tailor our content to be more helpful and meaningful for you.
Thanks again for reading! We’re grateful for your partnership.
From the desk of...
Chris Meffe
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About Chris Meffe
Chris Meffe is Senior Vice President, Strategic Partnerships for Emdeon, overseeing strategy, operations, service, support and sales for channel partner customers. Meffe has been with Emdeon since 2000 when he joined as Vice President of Operations for the company. He is a graduate of Elon University with a BA in Economics.
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The "Complete" Answer to the Question of Growing Your Business
A look at your business priorities & Emdeon Provider Complete
Emdeon recently conducted a research study in partnership with a third party research firm to determine the priorities that our channel partners are most focused on in the next 12 to 18 months. The results were telling.
In some instances, the responses of channel partners mirrored those that would be expected of their customers. Electronic Medical Records (EMRs) and Meaningful Use, as well as ICD-10 changes were on the list. However, channel partners’ priorities went deeper, specifically calling out the key ways that they as solutions providers must be able to lead providers through the industry’s unfolding regulations and beyond. These priorities include:
• Customer retention
• Growth
• Increased ROI
• Maintaining excellent support through ICD-10 changes
• Upgrading of software to an EHR compatible system
• Overcoming implementation obstacles
• Integrating hospitals and physicians
• Finding innovative billing/payment software.
Some of these goals, like customer retention, growth and increased revenue, are likely to remain constant through any season. Others are ways of getting to what your customers are asking for.
Here is a question for you.
How do you establish a 24/7 excellent customer service department, grow your sales and expand services mentioned above, all without adding any new staff members, facilities or operations?
The answer is simple. Utilize Emdeon’s resources to make it happen.
That’s right. The full-service Emdeon Provider Complete model is a robust offering that can help you get to that goal of bringing more services, support—and value—to your providers, without having to add people, expand internal capabilities or acquire costly office space or expand operations. We have tailored this solution with a deep understanding of what you and your providers need to succeed in the healthcare landscape.
And if there is still a question in your mind why Emdeon Provider Complete should be your choice, we have a very straightforward answer for that also. Through your one connection to Emdeon, your providers have access to the most labs, pharmacies and payers in the industry enabling health information exchange, Meaningful Use, lab results & orders, ePrescribing, a full suite of EDI solutions and industry leading patient payment solutions. No one else can offer all of this to your providers. With a business partner like Emdeon, this can become your strength also.
Here’s a quick look at the Emdeon Provider Complete Solution offering:
• Say goodbye to months of backlogged payer enrollments because Emdeon will take care of all that. We closely monitor providers as they are going live to minimize rejections
• We also provide front line support for all EDI related issues so that you don’t have to. There will no longer be a need for you to be the intermediary point as your providers will be able to submit and track all support issues directly with Emdeon.
• Proactive claim rejection monitoring is also provided so providers can rest easy knowing that their cash flow is being closely monitored by Emdeon.
• Emdeon can be an extension of your sales team, reaching out to your providers and helping cross-sell solutions that benefit both you and your providers.
• Emdeon’s revenue cycle management capabilities can be tightly integrated into any practice management software.
The Emdeon Provider Complete Solution helps you not only compete, but win as well. Emdeon processes billions of health information exchanges annually within our expansive network of hospitals, pharmacies, doctors, dentists and laboratories. We have developed innovative technology solutions for claim rejection monitoring, payer enrollment for providers, 24/7 customer support and more. Our solutions are engineered for compliance and can be easily implemented and integrated while being easy to use.
Emdeon Provider Complete Solution is designed to help make you and your providers successful. With Emdeon Provider Complete, your business won’t miss opportunities or leave providers with fragmented services. You can offer a total package to your providers while being able to focus on customer retention and growth.
To learn more or get started, please call 855.559.8654 or email ProviderSolutions@emdeon.com.
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From Politics to Practice
What we learned at MGMA. By Gene Boerger, V.P. of Professional Product Management at Emdeon
On the surface, the agenda for the 2012 MGMA annual conference (San Antonio, Oct. 21-24) contained few surprises: Education sessions focusing on ICD-10, ARRA, administrative simplification, Meaningful Use and ACOs.
What was unexpected, however, was the energy invested by more than 3,000 people in attendance in transforming the politics of these issues into actionable strategies. Attendees and vendors alike were eager to convert the principles of reform into practice. We strategized with numerous provider groups to share how our expertise in care management, clinical information exchange and revenue optimization can transform industry concepts into real, workable scenarios. From our viewpoint, attendee interests fell into four major categories:
1. Solution engineering. We spoke with leaders at medical groups who recognize they need new solutions and new processes to achieve their objectives. Educational sessions, hallway discussions and vendor meetings centered on best practices and lessons learned. Attendees seemed to have a grasp of what they need and were tuned in to asking questions about how to get from here to there. Vendors were on the same wavelength. Countless meetings were held outside of exhibitor hours, where discussions about how to collaborate and integrate technologies to provide a more comprehensive whole abounded.
2. Care Management. Discussions about new care and reimbursement models, such as accountable care organizations (ACOs) and other pay-for-performance arrangements, have progressed from the abstract (“these approaches will help us control costs and improve care”) to the concrete (“who needs to be involved and what precisely will they be doing?”). Attendees explored the structures needed for greater focus on care management and heightened levels of coordination among providers. These conversations also dug deep into alignments—particularly as they affect community physicians—with hospitals.
3. Data drivers. As quality measures become engrained in emerging reimbursement models, medical groups increasingly need advanced data collection, analysis and reporting capabilities to successfully participate in a pay-for-performance or ACO-type model. Attendees recognized that their EHRs must work harder and that health information exchange (lowercase) is crucial. With a traditional focus only on delivering care—and not necessarily measuring it—providers are now taking a crash course in what tools are available, how they need to be configured and what they can do with the data that’s produced.
4. Business success. Billing professional fees. Proper coding and revenue optimization. Preparing for (and passing) audits. Contract negotiations. Use of outsourcing and technology. Patient collections. All activities that impact the bottom line—with a plethora of “practice proven and time tested” solutions for the challenges many medical groups face—were widely discussed. To arm our providers with information to improve business success, Emdeon held several educational presentations aimed at increasing revenue while effectively managing operations. Attendees agreed these considerations were more important in 2012 than ever before because of the incentive and payment reduction programs payers have adopted.
Emdeon made its presence felt throughout the conference, joining more than 350 other companies on the trade show floor with a dynamic booth that hosted long-time customers and new prospects. Emdeon was joined by the American Academy of Family Physicians for a speaking engagement in the MGMA Innovation Center on Care Management, and Emdeon representatives also delivered a number of in-booth educational sessions on topics ranging from how to remove barriers to submitting clean electronic orders to revving up cash flow by accepting online payments.
Overall, the mood of MGMA seemed to be of anticipation, partly fueled by the impending presidential election. Many attendees seemed to be of the opinion that the trends spurred by healthcare reform legislation would continue—and that they are embracing and preparing for new directions.
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Setting the Stage for Stage 2. Where We Are Now & What You Need to Know.
(Part 1 of 4)
Stage 2 of the Meaningful Use (MU) incentive program is being billed by some as “a giant leap in data exchange1.” The overriding goal of the program is to advance the secure exchange of information within our health system between all of a patient’s providers as well as the patients themselves —and that is a giant leap from where the system is currently, indeed. Of course, with every giant leap comes the chance for big missteps. That’s why the time is now to prepare for Stage 2 objectives and requirements.
