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:
