Meaningful Use Update

Anatomy of a patient-friendly bill
What’s in the Final Rules and How it Will Impact Your Practice

It’s no secret that the Meaningful Use criteria under the HITECH provisions of the American Recovery and Reinvestment Act (ARRA) requires healthcare providers to successfully exchange electronic clinical healthcare information, such as ePrescriptions, to receive incentives and avoid penalties in payments from Medicare and Medicaid. Eligible professionals who meet the criteria can receive up to $44,000 from Medicare or up to $64,000 from Medicaid over five years, starting in 2011. After receiving over 2,000 public comments, the Department of Health and Human Services issued a final set of rules that addressed a number of the concerns that had been expressed during the comment period. Although the final rules contain hundreds of pages of requirements, they do offer greater flexibility and are expected to accelerate the adoption of electronic medical records (EMRs) in physician practices across the country. Join us as we examine the final rules on Meaningful Use and how Emdeon can assist your practice in meeting those requirements.

Meaningful Use Requirements
To ensure that physicians are using EMRs to improve the quality of care and to exchange healthcare information with other providers and patients, the government has mandated that doctors meet certain requirements for Meaningful Use. There are three stages of Meaningful Use, which will have progressively more demanding requirements. Stage 1, covering 2011 and 2012, focuses on capturing information electronically in a coded format; using that data to track key conditions and coordinate care; implementing clinical decision support; and reporting quality measures. Stage 2, which will take effect in 2013, will require the use of EMRs for “continuous quality improvement” and more structured data exchange. And Stage 3, starting in 2015, will take all of these processes further, with an emphasis on decision support tools, patient self-management tools, and population health management, according to HHS. Non-hospital-based physicians are eligible for Medicare incentives if they can show Meaningful Use. For a doctor to be eligible for Medicaid incentives, at least 30 percent of his or her practice must consist of Medicaid patients (20 percent for pediatricians) and eligible professionals may receive EMR incentives from Medicare or Medicaid, but not through both programs.

Based on the final rule, eligible professionals must meet a set of 15 core objectives determined to be a starting point for Meaningful Use, as well as five additional objectives selected from a menu of 10 options, for at least a portion of their patients. This approach, which is different from the proposed set of 25 all-or-nothing criteria, is intended to give providers flexibility in meeting Meaningful Use. The final rule on Meaningful Use is available for download and includes program contact information for additional questions about these criteria.

Under the core objective list eligible professionals must use their EMRs to:

  1. Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

  2. Implement drug-drug and drug-allergy interaction checks

  3. Generate and transmit permissible prescriptions electronically

  4. Record patient demographics (sex, race, ethnicity, date of birth)

  5. Record vital signs and chart changes (height, weight, blood pressure, body mass index growth charts for children)

  6. Maintain up-to-date problem list of current and active diagnoses

  7. Maintain active medication list

  8. Maintain active medication allergy list

  9. Record smoking status for patients 13 years of age or older

  10. Provide clinical summaries for patients for each office visit

  11. On request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, and discharge summary and procedures)

  12. Implement capability to electronically exchange key clinical information among providers and patient-authorized entities

  13. Implement one clinical decision support rule and ability to track compliance with the rule

  14. Implement systems to protect privacy and security of patient data in the EHR

  15. Report clinical quality measures to CMS or States

Under the menu set of criteria, providers must implement five of the following 10 criteria:

  1. Implement drug formulary checks

  2. Incorporate clinical lab test results into EHRs as structured data

  3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

  4. Use EHR technology to identify patient-specific education resources and provide them to the patient as needed

  5. Conduct medication reconciliation between care settings

  6. Provide summary of care record for patients referred or transitioned to another provider or setting

  7. Submit electronic immunization data to immunization registries or immunization information systems

  8. Submit electronic syndromic surveillance data to public health agencies

  9. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available

  10. Send reminders to patients (per patient preference) for preventive and follow-up care

Notably, the Stage 1 criteria do not include documentation of visit notes in discrete categories. Many EMR products either lack this capability or offer very basic note-taking modules; so the government’s decision not to require it in Stage 1 will enable physicians to use these products to achieve meaningful use, if they meet other requirements. However, discrete documentation of notes may be required in Stage 2 or Stage 3.