The Biggest Challenges Revealed in Stage 1
According to a recent study published in the Journal of the American Informatics Association, the biggest challenge for hospitals participating in the MU program is Computerized Provider Order Entry (CPOE). Out of 2,475 hospitals in the study that intended to participate in MU, only 313 received incentive payments in 2011 during Stage 1. Half of those hospitals that didn’t meet Stage 1 requirements cited CPOE criteria as a top challenge. As we move to Stage 2, issues related to CPOE will remain as many hospitals are only beginning to adopt EHRs and build infrastructure to meet MU criteria.
For hospitals that were awarded incentive payments, giving patients access to their data in electronic form and generating numerator and denominator data for quality reporting directly from the Electronic Health Record (EHR) were reported to be the most significant challenges. The difficulty of providing electronic data to patients is very important to note and prepare for, as Stage 2 focuses on electronic patient communications and assigns heightened requirements to achieve program incentives.
According to Stage 2 Meaningful Use requirements final rule by Centers for Medicare & Medicaid Services (CMS), providers must achieve meaningful use under Stage 1 criteria before advancing to Stage 2. CMS has announced certain changes to Stage 1 CPOE; details may be found by clicking here.
What is different in Stage 2 as compared to Stage 1
In Stage 2, there are more core objectives for Eligible Professionals, Eligible Hospitals and Critical Access Hospitals (CAHs). Many Stage 1 core objectives have been merged or folded into other requirements. Eligible Professionals have 20 total objectives, including 17 core objectives and 3 (of 6) menu objectives. For Eligible Hospitals and Critical Access Hospitals (CAHs), there are 19 total objectives comprised of 16 core objectives and 3 (of 6) menu objectives.
Here’s a quick look at core objectives that Eligible Professionals must report on, as well as the six menu objectives they may choose from.
Core Objectives
1. Computerized Provider Order Entry (CPOE)
a. Use CPOE for more than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology.
2. ePrescribing (eRx)
a. Use eRx for more than 50 percent.
3. Demographics
a. Record demographics for more than 80 percent.
4. Vital Signs
a. Record vital signs for more than 80 percent.
5. Smoking Status
a. Record smoking status for more than 80 percent.
6. Interventions
a. Implement 5 clinical decision support interventions + drug/drug and drug/allergy.
7. Labs
a. Incorporate lab results for more than 55 percent.
8. Patient List
a. Generate patient list by specific condition.
9. Preventive Reminders
10. Use Electronic Health Record (EHR) to identify and provide reminders for preventive/follow-up care for more than 10 percent of patients with two or more office visits in the last 2 years.
11. Patient Access
a. Provide online access to health information for more than 50 percent with more than five percent actually accessing.
12. Visit Summaries
a. Provide office visit summaries for more than 50 percent of office visits.
13. Education Resources
a. Use EHR to identify and provide education resources more than 10 percent.
14. Secure Messages
a. More than five percent of patients send secure messages to their Eligible Professionals (EP).
15. Prescription Reconciliation
a. Medication reconciliation at more than 50 percent of transitions of care.
16. Summary of Care
a. Provide summary of care document for more than 50 percent of transitions of care and referrals with 10 percent sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR.
17. Immunizations
a. Successful ongoing transmission of immunization data.
18. Security Analysis
a. Conduct or review security analysis and incorporate in risk management process.
Menu Objectives (select 3 of 6)
1. Imaging Results
a. More than 10 percent of imaging results are accessible through Certified EHR Technology.
2. Family History
a. Record family health history for more than 20 percent.
3. Syndromic Surveillance
a. Maintain successful ongoing transmission of syndromic surveillance data.
4. Cancer
a. Maintain successful ongoing transmission of cancer case information.
5. Specialized Registry
a. Maintain successful ongoing transmission of data to a specialized registry.
6. Progress Notes
a. Enter an electronic progress note for more than 30 percent of unique patients.
For even more details, view the CMS’ Stage 2 Tipsheet by clicking here.
The Five Percent+ Factor: Focusing on Patient Engagement in Stage 2
Patient engagement—reciprocal communication between patients and providers—is a significant focus that everyone must be prepared for in Stage 2. To be eligible for incentives, providers must achieve the following patient action.
- More than five percent of patients must send secure messages to their eligible providers.
- More than five percent of patients must access their health information online.
For many Eligible Professionals, it may be quite daunting to evoke such engagement from over five percent of patients, as so many factors affect the transition to electronic information sharing. Technological, cultural and organizational barriers exist across communities nationwide. For example, CMS is introducing exclusions based on broadband availability by county, as some areas simply don’t have the Internet access necessary for five percent to take action even if they are willing to do so.
Timing for Stage 2
The final rule has been out since August 2012 and though there is an urgency for Stage 2, there is not the mad rush that surrounded Stage 1. Stage 2 test scripts have not yet been released in full from certification bodies and at this writing only three are out. Test scripts from vendors will be released in phases, with the launch of testing anticipated for December 2012 or January 2013.
For a complete look at Stage 2, visit CMS’ website by clicking here. There you’ll find tables, tipsheets and updates directly from CMS. In addition, continue to follow Emdeon for targeted announcements and interpretation of latest updates as it relates to your business. Emdeon will continuously guide you through Stage 2 so that you are prepared to offer expertise to your customers every step of the way.
Stay tuned for our next article in series, Planning for Certification and Strategies in Testing.
1. http://www.healthit.gov/buzz-blog/meaningful-use/meaningful-use-stage-2/
2. http://www.fierceemr.com/story/cpoe-huge-stumbling-block-meaningful-use/2012-10-02?utm_source=rss&utm_medium=rss
3. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTablesforEP.pdf
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New Payer Transactions Added Recently
Claims
Association de Maestros (PR), Payer ID: L0150
Assurant Health (Repricing for HealthSpan Network Only), Payer ID: ASNTH
CenterLight Healthcare, Payer ID: 13360
CenterPoint Human Services, Payer ID: 56122
ClubMD, Payer ID: 37272
Employee Benefit Systems, Payer ID: 42149
Good Samaritan Medical Practice Association, Payer ID: IP086
HealthPlan Services, Payer ID: 59140
Innovative Healthware Services, Inc., Payer ID: Call
J. Smith Lanier & Co. Administrators, Payer ID: 37272
JMH - SFCCN PHT (PSN, CMSN), Payer ID: 09822
JSL Administrators, Payer ID: 37272
Klais & Company (Repricing for HealthSpan Network Only), Payer ID: 3414A
MAPFRE LIFE, Payer ID: L0160
Mapfre Excel, Payer ID: L0100
Max Specialty Benefits, Payer ID: 27320
Medical Card System Inc (PR), Payer ID: L0170
Mutual Group (The) (US), Payer ID: 59140
NALC/Affordable, Payer ID: 53011
National Association of Letter Carriers, Payer ID: 53011
National Association of Letter Carriers/NALC, Payer ID: 53011
PHYSICIANS CARE NETWORK, LLC, Payer ID: PCN12
Pan American Life Insurance Company, Payer ID: L0180
Physicians Alliance/Stones River Regional IPA, Payer ID: 15749
Pittman & Associates, Payer ID: 37224
Plan de Salud Menonita (PR), Payer ID: L0190
RMSCO, INC., Payer ID: 16117
SANTA CLARA FAMILY HEALTH PLAN, Payer ID: 24077
SCAN ENCOUNTERS, Payer ID: 99157
Smokey Mountain Center, Payer ID: 13010
UMC HEALTH PLAN, Payer ID: 75130
UMR/Cincinnati (Repricing for HealthSpan Network Only), Payer ID: UMRC1
United Healthcare Ovations Insurance Solutions (AARP), Payer ID: 36273
