September marks the return of Congress to Washington and the continuation of a historical debate on healthcare reform. As healthcare annual spending tops $2.4 trillion, the stakes are high as Congress faces conflicting pressures to expand coverage and curtail spiraling costs. Controlling these costs is a top priority for President Obama and Congress and will be a key driver of economic stability and growth.
What began as a civilized debate turned into a full scale-political showdown during the August recess—playing out in raucous town hall meetings across the country. A majority of Americans want healthcare reform, but their views vary widely on the approach and funding of reform. Five different Congressional Committees are debating the issue, and three comprehensive bills have been released, including the long-anticipated Senate Finance bill. The question remains—can consensus be reached in a Congress that remains sharply divided on the details of reform?
President Obama Takes a Stand
Action on reform started early as Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee released a high level framework for reform just after Congress reconvened. That news was quickly overshadowed by President Obama’s speech to the joint session on September 9th. The speech was meant to reset the debate and clear up any confusion resulting from political posturing during the town hall meetings and debates during the recess.
The President delivered an emotional and eloquent speech that invoked the memory of Senator Ted Kennedy and attempted to refocus the debate on the merits of his vision for health care reform.
Key components of the President’s plan include:
• Ending pre-existing condition limits
• Limiting premium differences based on gender and age
• Eliminating loss of coverage due to health status
• Capping out-of pocket expenses
• Protecting Medicare
• Eliminating the "donut-hole" gap in Medicare Part D coverage for prescription drugs
• Creating a new health insurance exchange
• Providing new tax credits to help people buy insurance
• Providing small businesses with tax credits and affordable options for covering employees
• Offering a public health insurance option to assist the uninsured and those who cannot find affordable coverage
• Immediately offering new, low-cost coverage through a national "high risk" pool to protect people with pre-existing conditions until the new Exchange is in place
In an effort to reach across the aisle, President Obama did address the need for malpractice reform to help bend the cost curve. He also gave a “read my lips” pledge to make the reform deficit neutral. While a remarkable speech, the most concrete framework for reform emerged from the Senate Finance Committee as it began its long-awaited mark-up this month.
The Three Key Bills
Senate Finance Chairman Baucus released the Chairman’s Mark of the Committee’s bill on September 16th. Senate Majority Leader Harry Reid (D-NV) set a goal to get a bill to the floor for a full Senate vote by the end of September, but the Committee must still finalize the actual language that will appear in the bill. Expect intense philosophical and political debate addressing several of the more contentious provisions in the bill.
Here is an overview of the proposed Senate Finance Bill:
• Cost projected to be $856 billion over 10 years
• Creates health care affordability tax credits to help low and middle income
families purchase insurance in the private market
• Provides tax credits for small businesses to help them offer insurance to their
employees
• Allows people who like the coverage they have today the choice to keep it
• Reforms the insurance market to end limits on pre‐existing conditions and health status
• Eliminates yearly and lifetime limits on coverage
• Creates web‐based insurance exchanges that would standardize health plan
premiums and coverage information to make purchasing insurance easier
• Gives consumers the choice of non‐profit, consumer owned and oriented plans
(CO‐OP)
• Standardizes Medicaid coverage for everyone under 133 percent of the federal poverty level
• Requires adoption of standardized electronic administrative transactions to drive efficiency, reduce errors and lower costs
While the Senate Finance Committee bill is considered most likely to advance, two other bills have already been approved in key Committees—the Senate Committee on Health, Education, Labor, & Pensions (HELP) and the House Tri-Committee bill passed by the Committees on Energy and Commerce, Ways and Means, and Education and Labor. Those bills will need to be reconciled with the final version of the Senate Finance bill.
In July, the Senate HELP Committee, chaired by the late Senator Kennedy, became the first Congressional committee to approve meaningful healthcare legislation when it passed the Affordable Health Choices Act. Originally, The Congressional Budget Office (CBO) estimated the bill to cost less than $615 billion over 10 years, but this month the CBO confirmed in a letter to Senator Enzi the bill would increase the deficit by over $1 trillion and would lead to an increase in national health care spending.
Key provisions include:
• State health insurance exchanges
• Government-run, public health insurance option to compete with private insurers to drive costs down
• Individual insurance mandate, with some exceptions for those who cannot afford coverage
• Employers with 25 or fewer employees also exempt from penalties
• Prohibiting insurers from denying coverage based on their health status
• Promoting quality through financial incentives for providers
• Coverage of preventive health services
• Extending coverage for dependent adults until age 26
• No lifetime or annual limits on individual or group health insurance policies
The House Tri-Committee approved its own healthcare reform bill before leaving for the August recess. This bill known as H.R. 3200 was much more hotly debated and was approved in a much closer vote than the HELP Committee’s bill. It seemed unlikely that the bill would pass until several concessions were made to Blue Dog Democrats who had crossed party lines to protest certain provisions in the legislation.
Basic components include:
• Creation of a public insurance option
• Expanding access to health insurance
• Standardized benefits packages
• Provisions to end premium increases or coverage denials for "pre-existing"
conditions
• Eliminating co-pays for preventive care
• "Affordability credits" to make premiums affordable
• Caps on out-of-pocket expenses
• Employer mandate - pay or play
• Guaranteed catastrophic coverage
The Senate Finance Committee was widely viewed as the key to passing meaningful bi-partisan legislation this year. However, after three months of negotiations between the “Gang of Six”—the three Democratic Senators and three Republican Senators who helped craft the legislation—no Republican Senators would publicly support the Chairman’s Mark of the bill. Several key Democrats from both the House and the Senate have publicly stated their disapproval of the legislation in its current form as well. Senator Kennedy’s absence not only leaves Democrats without a statesman that could potentially bridge the partisan divide, but also leaves Senate Democrats one vote short of the sixty needed for a filibuster-proof majority when the debate advances to the floor.