Emdeon’s Meaningful Use Portal
Emdeon, which is the largest administrative network in healthcare and has extensive lab and pharmacy connectivity, offers an EMR Lite solution called the Emdeon Office Suite. This easy-to-use web-based application simplifies everyday administrative and clinical processes including eligibility and benefits verification, claims and payment management, patient billing and payment as well as clinical tools that can help providers meet Meaningful Use criteria. Emdeon Office Suite integrates these capabilities with hundreds of practice management systems so providers can link to their billing and scheduling system for patient demographic and insurance data. Lab results are imported directly into the EMR Lite satisfying an optional requirement of Meaningful Use. The Emdeon Office Suite can also be used as a “plug-in” product that supports bi-directional exchange of discrete data with conventional EMRs.

Emdeon Office Suite will meet Meaningful Use criteria or we’ll give you your money back*.

Call us today to learn how our products can help you qualify for Meaningful Use incentives, accelerate your reimbursement, improve your productivity and simplify workflows in your office.


*Emdeon will meet Stage 1 Criteria for Meaningful Use of EHR Technology or we will refund up to six months of fees. Terms and conditions apply.

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It Pays to Give Patients Options

Anatomy of a patient-friendly bill
Sign Up for Emdeon Patient Pay Online Before Year’s End and Get 90 Days FREE!

We’re sprucing up the Office with two innovative, patient-friendly solutions: Patient Pay Online and Patient Statements.

Emdeon Office Suite is already a versatile, spacious solution for providers like you. Every detail of this robust suite of applications—from eligibility and benefits verification and claims and payment management to ePrescribing, lab orders and results—is designed to meet providers’ unique needs by simplifying the business of healthcare. Of course, anything that helps providers manage the administrative side of healthcare provision is ultimately beneficial to patients as well; it’s a win-win.

Now we’re extending the Emdeon Office capabilities by integrating consumer-facing services. Patient Pay Online and Patient Statements are primarily focused on answering patients’ needs, but they’re sure to bear great results for your practice in the form of streamlined operations and a boosted bottom line. Once again, it’s a win-win.

Patient Pay Online
This application gives your patients a secure, self-service portal for making payments online. With easy, click-to-pay functionality and transparent account information available 24/7, patients are empowered with real-time data and spared the hassles of paper billing.

Your patient’s convenience equates to smoother compensation for you. As patients adopt Patient Pay Online, you’ll enjoy the pay-offs: improved cash flow, more timely compensation, reduced costs related to printed billing materials and less strain on your customer service and accounts receivable staff. Additionally, you’ll have access to deep reporting and analytics tools to effectively track payment information up to the minute, at any time.

Patient Statements
Patient Statements—now seamlessly integrated into Emdeon Office Suite—is your single-source for statement creation, processing, printing and mailing. In keeping with HFMA guidelines for Patient Friendly Billing®, Emdeon’s Patient Statements improves patient relations by offering the most accurate, clearly stated billing communications delivered in a timely, streamlined invoice processing.

This immensely practical solution alleviates the logistics of invoice processing and mailing for providers. Customizable statements are generated and diverted to Emdeon’s high volume mail site for processing and sending, while our Address Cleansing Services scrubs lists for accuracy. Patients receive prompt, easy-to-read and reliably accurate statements, and that leads to quicker, more complete provider compensation and better cash flow. Additionally, providers face fewer customer service calls and save time and money by transferring mailing operations to Emdeon.

The Pay-off: Get Emdeon Patient Pay Online FREE for 90 Days
If you’re already an Emdeon Office client, you can easily incorporate Patient Statements and Patient Pay Online into your daily practice. Sign up for Patient Pay Online by the end of the year, and we’ll waive our fee for 90 days.

To launch these versatile solutions simply call us at 866.369.8805 or visit us online to discover more about the new services of Emdeon Office Suite.

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HIPAA Simplified

Anatomy of a patient-friendly bill
One of the major discussions this summer has revolved around the Errata for some of the HIPAA 5010 Implementation Guides (TR3s). X12N released the Errata for publication on August 5, and they are now being considered for adoption as a part of a standard by Centers for Medicare and Medicaid Services (CMS). Even though the Errata have not yet been adopted by the Department of Health and Human Services (HHS), many Covered Entities are nonetheless preparing to update their gap analyses accordingly if and when the Errata are adopted.

In simple terms, the Errata are supplemental information that contain modifications to some of the TR3s. Not only must senders adopt the Errata, but so also must receivers if they are to perform a successful exchange of information.