Wells Fargo Third Party Administrators, Inc. (Formerly JSL Administrators), Payer ID: 37272
Western Mutual Insurance, Payer ID: 37247
California Medicaid (Medi-Cal), Payer ID: SKCA0
Care Access PSN, Payer ID: 65063
Eligibility Inquiry and Response
CareSource, Payer ID: 00325
Illinois Medicaid - SCHALLER ANDERSON, Payer ID: ILMSA
Integral Quality Care FL - SCHALLER ANDERSON, Payer ID: IQCFL
KEMPTON COMPANY, Payer ID: KEMCO
MEDICAL CARD SYSTEM (MCS), Payer ID: MEDCS
Schaller Anderson MajestaCare VA, Payer ID: MACVA
TRIPLE-S (BCBS PUERTO RICO), Payer ID: BCPRC
Texas Christus - SCHALLER ANDERSON, Payer ID: TXCSA
United Healthcare Shared Services, Payer ID: UHIS
Blue Cross Blue Shield of Mississippi, Payer ID: 00075
Blue Cross Blue Shield of Mississippi, Payer ID: BCMS
Puerto Rico Medicaid, Payer ID: AID60
Claim Status Inquiry And Response:
AmeriHealth Mercy Health Plan, Payer ID: AHMHP
Horizon New Jersey Health, Payer ID: HNJH
Illinois Medicaid - SCHALLER ANDERSON, Payer ID: ILMSA
Integral Quality Care FL - SCHALLER ANDERSON, Payer ID: IQCFL
KEMPTON COMPANY, Payer ID: KEMCO
Keystone Mercy Health Plan, Payer ID: KYMHP
MDWise Hoosier Alliance, Payer ID: MDWHA
Passport Health Plan, Payer ID: PPHPC
Schaller Anderson MajestaCare VA, Payer ID: MACVA
Select Health of South Carolina, Payer ID: SHSC
Texas Christus - SCHALLER ANDERSON, Payer ID: TXCSA
Blue Cross Blue Shield of Kansas, Payer ID: BCKSC
Blue Cross Blue Shield of Kansas City, Payer ID: BCKCC
Blue Cross Blue Shield of Mississippi, Payer ID: 00075
Blue Cross Blue Shield of Mississippi, Payer ID: BCMS
Missouri Medicaid, Payer ID: AID03
Missouri Medicaid, Payer ID: MO
For all payers, visit https://access.emdeon.com/PayerLists/
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HHS Announces FINAL Rule for ICD-10 Compliance Date and HPID
Health and Human Services has announced a Final Rule that confirms the proposed extension of the ICD-10 compliance date to October 1, 2014.
The Final Rule also establishes a unique health plan identifier (HPID), as well as a unique identifier for other entities (OEID), and modifies the NPI Rule to include pharmacy prescribers.
The Final Rule establishes these important dates:
• Health plans, with the exception of small plans, must obtain an HPID by November 5, 2014
• Small health plans must obtain an HPID by November 5, 2015
• Covered entities must use HPIDs in the standard transactions on or after November 7, 2016
The changes to the NPI rule become effective May 6, 2013.
HIPAA Simplified Expanded to Include ICD-10, other upcoming HIPAA and ACA Regulations
Emdeon’s HIPAA Simplified website (www.hipaasimplified.com) has been expanded to address ICD-10, as well as other upcoming regulations enacted by HIPAA and the Patient Protection and Affordable Care Act of 2010 (ACA).
New Section added for ICD-10:
We have added a new section for ICD-10 that includes Emdeon Clearinghouse FAQ’s. Emdeon’s ICD-10 Program Playbook will also be published in the near future, offering our customers an in-depth look at Emdeon’s ICD-10 strategy. The playbook will include:
• An overview of ICD-10, important facts and key changes between ICD-9 and ICD-10
• Guiding principles and governance of our ICD-10 program
• Emdeon’s ICD-10 implementation timeline
• Plans for customer messaging and communications
• Information on trading partner testing
To access the ICD-10 page, click the ICD-10 link from the HIPAA Simplified home page. Alternately, you can go directly to the ICD-10 page using the URL http://www.emdeon.com/5010/icd10.php.
Operating Rules:
The Patient Protection and Affordable Care Act (ACA) of 2010 requires The Department of Health and Human Services (HHS) to adopt operating rules for the HIPAA transactions. The first of these regulations, concerning the health plan Eligibility/Benefit and Claim Status transactions was issued in July 2011, with a compliance date of January 1, 2013.
The Operating Rules page of HIPAA Simplified presents frequently asked questions about the regulation and Emdeon’s readiness to keep you updated regarding this important milestone.
As an industry leader, we are committed to helping our trading partners successfully navigate the HIPAA and ACA regulatory timeline. Emdeon intends for HIPAA Simplified to be an evolving site and valuable resource for our customers.
Bookmark HIPAA Simplified and check back often!
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Best Practices in Patient Billing and Collections:
Make it easy and convenient for patients to pay their healthcare bills
Part 2 of a 4-part series designed to offer your small practice providers tips on improving their administrative and clinical operations.
Few people enjoy paying their bills—it’s just no fun to watch hard-earned money end up in someone else’s bank account.
No matter how well your providers take care of their patients, they’re just as hesitant to open their wallets. It stands to reason, then, that your providers need to make the process as painless and convenient as possible. Online portals can be the perfect solution. Consumers have grown accustomed to managing their affairs via the Web and expect this level of service in all areas of their lives—including healthcare.
The healthcare industry, however, has yet to make patient-facing, Web-based payment tools a universal option. Small practices must pay especially close attention to cash flow, so encouraging timely and accurate payment by bringing the process online is crucial.
Optimizing the online advantage begins well before a patient encounter. Web-based registrations tools, for example, allow patients to sign in prior to their arrival and the practice to capture important information. Patients are free to register at their convenience days before their appointment, instead of arriving at the doctor’s office early just to fill out paper forms. The practice benefits, as well, because it has access to legible, accurate information to streamline the claims and billing process.
Then, after the visit, patients can conveniently—and promptly—settle their accounts via the secure portal. Not only is cash flow improved, practices can reduce administrative expenses by removing some of the burden of collections from their office staff.
When introducing online capabilities to their patients, practices must promote the portal to ensure it’s used. A “multi-touch” campaign offers the best approach. Posters in the lobby, hallways and exam rooms can announce the new payment option. Registration and check-out staff should mention the availability of the portal and maybe even hand out postcards, refrigerator magnets or other tchotchkes. An additional reminder can be printed on billing statements still being mailed.
It’s important to promote the portal on the practice’s website, as well, preferably on the home page. This serves as a constant reminder for current patients and might attract individuals looking for a new doctor.
Other ways to encourage use of an online payment option include:
• ensuring the portal features easy-to-use instructions and simple navigation;
• making sure the portal displays contact information prominently in case patients need help; and
• assuring patients that the portal is secure and all private information is protected.
One final note: Keep in mind that patients of all ages might use online tools. They should include the full-bodied features the younger generation has come to expect, but be simple enough so those less technology-savvy can navigate the process easily as well.
Emdeon’s Patient Pay Online Express is a patient-facing application designed to help small providers enjoy success with Web-based portals. As an example, Concord Integrated Health, a chiropractic medicine practice located in Concord, Massachusetts, was increasingly burdened by the conventional process for generating and sending patient statements. At the time, it was generating between 250 and 300 statements per month. Along with implementing an automated billing service, Concord Integrated Health began using the Emdeon Patient Pay Online Express solution to answer patient demand for Web-based payments. With individuals able to view billing amounts and pay their accounts online, at anytime, the amount and promptness of payments greatly increased.