If talks continue to deteriorate between the two parties, Senate Democrats might be willing to pursue the budget reconciliation process which would allow the legislation to pass the Senate with a simple majority instead of 60 votes. Earlier this year, the Senate agreed to a deal that would allow the process if a bill has not passed by October 15th.
Expect the debate to escalate in the days ahead as the Senate Finance legislation advances towards the floor. With Republicans stating the bill goes too far and Democrats criticizing the bill for not going far enough, Congress will need a near herculean effort to bridge the divide and pass meaningful bi-partisan health care reform this year.
Emdeon Supports Sensible Policies, Practical Solutions
Emdeon supports and promotes sensible public polices and practical solutions that make healthcare efficient. Our goal has been to help reframe the healthcare reform debate and focus on actions we can take today to take costs out of the system. Key areas like administrative simplification, program integrity/fraud and abuse, third party liability cost avoidance and public beneficiary management offer billions in potential annual savings.
The U.S. Healthcare Efficiency Index™, launched by Emdeon in 2008, identified $300 billion in savings over 10 years from automating the most basic healthcare administrative transactions. Emdeon has worked to raise awareness of these potential savings that can free up dollars to pay for delivery of care or offset costs of longer term reforms. Currently all three major bills include provisions in these key areas.
Congress Returns to Resume Critical Healthcare Reform Debate
At Last, Breast Health Literature is Reachable at Teachable Moments
Emdeon Partners with Susan G. Komen for the Cure® for Unprecedented Education & Awareness Campaign
Today, the scenario often works like this.
A woman goes to the doctor for an annual check-up. She dreads the unpleasant but necessary aspects of her exam yet accepts them as her duty to stay healthy. At some point in the visit, the healthcare provider inquires if she conducts regular self-breast examinations. The woman answers timidly “sometimes,” at which point the provider states the importance of self-exams. The woman, already feeling less than comfortable, hears the advice as she does every year. By the time the check-up is done, she’s thinking about her next stop (back to work, off to the store, etc.), never to ponder self-exams again until next year’s check-up comes around.
In the future, thanks to the real-time technology of Emdeon Office and the real-life information of the Susan G. Komen for the Cure®, the scenario will work something like this.
...The woman answers timidly, “sometimes,” at which point the provider offers the patient relevant breast health information printed just for her that addresses key issues and tips she can apply daily to change her “sometimes” into a solid “Yes!”. The woman, feeling empowered by useful information, finally decides to prioritize her breast health. By the time the check-up is done, she’s thinking about her next stop (back to work, off to the store, etc.), yet will definitely ponder self-exams later that evening thanks to the materials she has in hand.
That’s right. The scenario is about to change, and hopefully you and your fellow Emdeon Office users will be compelled to participate and inspired to save a life!
Emdeon and Susan G. Komen for the Cure are partnering to revolutionize in-office, teachable moments by making breast health literature readily available to patients through their healthcare providers. Providers who utilize Emdeon Office—presently tens of thousands of offices nationwide—will be able to print out practical, useful information for patients during appointments and points of care, potentially empowering thousands upon thousands of people with deeper knowledge about how to detect and respond to risk factors, face challenges and get help.
This is an ultimate ‘real-time meets real-life’ opportunity.
(And you thought Emdeon Office was only helpful for your practice’s verifications and administrative and financial functions!)
The information that will now be available through Emdeon Office is wide-ranging and immensely relevant. Topics such as “Breast Cancer Risk Factors”, “When You Discover a Lump”, and “Sexuality & Intimacy” are presented in effective language to teach patients when they’re most reachable. These modern educational materials, printable in English and Spanish and accessible in six versions, are filled with life-saving information, practical tips and inspiring content—the hallmarks of the compassionate quality common in all Komen for the Cure communications tools.
Emdeon’s product development team has worked closely with the Komen organization to build this innovative capability into the Emdeon Office portal. The system does not limit the number of downloads or print-outs of the materials and will function seamlessly and simply within Emdeon Office.
The revolutionary campaign is launching in October, National Breast Cancer Awareness Month, putting life-saving information in the hands of providers who are ready to teach, want to change the scenario for their patients and are inspired to save lives.
And the envelope, please… (Make that millions of envelopes, please!)
Think pink and save a life!
If you see a pink slip in your mailbox from Emdeon during October, you don’t need to worry! To kick off the revolutionary partnership with Susan G. Komen for the Cure and help raise awareness, Emdeon’s print and mail facility will produce outgoing envelopes during the month of October, marked with the motivational message “Are You Inspired to Save a Life? Find out how at www.komen.org/inspire”. Emdeon sends millions of consumer statements each month, and that means millions of people will be thinking pink in October.
For more details, visit www.komen.org/inspire
Emdeon ON24/7: Your Ticket to Real Time, Any Time Resolutions
Your need for support isn’t on a time clock, and it certainly doesn’t keep normal business hours. Thankfully neither does Emdeon ON24/7, the real time, any time source for support and issues resolution available to all Emdeon Office users. Though you may expect the unexpected in this business, (payer outages, customer service alerts, industry updates), Emdeon ON24/7 helps explain the unexpected. Likewise, it helps find solutions so you can navigate the challenges more easily to keep your office running as smoothly as possible.
As an Emdeon Office user, you’re already accustomed to round-the-clock accessibility for online task handling, benefits information and claims management. The ease and immediacy of Office’s functionality helps you work efficiently, regardless of “normal business hours.” Emdeon ON24/7 is an extension of the timely services you’re already using. This tool is always available to help you get answers, updates and alerts in real time, no matter what time of day (or night) you log on.
Support is always at your right hand. When you log into Office, look at the right hand side of your screen. There you’ll find Emdeon ON24/7, your gateway to immediate updates and news through the Emdeon network; no special log in is required. If you are experiencing difficulties, this is the place to check for word about outages, updates or problems; it’s also handy for accessing information about issues that have yet to affect your office operations.
