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.
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HIPAA 5010 - The end of the journey in sight
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.
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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/