To help our clients with HIPAA readiness, Emdeon is publishing updated gap analyses for the transaction code sets to reflect the Errata once they are adopted by CMS. Like all of our other documentation on HIPAA Simplified, these updated gap analyses will be available to download for free. Visitors only need to type in their email addresses, and they’ll be able to pick from our vast library of documentation.

For visitors who search for new documentation on HIPAA Simplified, we have good news: we’re currently updating our Frequently Asked Questions (FAQ) to incorporate new questions we’ve answered since publishing the first FAQ.

Additionally, our Pharmacy team has been working on new NCPDP D.0 gap analyses. As always, we’ll update our Downloads page to highlight the new or updated documentation for quick access and easy download.

We’re also excited to announce that Emdeon will be launching a new regulatory e-newsletter later this year, which we’ll use not only to communicate updates to HIPAA Simplified, but also to keep our clients up-to-date on industry news that will impact them. We’ll also use the e-newsletter to announce the publication of new documentation. Check HIPAA Simplified over the next few weeks as we share more information about how to stay in the loop concerning the ongoing transition to HIPAA 5010.

We’ll now be posting HIPAA Simplified updates and announcing new documentation on social networking websites. Follow Emdeon on Twitter, Facebook, and LinkedIn to stay up-to-date on news as it happens.

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A Quest to Improve Workflow Leads to Efficient Patient-Centered Care

Anatomy of a patient-friendly bill
21st Century Family Practice’s revenue cycle management and workflows were not living up to the organization’s stated vision of efficiency through the use of technology. The practice’s lean staff lost precious hours each week being left on hold during phone-based eligibility verifications, tracking the status of claims, as well as dealing with denial management and handling paper-based processes— including billing. And the delays involved with receiving lost or denied claims notifications by mail were impeding the practice’s cash flow, as payments were often greatly delayed or ultimately converted to bad debt.

21st Century implemented Emdeon Office Suite to completely revamp the way the practice operates in all aspects of administrative/business functions, including the all-important billing process. The team found Emdeon’s applications were aligned with their goal to improve revenue cycle management by making processes more efficient. “We were looking for a single partner to provide all the functionalities of our office for claims and eligibility,” explains Harry Singh, Practice Administrator with 21st Century. “Emdeon is a one stop solution to provide all we need, plus additional services that are also now an essential part of our office.”

The goal of improving revenue management through better efficiency has been achieved. 21st Century’s overall cash flow is notably enhanced since the implementation of Emdeon Office Suite. Currently, 70% of total accounts are received within 0-30 days, up from just 30% before the Emdeon solutions were implemented. “The improvement in our total collections has come about as a result of submitting the claims on time and electronically, and also collecting them on time - with Emdeon solutions’ 360 degree approach,” states Singh.

This is a true success story, as the specific results and Harry Singh’s praise attests. The complete, compelling success story including details about challenges, goals and impressive outcomes can be found in the Emdeon Office Suite Case Study. Read all the stats and specifics about how Emdeon helped 21st Century Family Practice achieve:

- reduction of AR days
- staffing efficiencies
- improved cash flow
- strategies for long term success

You can experience your own Emdeon success story! Call us today at 866.369.8805 to find case study-worthy solutions for your business operations.

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New Payer Transactions

New payers on board with Emdeon. Take a look at the new list
New payers added recently:

• Advantica Benefits; Claims
• Alta Bates Medical Group; Claims
• American Family Medicare Supplemental; Claims
• AmeriChoice of New Jersey, Inc.; Claims
• ATA FL; Claims
• BCBS of LA; Claims
• Benefit & Risk Management Services; Claims
• Benefit Administrative Systems; ERA
• BCBS of Montana; ERA
• Coventry Health Care; ERA
• Empire Omnipro (BC NYC); ERA
• Employee Benefit Systems; Claims
• Employers Insurance Group; Claims
• Florida Health Care Plan; Claims
• Freedom First; Claims
• Healthtran; Claims
• Hometown Health Plan Nevada; ERA
• InterCare Health Plans Inc.; Claims
• JMH Medicare Advantage; Claims
• MAMSI Life and Health Insurance Co. (MLH); ERA
• MBA Benefit Administrators, Inc.; Claims
• MD Medicare Part A; ERA
• Medicaid Hawaii Waivers; Claims
• Medical Services Initiative; Claims
• Medicare Blue Private; Claims
• MetroPlus Health Plan; ERA
• Metropolitan Transit Athority; Claims
• MidCoast IPA; Claims
• National Health Insurance Company; ERA
• Nebraska Medicaid; ERA
• New Era Employee Welfare Benefit Plan Trust; ERA
• NHI Billing Services, Inc.; Claims
• North American Benefits Network (Cleveland, OH); Claims
• Optum Specialty Services / Americhoice of NJ; Claims
• PEHP (Public Employees Health Program); ERA
• Pennsylvania Medicaid; ERA
• Providence PPO; Claims
• Regence UT BCBS; ERA
• Regence UT BCBS FEP; ERA
• San Louis Obispo Select; Claims
• Sheffield, Olson, & McQueen, Inc; ERA
• Southwest Airlines; Claims
• SRS Hilton Worldwide, Inc; Claims
• SuperiorSTAR Pregnant Women; Claims
• Surency Life and Health; ERA
• The Beacon Mutal Insurance Co.; Claims
• Tower Life Insurance Co.; ERA

For a complete list of the payers in our network, visit our website at

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See the full list >>

Emdeon Office Suite: start with the end-to-end solution in mind

Anatomy of a patient-friendly bill
Powerful Platform Starts—and Closes—the Loop for Busy Practices

Emdeon just added more spin to the revenue cycle with the launch of the new Emdeon Office Suite.

This progressive product now offers integrated innovations that work intuitively with all administrative tasks—from patient access to payment. Long known as the go-to for eligibility and claims support, today’s Emdeon Office Suite provides a complete suite of solutions, and the outcome is a smooth end-to-end workflow for busy practices like yours.

In practical application, Emdeon Office Suite provides superior functionality for all the in-between tasks that are core to running a professional practice. And because these tasks are integrated into a unified suite that’s designed to seamlessly share data, everything works together simply and reliably.

Available through the NEW Emdeon Office Suite:
Real-time Eligibility and Benefits Verification
Eligibility and benefits verification helps to simplify and streamline patient access. 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 enable you to see an estimate of what your patients will owe at check-in.

Complete Claim Management
Submitting claims, including Workers’ Compensation eBills and Automobile Medical electronic bills and attachments is quick and easy with direct data entry and batch upload options from any practice management system. Our innovative, award-winning reporting and analytics tools give you complete visibility and tracking capabilities from the point of claim submission through payment so you can see where your revenue is anytime during the claim lifecycle and the mobile version enables you to see where your money is on your iPhone®, Android(TM), Windows Mobile(TM), Palm® or other “smart” portable device anytime, anywhere.

Point of Service Payment
Emdeon Office Suite securely accommodates debit and credit card payments to bolster payment collections, particularly at the point of service. Upfront payment significantly helps to shorten the cycle and close the loop for provider compensation.

Powerful Payment Management Tools
Revenue and profit are the lifeblood of any business and Emdeon payment tools can help you increase both, while improving efficiency. Emdeon Office Suite delivers valuable electronic payment and reconciliation processes that help providers eliminate paper checks and simplify secondary claims. As a result it can dramatically reduce expenses, shorten the reimbursement cycle and streamline workflow. By increasing efficiency it creates time for providers and staff to focus on reconciling outstanding payment issues to capture otherwise lost revenue.

Single Click Statements
New to Emdeon Office Suite, the patient statements option provides one-click access to fast, accurate statement processing and dissemination. This affordable service is integrated to immediately accept transmitted billing information and promptly process, print and mail statements and invoices. This reduces the time and effort involved in traditional billing methods, shortening the cycle of compensation.

Clinical Tools
The updated suite includes a handy Clinical Tools tab that represents the future integration with Emdeon Clinician, an EMR Lite solution with leading Health Information Exchange. Our EMR Lite consolidates electronic prescribing and lab ordering, as well as results distribution. These clinical tools work in concert with all office functions and importantly, they also aid in helping providers meet Meaningful Use criteria and, thus, qualify for stimulus incentives.

Ceaseless Support
Emdeon Office Suite is supported by the always-open-for-business Emdeon ON24/7. This user-focused solution not only provides call-in support, it accepts request submissions online anytime so that those needing assistance aren’t funneled into a maze of phone calls, hold messages and automated systems. Requests are received and processed immediately and answered efficiently.