Get personalized support for issues specific to you. This innovative, live support system is designed to not only help and inform regarding system-wide or nationwide issues; it’s created to offer customized, personalized resolution for user-specific issues. You can log on at your convenience, use the tools to initiate service requests and move at your own pace regarding situations at hand—as simply and securely as using Emdeon Office.
Solutions Availability Reporting: With an unwavering goal of 100% uptime, Emdeon tracks and reports uptime for the company’s core infrastructure. This valuable information is used company-wide to influence strategies and tactics focused on reliability.
State your case-in your own words anytime. When creating and stating your case, you can use your own words with Emdeon ON24/7. The system doesn’t function on impersonal automation that needs you to explain your situation by answering confining yes/no questions or clicking on predefined terminology or descriptors. We want and need to hear what’s going on in your words and terms because we involve real people in assessing and answering your requests.
Use of Ticketing: To achieve uninterrupted uptime, it is essential to do more than trouble shoot. Emdeon utilizes a ticketing system to denote and resolve issues while creating a reference for historical resolution. This approach helps to identify patterns and root causes and institute long term solutions.
Transparent support will see you through. Once you create a case, you can then track progress in real time, any time through the Emdeon ON24/7 system. We’ve built in total transparency, so that you know the status and details throughout the progression and resolution of your request. You can check for yourself to ensure all the details are properly logged and documented, and you can upload necessary evidence and files as needed at your convenience, 24/7. There’s no veil, so you can see where things stand until we see your issue through.
Explain or train 24/7. Consider Emdeon ON24/7 the one-stop resource for answers and updates. With an always-updated array of FAQs, payer fact sheets, training materials and real-time alerts at your right hand, you can train your staff and explain issues with ease and clarity. The system is designed to be easily manageable for multiple users and provides convenience to fit into your office’s workflow.
If the idea of “normal business hours” seems almost comical in your busy office, remember to rely on the support that’s at your right hand around the clock: Emdeon ON24/7.
No need to call
• No special log in required - accessible to all Emdeon Office users
• Round the clock support with no need for phone calls
• Fast, accurate answers online, all the time
• Transparent ticket tracking 24/7
• Real resolutions in real time
• Training, FAQs & payer info always accessible
When was the last time you were wowed by your claim reports?
Announcing Emdeon Vision for Claim Management.
Why search for claims like this...
when you can quickly view claims and identify claim rejection trends....
Emdeon Vision for Claim Management is a powerful, web-based application designed to give providers the same simplified, end-to-end visibility into the claim cycle that the Emdeon support uses. Emdeon compiles claim information received and generated during claim processing, and presents it in an easy to use application for tracking through the adjudication process. Versatile search methods and claim reports, displayed in consistent formats, eliminate the labor-intensive work of monitoring paper claims.
Emdeon Vision for Claim Management is now integrated into Emdeon Office and is available at no additional charge. If you already use Emdeon Office then fifteen months of historical claim data is already available to you.
Emdeon Office with Vision for Claim Management Features
• Interfaces with ANY existing practice management system
• No hardware or software installation required
• Clearinghouse edits to increase payer acceptance rates
• Visibility into all claims, accepted or rejected
• Interactive dashboards enable you to drill down, search and see claim details
• Claim search results returned in seconds!
This feature requires no enrollment. Fifteen months of historical claim data is already available to you. Log into your Emdeon Office account. Select Send Claims > Claim Management. Enter information you want to review, and begin seeing your claims in a whole new way.
Emdeon Podcast Series
Physicians Practice and Emdeon have teamed up to bring you a series of short podcasts focused on how you can get more out of your practice. In these podcasts, you'll learn from industry leaders as they discuss topics such as Best Practices for Picking a Clearinghouse and Top Billing Errors and How to Avoid Them.
Click the Learn More button to listen to this month’s podcast– also available on iTunes.
eHealth Educational Seminar
October Please visit our EDI Transaction Center online to register online and obtain other information that will help you send more transactions electronically.
A FREE seminar covering payer requirements for filing claims electronically, benefits of real-time transactions, and understanding electronic claims submission reports. Staff from provider offices, hospitals, facilities, billing services, etc. are invited to learn more about how to save money and improve efficiency by effectively utilizing electronic transactions. Participating payer representatives will be present at each seminar to answer any questions you may have about filing claims!
• October 6, Tampa, FL
• October 8, Jacksonville, FL
• October 29, Raleigh, NC
Do you know?