Dr. Jeff Robichaud, Chief of Concord Integrated Heath’s Chiropractic Medicine Department, summarizes that “by allowing patients to pay their bills online, we are seen as a practice that is providing the most up-to-date solution for them. Patient Pay Online drives patients to our website as well, so we can have a presence with them beyond the in-person office visit.”i
With a secure system accessible to patients 24 hours a day, seven days a week, the Emdeon Patient Pay Online Express solution improves collections and data accuracy, while offering patients greater convenience. Emdeon helps speed up the billing and payment cycle, improving finances, reducing staff time invested in administrative tasks and giving your providers more time to spend with patients.
Nothing will remove the sting of paying a medical bill completely, of course. But by reducing the hassle and offering an option that fits into the patient’s lifestyle, practices eliminate some resistance—resulting in timely payments and improved cash flow.
For more information on how Concord Integrated Health has experienced increased payments and patient satisfaction through the use of Emdeon’s Patient Pay Online Express, please click here
(Note: Stay tuned for an in-depth look at other ways to improve customer relations to enhance patient billing and collections in the next issue of this newsletter.)
i “Emdeon Patient Billing & Payment Solutions: Efficient technology for reducing costs and accelerating patient payments,” Emdeon Business Services LLC, July 2011
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Centers of Attention
Attention to Detail Keeps Emdeon Data Centers Running and Your Transactions Going 24x7x365
Recently, there was an intense lightning storm in Nashville, the city that’s home to Emdeon and one of its state-of-the-art data centers. The wild weather took down trees, sparked fires and flash floods and left parts of the area temporarily in the dark. Yet your data and essential administrative transactions were never in harm’s way—not even for a moment. With careful building design and construction, methodical interior layout, multilayered security and massive yet intricate operational systems, Emdeon’s data centers helped to ensure that our services and solutions continued to run smoothly.
Emdeon invested over $27 million in 2011 to build a new data center in Nashville which is just one of two highly secure locations meticulously built with redundant infrastructure and network architecture designed to provide 24/7 uptime, 365 days a year.
The second data center, located 200 miles away in Memphis, is connected to the Nashville facility by two ten gigabit pipelines. Not only does each data center serve as seamless, airtight back-up for the other for most applications, each facility has layer upon layer of redundant architecture within itself. There’s literally failsafe measure upon failsafe measure in place in both locations to safeguard data and avert system outages.
So how exactly do they work? The Emdeon data centers mirror each other and function like the brains and nervous system of the company. Both locations house state-of-the-art command centers that are staffed at all times around the clock and even on holidays to monitor and rapidly respond to even the slightest hint of a service disruption.
Command Center
Millions of dollars worth of servers (2,700 total servers with much room for growth) handle literally billions of transactions each year and are protected by some of the most impressively configured temperature controls, fire suppression systems and uninterrupted power supplies.
Larry Graubner, Emdeon Vice President of Information Technology
Here are specific highlights of just how far we’ve gone to help you carry out the business of healthcare.
• Security: Security is provided 24x7x365 by a separate group that reports independently to the Chief Information Officer (CIO). All activities throughout the facilities are recorded by video surveillance. Exterior and interior doors are secured with dual mode access requiring card swipe and biometric fingerprint reading for entry.
• Power: Data centers operate with state-of-the-art electrical systems backed by uninterruptible power supplies and turbo-charged diesel generators. The systems have N+1 redundancy (a form of resilience that ensures system availability in the event of component failure), and all power sources receive testing and maintenance to ensure they’re always on the ready. Emdeon has prioritized diesel fuel resupply priority status, second only to hospitals and life support systems, in Nashville.
• Heating, Ventilation, and Air Conditioning (HVAC): Cooling towers maintain constant temperatures at the data centers using continuously recycled liquid coolant. Dual towers and 6,000-gallon reserve water tanks provide additional redundancy. Each location has nearly 400 tons of HVAC with backup pumps on standby if needed, while 200 temperature sensors work constantly to monitor the air and trigger alerts if needed.
• Hardware: Server pods (logically arranged groups of cabinets housing servers) have redundant network and Storage Area Network (SAN) fiber connections. Switches and routers are configured with redundancy for constant uptime and the data centers are designed to accommodate additional capacity at any time.
• Virtual Servers: Emdeon can also rapidly deploy new virtual servers to meet various business needs quickly and efficiently. A virtual server consumes a portion of a large “host” server. First a large host server is configured and installed. But unlike physical servers which have to go through the same order, unpack, configure and install cycle each time an additional server is required, the host server with unused capacity can be allocated on the fly to rapidly create several virtual servers which can be deployed in a matter of minutes, not weeks.
Network Switch
With every layer of security, safeguarding and monitoring, we prove that you and your business have our utmost attention. We’ve made phenomenal investments to ensure each and every one of the six billion transactions we process annually is handled with the care it deserves. The needs of your organization are at the heart of everything we do.
To learn more about the Emdeon data centers and our commitment to innovation, visit us online.
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Discover new ways to simplify your business when you connect with Emdeon
Find us online 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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New Payer Transactions Added Recently
Claims
Administrative Services Inc., Payer ID: 59141
Advantra Freedom, Payer ID: 25133
Advantra Savings, Payer ID: 25133
Allied Administrators (San Francisco CA), Payer ID: 94177
Altius (Utah), Payer ID: 25133
Association Benefit Plan, Payer ID: 25133
BENEFIT MANAGEMENT SERVICES, Payer ID: 56139
Banner Health AZ, Payer ID: SX145
Banner Health Co - ROCKY MOUNTAIN HMO GREELEY, Payer ID: SX145
Banner Health Co. - ANTERO GREELEY, Payer ID: SX145