Finally, a new user interface enhances the suite life with a modernized look and easy navigation. With intuitive operation and quick access to the tools used most often, the Emdeon Office Suite is simple to learn for all staff members. It easily integrates into day-to-day office activities—providing end-to-end solutions and closing the loop on revenue cycle management.

Check out the NEW Emdeon Office Suite!
Screenshot of the new look of Emdeon Office Suite

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Anatomy of a patient-friendly bill

Anatomy of a patient-friendly bill
Practical Lessons in Success from Seattle’s Northwest Hospital & Medical Center

“Patients need clear, understandable statements...sent out in a timely fashion. It has made a huge difference for us.”

To hear Janet Walthew discuss the topic, it seems so simple. You see, Walthew is the Director of Patient Financial Services at Seattle’s Northwest Hospital & Medical Center, an organization that has successfully transitioned to a patient-friendly billing model. Walthew and Revenue Cycle Senior Director, Mike Smith, led Northwest Hospital’s shift from an approach focused on major payers to a system keenly in tune with today’s patient-consumers.

So—just what did Walthew, Smith and the Northwest Hospital team do? They leveraged industry best-practices, consulted patients and found a new billing partner in order to create clear and concise financial communications.

Keeping the patient-friendly billing standards outlined by the Healthcare Financial Management Association (HFMA) in mind, the hospital designed several sample statements and surveyed patients to better understand which format most clearly communicated the information. Based on their input, the statement format was finalized.

The next step for Northwest Hospital was to find a partner who could implement its customized patient statement. This was not an easy task.

In the past, patient statements were relatively easy to produce since most of the information was pulled directly from one data file. To present the information in a more patient-friendly manner, the new statement required complex information processing – pulling data from six files and summarizing the content as needed. After contacting eight companies about printing and mailing the new statements, only Emdeon was able to comply with the requested design and manage the complex web of reporting required to generate the patient statements.

When the new statement was introduced, Northwest Hospital helped current account holders understand their new bill by providing a patient statement guide. This reference tool included an image of a sample statement with call-outs to identify the most important pieces of information on statements.

Since Northwest Hospital implemented a more succinct, plainly stated and well-designed patient statement, the hospital has enjoyed improved receivables, reduced volumes of patient inquiries—and a much healthier revenue cycle all around.

Below includes a list of the patient statement best-practices that Northwest Hospital implemented in order to become a patient friendly billing institution. How does your current statement compare?

a. Use unique fonts, color and capitalization for section headers.
On Northwest Hospital’s past statement layout, it was hard to quickly find information since section headers were the same font size as variable data. Northwest Hospital’s new statement features headers in a green font nearly two times larger than the black variable text. This helps patients visually categorize information and follow content easily.

b. Organize content in a logical order.
A glance at Northwest Hospital’s past bill could be overwhelming, as it contained minimal financial summaries and presented the information in a letter format. In contrast, the new layout eases customers into the details– beginning with basic account identifiers, to a summary of charges, then a detailed listing of itemized charges, ending with the patient’s outstanding balance.

c. Communicate that the insurance claim has been processed.
This clearly communicates that the insurance company has successfully processed the claim and the amount due listed on the statement is truly the patient’s responsibility to now pay.

d. Provide a summary of services and a subtotal of charges.
Northwest Hospital’s new bill includes a “Patient Services Provided” section on the left side of the statement that provides a general summary of charges such as “Pharmacy” and “Room Charges” along with subtotals for each.

e. Separate more detailed information from overview sections.
Northwest Hospital created a separate “Account Information” section located on the right side of the statement that provides more specific information. This section starts with the top-line charges (total from “Patient Services Provided”) minus insurance and patient payments previously applied. Finally, the remaining patient balance is listed.

f. Visually call out the amount you are requesting the patient to pay.
Northwest Hospital’s bill makes the “amount due” hard to miss. The bottom portion of the bill is green with a white call-out box reserved for this all-important total.

g. Use a call to action when highlighting the amount to be paid.
Previously, Northwest Hospital’s patient bill stated “Total Amount Due”. While accurate, this does not give instruction to patients about what to do with this information. On Northwest Hospital’s new bill, “Please Pay This Amount” clearly communicates what patients need to do.

h. Include a “Contact Us” section.
Clearly communicate all of the options available (by phone, by email, online, etc.) and provide your customer service hours of operation.

i. Give simple, quick alternatives to pay.
Northwest Hospital added a credit card payment form at the top of the patient statement that is pre-populated with customer information. Patients only need to add their credit card information and mail the payment stub to complete the transaction.