• Top reasons claims are rejected
• How to resolve claim rejections
• What information is required by each payer to file claims electronically
• How to submit secondary claims electronically
• The benefits of ERA/EFT
• What electronic reports you should be receiving and how to read them
• How to maximize your potential with electronic transactions
• Various EDI transactions available today
• What EDI transactions save you the most money
• What EDI transactions payers are recommending
New Payers on board
The Emdeon network of payers continues to grow
New payers added recently:
• Affordable Benefit Administrators, Inc. - Claims
• American Behavioral - Claims
• Atlantic Medical Insurance - Claims
• BritCay - Claims
• CareSource-Mid Rogue Health Plan - Claims
• CeltiCare - Claims
• Cenpatico Massachusetts - Claims
• Central Reserve Life - Claims
• Central Reserve Life - ERA
• Community Medical Group of the West Valley, Inc. - Claims
• Delaware Medicare Part A - Claims
• Denti-Cal - ERA
• Eastland Medical Group - Claims
• Elmcare, LLC - Claims
• Formula Card Dental - Claims
• H & A Administrators - Claims
• Health Choice Arizona - ERA
• Health Choice Generations - ERA
• Health Options of Illinois - Claims
• Healthsmart Accel - Claims
• Hinsdale Physician Healthcare - Claims
• Holy Cross Health Partners - Claims
• Ingalls Provider Group - Claims
• Korean American Medical Group - Claims
• Lakeside Comprehensive Healthcare - Claims
• Lakeside Medical Group - Claims
• Maine Medicare A - ERA
• Mid Rogue Oregon Health Plan - Claims
• Mississippi Medicaid - Claims
• Mississippi Physicians Care Network - Claims
• MPA-Custom Provider Network - Claims
• Northern Minnesota Dental - Claims
• Northwest Community Health Partners - Claims
• Oak West Physician Association - Claims
• OMNI/Medicore HP - Claims
• PacificSource Health Plans - ERA
• Paragon Benefits, Inc. - Claims
• Passport Health Plan - Claims
• Personal Insurance Administrators, Inc. (Agoura Hills, CA) - Claims
• PreferredOne (MN) - Claims
• Prime West Health - Claims
• Secure Health Plans of Georgia, LLC - Claims
• Senior Care Partners - Claims
• Seven Corners - Claims
• Sheffield, Olson, & McQueen, Inc - Claims
• Silver Cross Managed Care Organization - Claims
• State Auto Insurance Companies - Claims
• Swedish Covenant Hospital - Claims
• Tehtys Health Ventures - Claims
• TriHealth Physician Solutions - Claims
• University of Illinois at Chicago, Division of Specialized Care for Children -Clai ms
• Value Options New Mexico - Claims
• Verdugo Hills Medical Group - Claims
• Wenatchee Valley Medical Center - Claims
• West Covina Medical Group – Claims
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists.php:
White Paper Shines Light on Administrative Waste: Offers Practical Steps for Cutting Healthcare Costs through Existing Infrastructure, Collaboration
CHICAGO, April 6 /PRNewswire/- The U.S. economy transmits over 18 billion electronic payments each year, yet approximately half of all healthcare financial transactions are still paper-based. Costs of paper, printing, postage and labor for manual processes in healthcare are estimated to add up to nearly $30 billion a year in waste(1). As healthcare reforms are considered in Washington and in all 50 states, administrative savings represent a bright spot- low-hanging fruit- that could help pay for longer-term reforms.
To help inform this dialogue, Emdeon, in cooperation with the Center for Health Transformation, today unveiled an important white paper at the HIMSS 2009 Annual Conference. The white paper, "Taking the Paper Out of Paperwork: How Electronic Administration Can Save The U.S. Health System Billions," looks at the gaps in the industry that keep it dependent on manual processing- and offers practical steps for breaking this costly and inefficient cycle.
"In these trying economic times, combined with the specter of unsustainable spending, Medicare insolvency and runaway growth in Medicaid, we must find those IT solutions that can not only save lives but can also lower costs," said Former House Speaker Newt Gingrich, founder of the Center for Health Transformation.
The white paper provides a step-by-step roadmap for both payers and providers and highlights best practices that are delivering tangible results today. This pragmatic approach leverages technology and infrastructure that already exist- and provides a vision for a new kind of industry collaboration.
"It's not about infrastructure," says George Lazenby, chief executive officer of Emdeon. "The infrastructure is there, and the technology exists. All the constituents are looking for ways to optimize their business processes."
Among the barriers cited are lack of integration, lack of complete standards, competing priorities between stakeholders and a perceived lack of value to healthcare providers.
"We see higher adoption of electronic healthcare transactions when they meet the needs of both providers and payers," said Lazenby. "It's about making the information available at the point where decisions need to be made."
Recommendations outlined in the white paper include:
For Payers
• Develop and pilot reimbursement programs that reward quality healthcare practice and results, including electronic information exchange
• Ensure all future information technology development is done according to industry standards
• Collaborate around multi-payer functionality understanding that providers want a single resource for interacting with health plans
For Providers
• Keep abreast of federal funding opportunities for health information technology
• Include process re-engineering for an electronic end-to-end eligibility, claims and payment process in electronic medical record (EMR)implementation strategies
• Work with medical societies and specialty groups to advance national standardization goals
About Emdeon
Emdeon is a leading provider of revenue and payment cycle solutions that connect payers, providers and patients to integrate and automate key business and administrative functions throughout the patient encounter. Through the use of Emdeon's comprehensive suite of products and services, its customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle process. Emdeon is owned by General Atlantic LLC and Hellman & Friedman LLC. For more information, visit www.emdeon.com.
Link to the white paper:
http://www.emdeon.com/pdfs/TakingPaperOutofPaperwork.pdf
(1) National Automated Clearinghouse Association, ACH 2007 Volumes, May 19, 2008; U.S. Healthcare Efficiency Indes™, www.ushealthcareindex.com February 2, 2009.
SOURCE: Emdeon
"See"EO: Chief Executive Officer, George Lazenby, Sees All in Emdeon's Infrastructure
Take a peek behind the technology that makes innovative system monitoring possible
From his office in Nashville, Tennessee, Emdeon CEO, George Lazenby, always has a clear view. This fact has nothing to do with what he can see outside his window. Instead it refers to what he can see inside his organization. With an innovative in-office infrastructure monitoring system, Lazenby can watch all aspects of Emdeon business and service performance—in real-time, at any time. He has unobstructed visibility of every level of the company’s infrastructure, and he watches intently with the goal to better serve customers.
Even the smallest details are within view with this real-time infrastructure monitoring system. Lazenby can see how long it takes for every customer service call to be answered. He’s able to keep a watchful eye on Emdeon’s two data centers and all activities, from billing and reporting to product functions and service. If it takes more than 30 seconds for a customer service call to be answered or there’s even a slight glitch at any point in the process, he’s able to know it—and address it—immediately. And, if he’s not in front of his in-office infrastructure monitoring system, email alerts are sent directly to him should anything merit immediate attention. The monitoring is so thorough that Lazenby can drill down to any point in the vast corporate infrastructure to identify who on his team is responsible for anything he observes. And because monitoring is only valuable if the company is able to respond to issues as they are revealed, Emdeon’s infrastructure is built to provide inherent tactical responsiveness. The company can not only identify problems, but track patterns and take fast action to implement solutions.
According to Lazenby, this level of monitoring and response is the fruit of a continued concentrated focus on improving service levels across the board. The company’s IT division has successfully consolidated operations so that communications are tight, technological functions run efficiently and reliability is consistent. Of course, with the CEO constantly a click away from “seeing all,” accountability comes from the C-suite out—positively affecting performance company-wide. “Urgency is increased when the good people who work here realize addressing service and performance issues are so important that I have a monitor in my office that tracks everything up to the second,” Lazenby explains. “A proactive process emerges from this level of visibility.”
Additionally, this comprehensive monitoring has enabled Emdeon to identify and improve many things that were previously under the radar. Correlations are identified between various aspects of operations and service and can be addressed effectively. By drilling down to find issues that affect interdependent functions, Emdeon is able to eliminate causes of down time and improve reliability. “What we do is critical to what our customers do,” states Lazenby. “That’s why we invest in things like this.”
Lazenby’s in-office infrastructure monitoring system is a quick, comprehensive reference tool created expressly for the CEO. However, the goal is to one day provide customers access to similar information. That’s how confident and committed Lazenby and the team at Emdeon are regarding the integrity and transparency of service. Though sharing the infrastructure monitoring system with customers is likely a few years out, the high quality, real-time data, stats and reporting are already in place and in use—to the customers’ benefit.
As a matter of fact, Emdeon’s extensive monitoring system is the manifestation of the company’s ongoing efforts to improve its core infrastructure. Highly complex and multi-layered, Emdeon’s technology is constantly being honed to ensure near-flawless performance between divisions and disciplines. Ironically, this complexity ultimately provides transparency and simplicity for customers who enjoy such reliable service that they rarely need to think about what’s going on behind the curtain.
A peek behind the curtain reveals the vast complexities of all that goes into Lazenby’s seemingly simple, clear view. Emdeon is ceaselessly engaged in improving its technologies and service. In an infrastructure that runs deep and wide, every aspect of operations is interdependent on the other and it takes a skilled and committed team to navigate the challenges and opportunities that technology brings. “Of course, customers have no need to worry about all that,” Lazenby summarizes, “with this, they know we’re on the case...providing integrity of service.”
With that kind of viewpoint, it’s quite clear. Emdeon is committed to simplifying the business of healthcare no matter how complicated that process may be.
Overall Technology Strategy: Emdeon has long been committed to quality management in IT with the goal of 100% reliable performance and efficiency of operations. Already, the company has achieved near Six Sigma levels of sustained performance/service while containing costs. This strategy is a core differentiator for Emdeon with its customers.
Data Center Consolidation: Emdeon now operates two world-class data centers (rather than several locations), geographically distant from one another and equipped with the highest levels of security and functionality possible with today’s technology. These facilities are fortified to sustain operations even in the most extreme scenarios (i.e. - natural disasters).
Solutions Availability Reporting: With an unwavering goal of 100% uptime, Emdeon tracks and reports uptime for the company’s core infrastructure. This valuable information is used company-wide to influence strategies and tactics focused on reliability.
Business Activity Monitoring through Technology: As previously described, Emdeon has advanced its monitoring capabilities to not only watch and respond to issues by division; the company now monitors company-wide interdependencies, in total view and in real-time. In addition to constant assessment of IT infrastructure, Emdeon has added Call Center monitoring to ensure impeccable frontline service.
Use of Ticketing: To achieve uninterrupted uptime, it is essential to do more than trouble shoot. Emdeon utilizes a ticketing system to denote and resolve issues while creating a reference for historical resolution. This approach helps to identify patterns and root causes and institute long term solutions.
IT Service Management (ITSM): Emdeon has implemented ITSM to proactively lead the company to new heights in technological service. With a goal to earn ISO certification and implementation of a comprehensive information security framework by end of year 2010, Emdeon’s ISTM team is focused on integrating procedures that intrinsically improve IT operations, maximizes internal resources and ultimately provides the best service for customers.
Dealing with Accelerating Patient Responsibility
The market is shifting, and with it the portion of a physician's bill for which the patient is responsible is increasing. Over 40 million Americans are uninsured and it’s getting worse in our challenging economy. However, there are solutions to help physicians protect their bottom line. Physician’s Practice and Emdeon have partnered to provide some insight into these challenges. Click the PODCAST below to listen to a short, informative roundtable discussion on “Dealing with Accelerating Patient Financial Responsibility.”
Paper Cut
Solutions for making the Switch from Paper to Electronic Payments
At first glance it’s hard to imagine a provider wouldn’t clamor to receive payments through Electronic Funds Transfer (EFT.) The phrase itself connotes a seamless transfer of monies owed for services rendered. Providers receiving prompt, direct payment—that’s a great thing.
Adoption of EFT benefits not just providers; it benefits payers, patients and the public at large. Cutting the paper and going electronic is a win-win, win-win.
First and foremost, EFT provides significant cost savings. Across the board, all participants in the revenue cycle see notable savings/increased profitability long term with EFT. Savings are achieved through the elimination of costs for supplies and labor for printing, mailing, sorting and hand processing (keying, sending, filing, etc). EFT saves money lost through errors common to traditional funds transfer. When money is transferred electronically, checks don’t get lost in the mail, manual entry mistakes are avoided, and cash flows more smoothly. These savings are seen during payables and receivables—and at every point in the revenue cycle in between.
_____________________________________________________________
Billions of Dollars Could be Saved
The healthcare industry would realize nearly $30,000,000,000 in savings if total electronic conversion were to fully occur. Approximately $11,000,000,000 would be saved if just EFT were adopted industry wide. This data comes from the US Healthcare Efficiency Index™, a forum for monitoring the industry’s progress from a paper-based system to an electronic one. Who would benefit from the healthcare system saving billions of dollars by running more efficiently? Everyone.
_____________________________________________________________
Naturally, EFT is also a major time saver, and we all know time is a valuable currency in our fast-paced industry. When staff members don’t have to deal with the aforementioned printing, mailing, sorting, hand processing or manual keying, they work more efficiently and productively on tasks that are of greater, more lasting value. There’s no lag time waiting on mail delivery, check clearances, funds to be released or payments to post. Work flow and cash flow are improved.
It’s also worth noting that EFT is not only a leaner process, it’s a greener one as well. Cutting paper out of the process will measurably reduce the environmental impact of paying and receiving funds. Trimming waste ultimately results in less rubbish in landfills, as well as less precious square footage swallowed in storing documentation and copies.
_____________________________________________________________
A Leaner System. A Greener World.
Going electronic saves trees by reducing the amount of paper needed. to run the system. The US Healthcare Efficiency Index™ estimates that we would eliminate the need for 4,969,875,000 sheets of paper annually by adopting an electronic system.
_____________________________________________________________
With all these long term benefits in addition to the immediate potential for seamless payment, it’s a wonder total adoption of EFT has yet to occur. However for many providers, “seamless” isn’t always what it, well, seems. There are some key issues that must be addressed in order to make EFT the optimal choice for all providers.
The most common barrier is the expense involved in acquiring the needed technology just to get started. Even if a provider desires the long term savings of electronic payment, they may find the initial investment cost prohibitive. From large groups to small clinics, all providers have to invest in technology, even though their resources may be disparate. Though more and more affordable solutions for payment review, reconciliation and posting are appearing in the marketplace, the perception that technology is expensive is deeply rooted and challenging to overcome.
Another issue is lack of consistent, standardized data between payers and providers or allowed variances even when standardized code sets exist. With so many players in the game, it’s challenging to get everyone speaking the same coding language or requiring the same data during remittance. In addition, payments are often not processed electronically because providers did not initiate the claim electronically; every step of the process must tactically lead to the next.
Thankfully, the healthcare industry as a whole, motivated by the potential savings benefits reaching well into the billions, is addressing these issues with responsive solutions.
Most notably, standardization is proving to be immensely helpful. There’s a growing trend in payers standardizing electronic payments to their providers. As payers standardize the process, more providers will be able to make the transition, and everyone will benefit from economies of scale that come into play to help defray costs.
Additionally, HIPAA has mandated code sets to help standardize the process, though variances still exist in an industry as vast and complex as this. Certainly vendors—clearinghouses in the business of electronic data transmission—have been at the forefront of this transition and have developed technology to aid in the translation of data. Innovations and standardization will ultimately work together to navigate the process.
All said and done, it’s time to get on board and join the forward motion. While some industry professionals are somewhat set in their ways, preferring to keep the paper they’ve known and trusted rather than convert, the fact is the industry’s arrived at a ‘lead, follow or get out of the way’ juncture. As a matter of fact, the state of Minnesota is now the first to require all healthcare payers and providers to submit claims, eligibility and payments electronically. Other states may likely follow suit.
In the interim, we can all be assured by the ongoing transitions of colleagues in the industry. Some providers have already made great headway, and thankfully we can learn from each other.
Want more details about the efficiency of the healthcare system? Visit www.ushealthcareindex.com. Ready to cut the paper in your practice? Contact us today to talk about solutions.
Read More >>
eHealth Educational Seminar
August Please visit our EDI Transaction Center online to register online and obtain other information that will help you send more transactions electronically.
Emdeon is offering a free seminar covering payer requirments for filing claims electronically, benefits of real-time transactions, and understanding electronic claims submission reports. Staff from provider offices, hospitals, facilities, billing services, etc. are invited to learn more about how to save money and improve efficiency by effectively utilizing electronic transactions. Participating payer representatives will be present at each seminar to answer any questions you may have about filing claims!
• Week of August 17: Des Moines, IA
• Week of August 17: Omaha, NE
• Week of August 31: St. Louis, MO
Do you know?
• Top reasons claims are rejected
• How to resolve claim rejections
• What information is required by each payer to file claims electronically
• How to submit secondary claims electronically
• The benefits of ERA/EFT
• What electronic reports you should be receiving and how to read them
• How to maximize your potential with electronic transactions
• Various EDI transactions available today
• What EDI transactions save you the most money
• What EDI transactions payers are recommending
New Payers on Board
The Emdeon network of payers continues to grow
We have recently added the following payers:
• ACS Inc. - Claims
• Benefit Management Inc. of KS - Claims
• Better Health Plans Inc. - Claims
• Blue Choice Medicaid Managed Care - Claims
• Cahaba GBA Division of BCBS of Alabama - Claims
• CHP DIRECT SUPERMED - Claims
• CIGNA Voluntary - Claims
• Community Medical Group of the West Valley Inc. - Claims
• Connential Key Family - Claims
• Custody Medical Services - Claims
• District of Columbia Medicaid - Claims
• District of Columbia Medicaid - ERA
• Eastland Medical Group - Claims
• EDS - Claims
• First Coast Service Options - Claims
• Group Health Cooperative - WA State - Claims
• Group Health Options - WA State - Claims
• Korean American Medical Group - Claims
• Lakeside Comprehensive Healthcare - Claims
• Lakeside Medical Group - Claims
• MCNA DENTAL - Claims
• Meridian Health Plan - Claims
• Molina Healthcare of Ohio - Claim Status Inquiry and Response
• Molina Healthcare of Ohio - Eligibility Inquiry and Response
• Northstar Advantage - Claims
• PacificSource Health Plans - ERA
• PODIATRY NETWORK FL - Claims
• Renaissance Physicians Organization - Claims
• Rocky Mountain Health Care Corp. - ERA
• Rocky Mountain Health Plan - Grand Junction - Claims
• Select Benefit Administrators Inc. - Claims
• Texas First Health Plans (TIOPA) - Claims
• Texas HealthSpring - Claims
• Tricare North Region - Claims
• Unison Health Plan/Better Health Plans - Claims
• United Agriculture Benefit Trust - Claims
• Verdugo Hills Medical Group - Claims
• Viva Health Plan - Claims
• West Covina Medical Group - Claims
• Wisconsin Medicaid - Claims
For a complete list of the payers in our network, visit our website at www.emdeon.com/PayerLists/payerlists.php
Emdeon Asks the $30 Billion Question
Introducing the U.S. Healthcare Efficiency Index™
“What would you do with $30 billion?” This question sparked a groundswell of intrigue at the recent Healthcare 2.0 conference in San Diego. Purveyed on buttons and business cards at the event, this hypothetical inquiry alludes to the dollar value assigned to the cost of the healthcare industry’s voluminous inefficiencies as it lumbers toward becoming electronically-based. A guerrilla website—www.save30billion.com—supplemented the messaging, concurrently touting the $30 billion question to curious participants and putting a spotlight on a must-address issue for the industry.