Banner Health Co. - ANTERO HIGH PLAINS, Payer ID: SX145
Banner Health Co. - ANTERO MOUNTAIN SHADOWS, Payer ID: SX145
Banner Health Co. - CHOICE PLUS, Payer ID: SX145
Banner Health Co. - HMO GREELEY, Payer ID: SX145
Banner Health Co. - HMO HIGH PLAINS, Payer ID: SX145
Banner Health Co. - HMO MOUNTAIN SHADOWS, Payer ID: SX145
Banner Health Co. - PACIFICARE GREELEY, Payer ID: SX145
Banner Health Co. - PACIFICARE HIGH PLAINS, Payer ID: SX145
Banner Health Co. - PACIFICARE MOUNTAIN SHADOWS, Payer ID: SX145
Banner Health Co. - ROCKY MOUNTAIN HMO HIGH PLAINS, Payer ID: SX145
Banner Health Co. - SECURE HORIZONS GREELEY, Payer ID: SX145
Banner Health Co. - SECURE HORIZONS HIGH PLAINS, Payer ID: SX145
Banner Health Co. - SECURE HORIZONS MOUNTAIN SHADOWS, Payer ID: SX145
Banner Medisun, Payer ID: 77078
Carelink Health Plan, Payer ID: 25133
Carelink Medicaid, Payer ID: 25133
Carenet, Payer ID: 25133
Central Reserve Life Ins Co, Payer ID: 13193
Christian Brothers Services, Payer ID: 38308
Community Medical Group of the West Valley Inc., Payer ID: 66121
Continental General Ins Co, Payer ID: 13193
Coventry Advantra Texas, Payer ID: 25133
Coventry Health & Life (Oklahoma), Payer ID: 25133
Coventry Health Care, Payer ID: 25133
Coventry Health Care Carelink - West Virginia only, Payer ID: 25133
Coventry Health Care Carelink Medicaid - West Virginia only, Payer ID: 25133
Coventry Health Care National Network, Payer ID: 25133
Coventry Health Care Nevada, Payer ID: 25133
Coventry Health Care of Florida Inc., Payer ID: 25133
Coventry Health Care of Georgia Inc., Payer ID: 25133
Coventry Health Care of Iowa Inc., Payer ID: 25133
Coventry Health Care of Kansas Inc., Payer ID: 25133
Coventry Health Care of Louisiana Inc., Payer ID: 25133
Coventry Health Care of Nebraska Inc., Payer ID: 25133
Coventry Health Plan of Florida, Payer ID: 25133
Coventry Health and Life Insurance Company administered by PersonalCare, Payer ID: 25133
Coventry Health and Life Insureance (Tennessee), Payer ID: 25133
Coventry Missouri, Payer ID: 25133
Coventry Nebraska, Payer ID: 25133
Coventry Summitt Health Plan Inc., Payer ID: 25133
Coventry of Health Care Delaware Inc., Payer ID: 25133
CoventryCares, Payer ID: 25133
CoventryCares of Kentucky, Payer ID: 25133
Crescent Health Solutions, Payer ID: 56213
Diamond Plan (Maryland Medicaid), Payer ID: 25133
Eastland Medical Group, Payer ID: 66122
First Service Administrator's Inc Lakeland Florida, Payer ID: 59276
Foreign Service Benefit Plan, Payer ID: 25133
GHP (Group Health Plan), Payer ID: 25133
Great American Life Ins Co, Payer ID: 13193
Health America Inc./Health Assurance/Advantra, Payer ID: 25133
Health Cost Solutions, Payer ID: 62111
Health Services for Children with Special Needs, Payer ID: 37290
HealthEdge Administrators (Bakersfield CA), Payer ID: 95213
Healthcare USA, Payer ID: 25133
Healthways WholeHealth Networks, Payer ID: 58213
IU Medical Group Primary Care, Payer ID: SX172
Innovative Healthware Systems, Payer ID: Call
International Brotherhood of Boilermakers Employee Health Care Plan(IBBEHC), Payer ID: 48603
J. F. Molloy and Associates Inc., Payer ID: 61271
Kanawha HealthCare Solutions Inc., Payer ID: 57038
Kanawha Insurance Co., Payer ID: 57038
Lakeside Comprehensive Healthcare, Payer ID: 66127
Landmark Healthcare Inc, Payer ID: LNDMK
Lone Star TPA, Payer ID: 45289
Loyal American Life Ins Co, Payer ID: 13193
Martins Point Health Care, Payer ID: 53275
Mail Handlers Benefit Plan, Payer ID: 25133
Maryland Medicaid, Payer ID: 25133
Mid-American Benefits, Payer ID: Call
NAMCI/Global Care, Payer ID: L0110
Neighborhood Health Plan of Rhode Island (NHPRI), Payer ID: 5047
Network Health Plan of Wisconsin Inc., Payer ID: 39144
Omnicare, Payer ID: 25133
PersonalCare, Payer ID: 25133
Piedmont Behavioral Health, Payer ID: 6607
Primary Health Network, Payer ID: 82048
Principal Financial Group, Payer ID: 61271
Provident American Life & Health Ins Co, Payer ID: 13193
Regency Employee Benefits, Payer ID: 38221
Resolve Health Plan Administrators LLC, Payer ID: RHA01
Rural Carrier Benefit Plan, Payer ID: 25133
Sendero Health, Payer ID: 36426
Southern Health Service Inc., Payer ID: 25133
Texas Childrens Health, Payer ID: TXCSM
Texas Children's Star, Payer ID: Call
Total Community Care, Payer ID: 31182
Transchoice or TransSmile - First Service Administrator's Inc, Payer ID: 20807
True Choice USA, Payer ID: 54210
True Choice USA, Payer ID: TH083
UT- Altius (UHIN), Payer ID: 25133
United Teacher Assoc Ins Co, Payer ID: 13193
University of Missouri, Payer ID: 25133
Verdugo Hills Medical Group, Payer ID: 66126
Vista Health Plan, Payer ID: 25133
Wabash Memorial Hospital Association, Payer ID: 85256
Waterstone Benefit Administrators (Outside Oklahoma), Payer ID: 23051
WellPath, Payer ID: 25133
West Covina Medical Group, Payer ID: 66124
West Suburban Health Providers, Payer ID: 80942
Wellmark BCBS - Medicare COB, Payer ID: SB645
HMSO-Highline Medical Service Organization, Payer ID: 91164
CNA, Payer ID: C1035
Dallas Independent School District, Payer ID: J1494
Harris County, Payer ID: J1493
Meadowbrook Insurance Group, Payer ID: J1478
Eligibility Inquiry and Response
Coresource (MD PA. IL) , Payer ID: F3518200
Coresource (OH) , Payer ID: F3518300
Coventry Diamond Plan (MD MEDICAID), Payer ID: F2513100
Coventry Health Care Of Delaware , Payer ID: F2513000
Coventry Health Care Of Georgia , Payer ID: F2512700
Coventry Health Care Of Iowa , Payer ID: F2513200
Coventry Health Care Of Louisiana , Payer ID: F2513500
Coventry Health Care Of Nebraska , Payer ID: F2513600
Coventry Healthamerica & Healthassurance, Payer ID: F2512600
Coventry Southern Health Services (SHS), Payer ID: F2512800
Coventry Wellpath Select / Coventry, Payer ID: F2512900
CeltiCare, Payer ID: CELTI
Cenpatico - Illinois, Payer ID: CBHIL
Cenpatico - Kentucky, Payer ID: CBHKY
Cenpatico - Massachusetts, Payer ID: CBHMA
Cenpatico - Wisconsin, Payer ID: CBHWI
Cenpatico Behavioral Health, Payer ID: CBHMA
Consolidated Associates Railroad, Payer ID: CARIL
CoreSource - Little Rock, Payer ID: CORSE00205
Coresource - Ohio, Payer ID: 239
Director's Guild , Payer ID: F2370600
Fallon Community Health Plan , Payer ID: F2225400
Health Choice of Arizona, Payer ID: HCOAZ
J. F. Molloy and Associates Inc., Payer ID: 143
J.F. Malloy & Associates, Payer ID: PFINL00143
Kaiser Foundation - GA, Payer ID: F2131300
Kentucky Spirit Health Plan, Payer ID: CKYHP
Louisiana Healthcare Connections, Payer ID: CENLA
Meridian Health Plan of Illinois, Payer ID: MHPIL
Meritain Health, Payer ID: MTAIN
Molina Healthcare of California, Payer ID: MLNCA
Molina Healthcare of Florida, Payer ID: MLNFL
Molina Healthcare of Michigan, Payer ID: MLNMI
Molina Healthcare of Missouri, Payer ID: MLNMO
Molina Healthcare of Ohio, Payer ID: MLNOH
Molina Healthcare of Texas, Payer ID: MLNTX
Molina Healthcare of Utah, Payer ID: MLNUT
Molina Healthcare of Washington, Payer ID: MLNWA
Molina Healthcare of Wisconsin, Payer ID: MLNWI
Nippon Life Benefits, Payer ID: NIPON
Nippon Life Benefits, Payer ID: PFINL00144
Oxford Health Plans, Payer ID: 16
Personal Insurance Administrators (PIA), Payer ID: PIANC