For those of us who’ve worked in healthcare any length of time, it may be hard to fathom there’s $30 billion (with a “b”!) of business inefficiencies in our industry. Of course, we know the transition is far from complete, and there’s always room for improvement...but $30 billion worth? Aren’t we ceaselessly implementing technology or upgrading systems to accommodate a new mandate, fulfill a market demand or streamline revenue cycles?
And if there’s still a $30 billion chasm—even after all the electronic evolutions, solutions and changes, how can we ever be sure we’re making real progress?
Enter the U.S. Healthcare Efficiency Index™.
The U.S. Healthcare Efficiency Index is “an industry forum for monitoring the business efficiency in healthcare.” The Index, already online at www.ushealthcareindex.com, is poised to be the singular source for tracking the transition of our system from paper to electronic transactions.
This innovative forum—and the intriguing $30 billion question that was its precursor—are the brainchildren of Emdeon’s leadership team. Though the Index was born of Emdeon’s unwavering commitment to electronic efficiency, it is established, guided and advised by some of the nation’s most respected, authoritative experts from the healthcare industry and beyond. The charter advisory council includes the likes of Former House Speaker Newt Gingrich, founder of the Center for Health Transformation. Renowned statisticians Dr. Fritz Scheuren and Dr. Patrick Baier are creating processes for data gathering, analysis and reporting for the Index.
Emdeon’s Senior Vice President of Corporate Strategy Miriam Paramore serves on the Index’s advisory council and is a passionate advocate of the need for awareness and action.
“So many business leaders and policy makers assume that billing and payment related transactions have been ‘fixed’ and are fully automated, but that’s not so.” Paramore explains. “For example, when we tell people that medical payment transactions alone could create $11 billion in annual savings through direct deposit, they’re blown away. They had no idea there was such need for improvement.”
The Index is launching in phases to accommodate increased specificity over time. Phase 1 is focused on the potential savings for medical claims-related transactions. Future phases will address pharmacy, dental, vision and Worker’s Compensation. In addition to the tracking of financial data, the Index also follows environmental impact as the industry moves away from paper usage to electronic transactions. Information will be updated quarterly.
Log on and sign up. Visit the "Get Involved" page of the website to sign up for regular updates and opportunities to participate.
Advisory Council Roster (to date)
Fritz Scheuren, Ph.D.
Scheuren–Ruffner
Patrick Baier, D.Phil.
Milliman, Inc.
John L. Phelan, Ph.D.
Milliman, Inc.
Andrew Naugle, MBA
Milliman, Inc.
Jane Sarasohn-Kahn, MA, MHSA
THINK-Health
Health Economist and Author
Newt Gingrich
Center for Health Transformation
Miriam Paramore
Emdeon
Read More >>
Bring Your Green Ways to Work
We've all heard about the need for consumers to 'go green'. A new emphasis on conservation and sustainability continues to pop up in almost every industry as people want to know that their goods and services, no matter how big or small, are being produced responsibly and with the environment in mind.
While these market forces push large corporations towards high-profile green practices and heightened social awareness pushes consumers towards the same, small businesses, and especially healthcare practices, have a different set of concerns and considerations. For many, there is the perception that going green is expensive. In some cases, such as adopting alternative energy options or utilizing equipment made from sustainable materials, this can be true. However, there are also many areas where what is good for our environment is also good for your bottom line.
Here are a few tips to help make your healthcare practice greener while making it more efficient:
Save energy when possible—If you can turn off more lights, adjust the thermostat at night and switch to energy efficient halogen bulbs, you'll save on your energy bill and ease the burden on your local power grid.
Reduce driving—whether it's consolidating trips to the bank, the office supply store or for lunch if your practice pays for fuel at any point reducing the mileage driven helps your bottom line and the environment.
Power down—According to Time Magazine* setting computers to power down after 15 minutes of inactivity can cut its use by 70%, which not only saves energy, but can lengthen the life of many computers.
Ditch the paper—migrating manual and paper processes to newer and more efficient electronic ones can drastically reduce the amount of paper, ink and other materials your healthcare office uses every day while increasing productivity.
When it comes to ditching the paper, you need the right partner. Emdeon has the solutions to help you convert your paper registration, claim and payment processes to electronic ones. From the first patient encounter through the final payment and billing processes, Emdeon can help you save time and money while reducing paper waste and costs. Below are some Emdeon solutions that could help your practice:
Emdeon Officecan make sure your claims and eligibility transactions are not only paperless, but in real-time and more accurate than the manual alternative.
Emdeon Vision for Claim Managementlets you view the status of your claims submitted through the Emdeon network from almost any payer easily from the computer you already use.
Emdeon Payment Manageruses electronic funds transfers for claim payments to give you faster access to you funds and reduce burdensome accounting tasks.
What makes Emdeon a vital partner for healthcare practices looking to move beyond paper and realize more revenue is how our solutions work together. The information you collect on the front-end during patient registration is utilized to ensure accuracy and exhaust all payment options throughout the entire process.
How often do you get the chance to make your practice greener, and create efficient processes that increase your revenue? This is that chance. With Emdeon you'll be able to create a greener healthcare practice for you and your patients, all while saving time and money.
To learn more call Emdeon today at 866.369.8805, or visit us online at emdeon.com.
2008 Product Enhancement & 2009 Outlook
Emdeon Office Enhancements Launched in 2008
Credit card processing—We now have the ability to accept credit card transactions in Emdeon Office. After a 2-3 day enrollment process, users will be able to hand-key credit/debit card numbers for payment amounts up front. We are working on a card swipe functionality to pre-populate the card number coming in Q1.
Online provider enrollment forms—new feature allows the provider to enroll themselves electronically with the payer through an online form. This does away with the previous method of printing the document, completing then faxing. Now the user simply fills in the required fields and submits the request to the payer electronically.
BCBSMA claim upload adjustments—This feature allows a user to attach a file (max 11MB) to the claim adjustment email from BCBSMA.
Contract administration/user management enhancements—We've added more capabilities to the contract administrator to across the locations underneath their contract. New capabilities include: edit/create new locations, user search and edit primary contact, edit user information, lock/unlock, activate/deactivate, unlock a locked user as well as control all reports the user receives…the user in turn will have the ability to select which Emdeon Office reports they choose to receive.
ERS—Mail system. We have made some updates to improve the usability of the system to handle more like an Outlook or email program should. Highlights include: cross folder searching, folder sharing and overall appearance improvements.
Emdeon Office Enhancements Expected for 2009
NPI in ICE—We are adding a new field in our claim entry screen to accept NPI. This is estimated to be available in Q1.
Patient Responsibility Estimator (PRE)—Combines eligibility and paid claims data to generate an estimated payment the patient is responsible for at the point of service.
VAR self enrollment for claims/RT—This will be an enrollment enhancement providing the ability for a customer using a sponsored payer portal to upgrade their Emdeon Office account to an all-payer version of office for real-time (will be able to access virtually instantaneously) and to upgrade to be able to submit claims. Claims will still require the normal customer mapping process to begin submitting.
Office style revamp—We are updating the Emdeon Office interface to a more updated look and feel.
Address report verification and credit score—This will be a credit transaction with a focus on bad debt. The transaction will verify and return the patient’s most current address for provider records, as well as a credit report for the provider to use in determining the patient’s ability to pay before service is rendered.Read More >>
New POS Device Available
Emdeon is now offering a new POS device. The new Vx570 POS machine not only offers all standard POS functionality such as verifying eligibility for Medicaid and Medicare and credit card processing, but it also provides connectivity to all payers in the Emdeon network. The Vx570 also has the option of connecting via the Internet for faster transactions without tying up a phone line.
Call us today at 866.369.8805 for more information on the new Vx570 POS device.
New Payers On-Board
New payers added this quarter
Emdeon is pleased to announce the following payers as part of our constantly expanding network:
• AmeriChoice of New Jersey - Eligibility Inquiry and Response
• Assurant Health - Claims
• AssureCare Inc. - Claims
• Blue Cross Blue Shield of Alabama - ERA
• Blue Cross Blue Shield of Mississippi - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• Blue Cross Blue Shield of Missouri - Eligibility Inquiry and Response
• Blue Cross Blue Shield of Oregon (Regence) - Eligibility Inquiry and Response
• Blue Cross Blue Shield of Rhode Island - Eligibility Inquiry and Response
• Blue Cross Blue Shield of South Dakota - Eligibility Inquiry and Response
• Blue Cross of Idaho Health Services Inc - ERA
• Blue Grass Family Health/SRRIPA - Claims
• Corporate Benefits Service Inc. (NC) - Claims
• Evercare - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• FACS Group - Claims
• Federated Benefits - Claims
• Federated HR Services - Claims
• Global Healthcare Alliance - Claims
• HealthSpring - Claims
• Highmark Medicare Services - Claims
• Integra Group - Claims
• John Alden Life Insurance Co. - Claims
• Medica - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• MEDICAL DEVELOPMENT INTERNATIONAL - Claims
• MEMIC - Claims
• Midwest Security - ERA
• Missouri Mcare Part A WPS - ERA
• Molina Healthcare of California - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• Molina Healthcare of Florida - Claims
• Molina Healthcare of Indiana - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• Molina Healthcare of Michigan - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• Molina Healthcare of New Mexico - Claim Status Inquiry and Response
• Molina Healthcare of Ohio - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• Molina Healthcare of Texas - Eligibility Inquiry and Response
• Molina Healthcare of Utah - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• Molina Healthcare of Washington - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• Network Health Insurance Corp-Medicare - Claims
• Oxford Health Plans - Eligibility Inquiry and Response
• PacifiCare of California - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• PacifiCare of Oklahoma - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• PacifiCare of Oregon - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• PacifiCare of Texas - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• PacifiCare of Washington - Claim Status Inquiry and Response, Eligibility Inquiry and Response
• PHP of Michigan - Claim Status Inquiry and Response
• PHP of Mid-Michigan - Claim Status Inquiry and Response
• PHP of South Michigan - Claim Status Inquiry and Response
• PHP of Southwest Michigan - Claim Status Inquiry and Response
• PHP of West Michigan - Claim Status Inquiry and Response
• Physicians Mutual Insurance Company - ERA
• Secure Horizons California - Claim Status Inquiry and Response
• Time Insurance Company - Claims
• TRLHN/AU - Claims
• TRLHN/EB - Claims
• Union Security Insurance Company – Claims
For a complete list of the payers in our network, visit our website.