Principal Financial Group, Payer ID: 143
Principal Life Insurance Company, Payer ID: 143
Student Insurance, Payer ID: F7422700
Student Insurance, Payer ID: F7422701
Student Insurance, Payer ID: F7422702
Schaller Anderson Mercy Care Plan, Payer ID: AEMED
Significa Benefit Services Inc., Payer ID: F2324900
Significa Benefit Services Inc., Payer ID: F2325000
Today's Options, Payer ID: TDOPT
Touchstone Health PSO, Payer ID: 78
Us Healthcare, Payer ID: F2322200
UnitedHealthcare StudentResources, Payer ID: 290
UnitedHealthcare StudentResources, Payer ID: STDNT
Vytra, Payer ID: F2226400
Writers Guild , Payer ID: F2371000
BlueCross BlueShield of Vermont, Payer ID: BCVTC
Absolute Total Care, Payer ID: CTOTL
Bridgeway Arizona, Payer ID: CBRID
Buckeye Community Health, Payer ID: CBUCK
Cenpatico - Texas, Payer ID: CBHTX
Cenpatico Behavioral Health (Arizona), Payer ID: CBHAZ
Cenpatico Behavioral Health (Florida), Payer ID: CBHFL
Cenpatico Behavioral Health (Kansas), Payer ID: CBHKS
Cenpatico Behavioral Health (Ohio), Payer ID: CBHOH
Cenpatico Behavioral Health (South Carolina), Payer ID: CBHSC
Cenpatico-Arizona, Payer ID: CBHAZ
Cenpatico-Florida, Payer ID: CBHFL
Cenpatico-Kansas, Payer ID: CBHKS
Cenpatico-Ohio, Payer ID: CBHOH
Cenpatico-South Carolina, Payer ID: CBHSC
IlliniCare Health Plan, Payer ID: CLINI
Magnolia Health Plan, Payer ID: CMGHP
Managed Health Services Wisconsin, Payer ID: CMHWI
New Hampshire Medicaid, Payer ID: AID47
New Hampshire Medicaid, Payer ID: NH
Sunshine State Health Plan, Payer ID: CSSHP
Superior HealthPlan, Payer ID: CSHPT
Advantage by Bridgeway Health Solutions, Payer ID: CBRIA
Advantage by Buckeye Community Health Plan, Payer ID: CBUCA
Advantage by Managed Health Services, Payer ID: CMHSA
Advantage by Superior HealthPlan Services, Payer ID: CSHPA
Essence Healthcare, Payer ID: ESSNC
Claim Satus And Response:
AMC - Touchstone PSO, Payer ID: F2385600
Christian Brothers Services, Payer ID: F6127103
Coresource (Little Rock) , Payer ID: F7513600
Coresource (MD PA. IL) , Payer ID: F3518200
Coresource (OH) , Payer ID: F3518300
Coventry Diamond Plan (MD Medicaid), Payer ID: F2513100
Coventry Health Care Of Delaware , Payer ID: F2513000
Coventry Health Care Of Georgia , Payer ID: F2512700
Coventry Health Care Of Iowa , Payer ID: F2513200
Coventry Health Care Of Kansas Kansas City, Payer ID: F2513300
Coventry Health Care Of Louisiana , Payer ID: F2513500
Coventry Health Care Of Nebraska , Payer ID: F2513600
Coventry Healthamerica & Healthassurance, Payer ID: F2512600
Coventry Southern Health Services (SHS), Payer ID: F2512800
Coventry Wellpath Select / Coventry, Payer ID: F2512900
CoreSource - Little Rock, Payer ID: CORSE00205
Coresource - Maryland Pennsylvania & Illinois, Payer ID: 236
Director’S Guild , Payer ID: F2370600
Health Choice of Utah, Payer ID: HECHU
J. F. Molloy and Associates Inc., Payer ID: 143
J.F. Malloy & Associates, Payer ID: PFINL00143
Molina Healthcare of California, Payer ID: MLNCA
Molina Healthcare of Florida, Payer ID: MLNFL
Molina Healthcare of Michigan, Payer ID: MLNMI
Molina Healthcare of Missouri, Payer ID: MLNMO
Molina Healthcare of New Mexico, Payer ID: MLNNM
Molina Healthcare of Ohio, Payer ID: MLNOH
Molina Healthcare of Texas, Payer ID: MLNTX
Molina Healthcare of Utah, Payer ID: MLNUT
Molina Healthcare of Washington, Payer ID: MLNWA
Molina Healthcare of Wisconsin, Payer ID: MLNWI
Nippon Life Benefits, Payer ID: NIPON
Nippon Life Benefits, Payer ID: PFINL00144
Novasys Health, Payer ID: NOVAS
Oxford Health Plans, Payer ID: 16
Personal Insurance Administrators (PIA), Payer ID: PIANC
Principal Financial Group, Payer ID: 143
Principal Life Insurance Company, Payer ID: 143
Schaller Anderson Mercy Care Plan, Payer ID: AEMED
Significa Benefit Services Inc., Payer ID: F2325000
Today's Options, Payer ID: TDOPT
Writers Guild , Payer ID: F2371000
For all payers, visit https://access.emdeon.com/PayerLists/
Read More >>
HIPAA 5010 - The end of the journey in sight
The healthcare Industry continues its march to achieve 5010 compliance and we are beginning to see the light at the end of the tunnel. Emdeon along with other industry stakeholders is completely vested in helping its customers reach this very important mandate.
We all know that this transition has not been an easy one and has created financial pain throughout the healthcare industry, but the constant struggle is finally paying off. Emdeon is the single largest clinical, financial and administrative health information network in the nation. In 2011, we processed more than 6 billion health information exchanges and our numbers show significant insight into the industry. Our HIPAA 5010 insight and transition experience shows us that:
• Payer acceptance / rejection rates are stabilizing to pre-5010 levels
• Production issues are down 145 percent from record highs in January
• Claim support cases are down 64 percent since peak of 5010
• Overall payer rejections which peaked at over five percent are down to less than four percent
• New 999 reporting issues have dropped significantly
• Medicare claim status tie-out rates improved from post conversion low of 82 percent to a current rate of more than 99 percent (two percent higher than pre-5010 rate)
• Eighty three percent of inbound claims to Emdeon are received in 5010 format
• Eighty percent of claims outbound from Emdeon are being sent to payers in 5010 format
Overall, a lot has been achieved but there is still work to do until a successful and complete 5010 transition has been realized. The transition to HIPAA 5010 may continue to impact cash flow for some time and therefore we recommend that our providers continue to prepare for potential impact. Emdeon continues to execute toward a complete and successful transition to 5010, which is a goal we share with all industry stakeholders.
One item still impacting the transition is a result of post 5010 production behavior not being concurrent with 5010 test results. Our industry has experienced that test platforms with some payers did not fully represent production systems or were unable to test full production volume. Also, some payers were unable to produce valid file acknowledgement or claim status reporting during testing. As a result, the healthcare industry has experienced the following substantial impacts:
o 999s rejecting entire batches for one “bad” claim
o Payer rejection spikes with vague rejection messaging
o 277CA (claim status) transaction issues
o Issues with Electronic Remittance Advice (ERAs) without Tax IDs or having ERAs sent in both 4010 and 5010
If your organization is still experiencing some of the issues, utilize Emdeon Vision for Claim Management to assist with solving your issues prior to opening a case via Emdeon ON24/7. You can also consult the HIPAA 5010 - Top rejection reasons document to educate your providers more about specific issues.
Emdeon has focused on multiple key initiatives within our organization to assist our channel partners and providers.
• Emdeon added resources throughout the last two years in preparation of 5010.
• Our Operations and Information Technology departments have been re-engineered and personnel have been realigned to continuously flesh out the root cause of issues and identify behavioral traits in transaction processing and reporting feedback within payers and fiscal intermediaries
• We have revamped our industry communications across all submitter and payer channels and created a “catastrophic rejection” team that outreaches to our partners with same day identification, root cause and training for all catastrophic daily rejections
• Emdeon has held 5010 specific webcasts for all channels to take part in. These webcasts describe specifically what is being identified and resolved while focusing on how the healthcare industry needs to partner together in order to continually resolve all 5010 related issues
• Key industry stakeholders – Emdeon is continuing to facilitate communication and connect CMS, payers, submitters and third party vendors
• Emdeon is very involved with industry level communications such as:
o Becker’s Hospital Review, News article on preparing hospitals for ICD-10, Meeting the Deadline: A Timeline for Hospitals' ICD-10 Transition
o Debbi Meisner, Part B News, Feature article on the 5010 transition, 5 HIPAA 5010 edits to avoid when testing claims (clip available offline)
o Debbi Meisner, Healthcare IT News, by lined commentary on 5010 preparedness, HIPAA 5010: Are You Ready for the New Transaction Standard?
o Debbi Meisner, AAFP News, News article on the state of 5010 and how doctors can help, http://www.aafp.org/online/en/home/publications/news/news-now/practice-professional-issues/20120215compliance5010.html
o Debbi Meisner, enforcement delay, the actual transition and the benefits to those on the other side on the Government Health IT news site,
http://www.govhealthit.com/news/commentary-how-hipaa-5010-has-fared
• Emdeon is holding regular meetings with CMS, WEDI and other Industry leaders in the payer, clearinghouse and submitter space to identify issues and share best practices on resolution
• Where possible, Emdeon is standardizing vague or un-actionable payer rejection messages to allow Providers to correct and re-file in a timely manner
Our healthcare industry is multi-dimensional and constantly evolving. Emdeon is committed to advance with it while helping our customers evolve too. For additional information about HIPAA 5010 transition and ICD-10 compliance, please visit hipaasimplified.com.
Read More >>
Best Practices in Patient Billing and Collections: Effective Approaches and Tools for Patient Communications
Part 1 of a 4-part series designed to offer small practice providers tips on improving their administrative and clinical operations.
Consider how long it takes to pay your energy bills. Every month, the bill comes in. You are expecting it. You know your service will be cut off if you fail to send a check. So you promptly pay the bill. The time from service delivery to payment collection for utility companies is only a matter of weeks, even with customers who continue to pay through the mail. It’s hard to imagine anything longer than that.
In contrast, the time between a patient visit and full remittance is typically much longer—often dragging on for months.
This is a major pain point for most practices. When your providers don’t get paid in a timely manner, cash flow suffers for both you and your providers. Often, the longer it takes to receive patient remittance, the less likely providers will get paid in full. Discounts may be negotiated, for instance and providers may be forced to write off balances they have no hope of settling.
The bad news is that the problem is expected to get worse. Patient responsibility—out-of-pocket payments—rose nearly 50 percent between 2000 and 2010 to an all-time high of $299.7 billion.* This trend is likely to continue as payers look to relieve their own financial pressures, including increased competition and rising costs for medical care.
Physician practices can achieve a certain degree of control over the situation, however, by recognizing contributing factors, managing “patient-responsible” balances more proactively and communicating with patients more effectively. Here are some tips and tactics to keep in mind.
1. Educate your providers to ensure that the information they have about their patients is current and accurate. This information is provided by the patient through registration forms at the time of the visit or through online forms that the patient can submit prior to arriving at the doctor’s office. Whether your providers use your software or their own technology to capture patient registration, it is important to verify this information with their commercial and Medicare patients at least once a year to keep records up to date. Medicaid patients are the exception: because of the generally transient nature of this population, information should be checked at the beginning of each month.
2. Traditionally, physician practices have not asked and thus often choose not to, bill their patients at the end of the visit. They know insurance will pay some of the charges and prefer to wait until they receive insurance reimbursement to then calculate the patient’s portion. However, providers can close this gap by verifying benefits and eligibility before patients arrive at their office for the appointment. Emdeon is connected to the largest group of commercial and government payers in the industry through which accurate eligibility information can be verified in real-time or high-volume batches. And easy-to-read benefits statements enables providers to see an estimate of what their patients will owe at check-in. This allows providers to educate patients about what’s covered and what’s not and ultimately, what they owe and should pay at the time of service.
3. Use the phrase “final bill” liberally on patient statements. Patients pay more quickly when they understand their balance is really and truly due NOW. After providers have received insurance reimbursement, they should generate a final bill—even if it’s the first statement they have sent. This will alert patients that the amount presented is final and creates a sense of urgency to send payment. Patients may also be more inclined to pay in a timely manner if given a secure online payment option.
Because of the “caring” nature of medicine, some practices in the past have found it difficult to pursue payment from patients. But by utilizing the approaches outlined above, practices can be better equipped to adopt a process to discuss charges openly and encourage timely payment that will allow providers to stay competitive as the trend in patient payment responsibility continues to grow.
By using our innovative reporting, analytics and payment tools like Emdeon Vision for Claim Management, Emdeon Expressbill, and Emdeon Patient Pay Online your providers can see where their revenue is at all times. Our combined approach of strong communication and technology services will cut costs, and speed up the billing and payment cycle giving your providers more time to spend with their patients.
(Note: Stay tuned for an in-depth look at online strategies to enhance patient billing and collections in the next issue of this newsletter.)
If you would like to re-publish provider-focused version of this article or any other for your own newsletter, please email us at channel_partners@emdeon.com.
* “Consumer Out-of-Pocket Payments for National Health Expenditures,” Centers for Medicare and Medicaid Services, Office of the Actuary, Jan. 2012.
Read More >>
Become the Connecting Point Integrate Lab Connectivity Technology to Save Customers Time, Money & Align with Stage 2 Rules
Did you know technology is available to connect providers to labs through Electronic Medical Records (EMRs) without the exorbitant fees for set-up and annual maintenance common to point-to-point connections? There is also a sustainable business model and revenue stream available for Electronic Health Records (EHR) vendors that embrace the shift to the latest technology.
It is natural for the market to eventually shift to more efficient, more affordable technology over time. However, the demands of Stage 2 Meaningful Use rules will likely expedite the evolution away from the point-to-point business model for laboratory connectivity. For any organization looking to stay at the forefront and maximize revenue, the time is now to integrate the latest technology.
Organizations that have not yet made the shift from the point-to-point model are not alone; we are in the early stages of transitioning. Even at the recent Executive War College on Laboratory & Pathology Management, a conference attracting lab business leaders, vendors and policy makers from across the country, it was clear from discussions that many “EMR Hubs” continue to run on dated, point-to-point connectivity that has high-cost and high-maintenance.
However, the latest technology is poised to lead the industry in a new direction. This technology standardizes lab connections through a single interface. As a cloud-based Software-as-a-Service (SaaS), it offers easy implementation and integration, responsive speed in use and little to no ongoing maintenance. This helps accelerate your speed to market with value added solutions for your customers while helping them achieve meaningful use certification.
That last point is significant.
Under the most recently stated rules of Stage 2 meaningful use, at least 40 percent of lab results must be incorporated into EHRs as structured data. Furthermore, Stage 2 doubles (computerized provider order entry) CPOE requirements to 60 percent. Stage 2 will lead to increased order modules in EHRs. This means it will be more important than ever that connectivity between providers and labs be supported through their EMR solutions and that the connectivity extend beyond major labs to include smaller/specialty ones, as well. In fact, according to a recent study*, 57 percent of small practices, 88 percent of large practices and 79 percent of hospitals indicated that achieving Meaningful Use is very important or critically important to their organization. This is a top priority of our industry.
The shift away from the point-to-point model is certainly good news for providers and labs who presently must pay the high fees, wrestle with multiple interfaces and fret about meaningful use compliance. With this new model, providers won’t have to limit their connectivity only to those labs where they do a majority of their work-- the barrier to entry to access all labs is substantially lower.
What is good news for providers and labs is good news for businesses like yours as well. This easy-to-integrate, easy-to-implement technology adds more value to your EHR system in the immediate and long term. You can offer this high-tech advancement for minimal capital investment (and minimal risk) because the infrastructure is in the cloud.
Emdeon is a leading resource in the industry for lab connectivity solutions that go beyond antiquated point-to-point offerings. By using our clinical exchange solutions, you can infuse your EHR system with connections to over 300 laboratories and hospitals, as well as access virtually all pharmacies through our ePrescription transaction routing. With Emdeon, you can become your customer’s ultimate connecting point...without doing all the heavy lifting.
Are you ready to help your customers connect the dots to find an alternative to point-to-point, and increase your opportunity to grow revenue?
Contact us today
About the author:
Michele Judge is Senior Director of Clinical Services at Emdeon. She has over 20 years experience in managing, deploying and developing computerized physician order entry solutions for laboratories, hospitals and pharmacies.
*SOURCE: Emdeon Q12012 Healthcare Insights Report on Small Practice, Large Practice, and Hospitals.
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Discover new ways to simplify your business when you connect with Emdeon
Find us online 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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New Payer Transactions
Claims
Aetna Better Health Inc., Payer ID: 34734
Agency Services Inc, Payer ID: 64158
Benefit Management Group-NV, Payer ID: 36459
CTI ADMINISTRATORS INC., Payer ID: 42141
Carpenters Health and Welfare Fund of Philadelphia, Payer ID: CX101
Claims Management Services, Payer ID: 39141
Clarian Health Plans Inc., Payer ID: 95444
Connecticare - Medicare, Payer ID: 78375
CoreSource Little Rock, Payer ID: 75136
DiaTri LLC, Payer ID: 36439
Employee Benefit Systems, Payer ID: 42149
Fallon Community Health Plan, Payer ID: 22254
GHI - Medicare Private Fee for Service, Payer ID: 22937
GHI - New York (Group Health Inc.), Payer ID: 13551
GHI HMO, Payer ID: 25531
Geisinger Health Plan, Payer ID: 75273
Group Health Cooperative of South Central Wisconsin, Payer ID: 39167
Group Health Inc., Payer ID: 22937
HIP - Health Insurance Plan of Greater New York, Payer ID: 55247
Harrington Health-Kansas (formerly known as Fiserv Health-Kansas), Payer ID: 62061
Harvard Pilgrim Health Care, Payer ID: 4271
ISLAND HOME INSURANCE COMPANY, Payer ID:
IU Medical Group Primary Care, Payer ID: SX172
Integra Group, Payer ID: 31127
LIFE Pittsburgh, Payer ID: 25181
Landmark Healthcare Inc, Payer ID: LNDMK
MED PAY, Payer ID: 88058
MEDICA HEALTH CARE PLAN INC., Payer ID: 78857
March Vision Care Inc., Payer ID: Call
Meritain Health / Agency Services, Payer ID: 64158
Meritain Health/North American Administrators, Payer ID: 64157
Metropolitan Health Plan, Payer ID: 10850
Montefiore Contract Management Organization, Payer ID: 13174
Network Health, Payer ID: 4332
Network Health Insurance Corp-Medicare, Payer ID: 77076
North American Administrators Inc., Payer ID: 64157
North American Health Plan, Payer ID: 64157
North American Preferred, Payer ID: 64157
Northstar Advantage, Payer ID: 60058
ODS Health Plan, Payer ID: 13350
PacificSource Health Plans, Payer ID: 93029
Paragon Benefits Inc., Payer ID: 58174
Prism-First Health, Payer ID: 37303
Screen Actors Guild, Payer ID: 99289
Touchstone Health PSO, Payer ID: 23856
Trellis Health Partners, Payer ID: 36397
Vytra Healthcare, Payer ID: 22264
Weyco Inc., Payer ID: 38232
Wisconsin Department of Corrections, Payer ID: 74101
Anthem Blue Cross, Payer ID: 47198
Associated Benefits, Payer ID: 50266
Blue Cross Blue Shield of New Mexico, Payer ID: SB790
Blue Cross Blue Shield of Oklahoma, Payer ID: SB840
Illinois Medicaid, Payer ID: SKIL0
Nebraska Medicaid, Payer ID: SKNE0
New Hampshire Medicaid, Payer ID: SKNH0
Eligibility Inquiry and Response
Ameritas Group, Payer ID: AMERITAS
Ameritas Life Insurance Company, Payer ID: 425
CoreSource - FMH, Payer ID: CORSE00204
CoreSource - FMH, Payer ID: CRSKC
CoreSource - Little Rock, Payer ID: CORSE00205
CoreSource Little Rock, Payer ID: CRSAR
Coresource - FMH, Payer ID: 204
Coresource Little Rock, Payer ID: 205
First Ameritas of New York, Payer ID: 426
First Ameritas of New York, Payer ID: AMTAS00426
First Reliance Standard Life Ins Co., Payer ID: 428
First Reliance Standard Life Insurance Company, Payer ID: AMTAS428
MMSI, Payer ID: 85
MMSI, Payer ID: MMSI
Medica, Payer ID: 404
Medica, Payer ID: MEDIC
Medical Mutual of Ohio, Payer ID: 211
Medical Mutual of Ohio, Payer ID: MMO00211
Nippon Life Benefits, Payer ID: NIPON
Peoples Health, Payer ID: PPLSH
Reliance Standard Life Insurance Company, Payer ID: 427
Reliance Standard Life Insurance Company, Payer ID: AMTAS00427
SAMBA Health Benefit Plan, Payer ID: SAMBA
Standard Insurance Company, Payer ID: 429
Standard Insurance Company, Payer ID: AMTAS00429
Standard Life Insurance Company of New York, Payer ID: 430
Standard Life Insurance Company of New York, Payer ID: AMTAS00430
ameritas, Payer ID: AMTAS00425
Blue Cross Blue Shield of Pennsylvania (Highmark), Payer ID: BCPAC
Blue Cross Blue Shield of Pennsylvania - Highmark, Payer ID: 440
Mountain State, Payer ID: MTNST
Affinity Health Plan, Payer ID: AFNTY
New Jersey Medicaid, Payer ID: AID19
New Jersy Medicaid, Payer ID: NJ
South Dakota Medicaid, Payer ID: AID28
South Dakota Medicaid, Payer ID: SD
Claim Status And Response:
Ameritas Group, Payer ID: AMERITAS
Ameritas Life Insurance Company, Payer ID: 425
CoreSource - FMH, Payer ID: CORSE00204
CoreSource - FMH, Payer ID: CRSKC
CoreSource - Little Rock, Payer ID: CORSE00205
CoreSource Little Rock, Payer ID: CRSAR
Coresource - FMH, Payer ID: 204
Coresource Little Rock, Payer ID: 205
First Ameritas of New York, Payer ID: 426
First Ameritas of New York, Payer ID: AMTAS00426
First Reliance Standard Life Ins Co., Payer ID: 428
First Reliance Standard Life Insurance Company, Payer ID: AMTAS428
MMSI, Payer ID: 85
MMSI, Payer ID: MMSI
Medica, Payer ID: 404
Medica, Payer ID: MEDIC
Nippon Life Benefits, Payer ID: NIPON
Peoples Health, Payer ID: PPLSH
Reliance Standard Life Insurance Company, Payer ID: 427
Reliance Standard Life Insurance Company, Payer ID: AMTAS00427
SAMBA Health Benefit Plan, Payer ID: SAMBA
Standard Insurance Company, Payer ID: 429
Standard Insurance Company, Payer ID: AMTAS00429
Standard Life Insurance Company of New York, Payer ID: 430
Standard Life Insurance Company of New York, Payer ID: AMTAS00430
For all payers, visit https://access.emdeon.com/PayerLists/