Pay-by-phone and internet based payment options with directions were also added to the patient statement to encourage the use of automated payment collection.

Emdeon is the leading provider of integrated Patient Billing & Payment Solutions that help healthcare professionals, like Smith and Walthew at Northwest Hospital, optimize their cash flow management while reducing administrative costs. Patients Statements are now available through Emdeon Office Suite. To discover how you can easily and affordably send your patient statements call 866.369.8805 or visit our enrollment site.

Customize statements with your preferred format and colors
Examples of customized bills

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U.S. Healthcare Efficiency Index Advisory Council issues national progress report on healthcare efficiency

U.S. Healthcare Efficiency Index Advisory Council issues national progress report on healthcare efficiency
For more than a year, the Advisory Council for the U.S. Healthcare Efficiency Index® (USHEI) has asked the healthcare industry, "What would you do with $30 Billion?" as a way to raise awareness of the potential savings from the administrative side of healthcare.

Today, the USHEI Advisory Council released new findings that suggest the needle is starting to move more rapidly on electronic adoption though there is still much work to be done. The USHEI National Progress Report on Healthcare Efficiency suggests continued progress on the adoption of electronic medical claims which, according to the sample cited in the report, are being transmitted at a current rate of 85%, which is a 10% increase over the USHEI Phase 1 findings released in December 2008. Likewise, adoption of electronic remittance advice transactions stands at 46%, which is significantly higher than the 26% estimate from Phase 1.

The USHEI is an industry forum for monitoring business efficiency in healthcare and tracking the transition from a paper- and phone-based healthcare system to an electronic one. It is governed by an independent Advisory Council responsible for overseeing the effort, developing the data collection methodology and reporting on progress across the healthcare industry.

The administrative simplification provisions of the recently signed healthcare reform law call for additional electronic business transactions, such as electronic funds transfer (EFT) payments, to be adopted by the industry. The new law also requires more uniform standards and a set of operating rules for all covered electronic transactions. The USHEI will continue to serve as a central reference for tracking progress and the cost savings associated with electronic adoption, including the transactions called for by the healthcare reform law.

"The report will show you how we are working as one interdisciplinary team focused on one big goal," said USHEI Advisory Council member Jane Sarasohn-Kahn of THINK-Health. "Along the journey toward efficiency, Americans will realize improved convenience, quality and cost-savings. And they'll get the sort of health system they expect as modern, online tax-paying, bill-paying, healthcare consumers."

The USHEI National Progress Report on Healthcare Efficiency represents a snapshot of the progress of the USHEI. Phase 1, launched by Emdeon (NYSE: EM) in December 2008, focused on analyzing industry data available through research reports and other sources. Phase 1 included five basic medical claims-related transactions: Claims Submission, Eligibility Verification, Claim Status, Claim Payment and Remittance Advice.

Phase 2, launched last summer, marked the beginning of primary data collection with major healthcare payers. To facilitate the data collection process, the USHEI team spent several months developing its National Data Collection Center which allowed participants to self-report transaction data through a secure, password protected web portal. Non-identifiable data was sent to statisticians at Scheuren– Ruffner, where it was aggregated and analyzed. The USHEI Advisory Council, under the guidance of the statisticians, worked to develop a data collection methodology which would then be tested using a smaller sample of payers and transactions. Once the analysis is completed on the smaller sample, outreach will begin to the entire payer community to complete data collection and analysis on the remaining transactions.

Today's initial findings are based on data gathered from an initial sample of 113 payers that includes two large national payers and over 100 medium and small regional payers. This data sample is estimated to represent approximately 122 million covered lives or about 40 percent of the U.S. population.

Key findings discussed in the USHEI National Progress Report on Healthcare Efficiency include:

Continued progress on adoption of electronic medical claims. The data shows a current electronic rate of 85% which represents a 10% increase over the Phase 1 findings.

Adoption of electronic remittance advice transactions is also higher. The data shows a current electronic rate of 46% as compared to 26% in Phase 1.

Continuum of Automation: Calculating the cost differences between manual and electronic healthcare transactions is becoming more complex. Rarely is a provider practice purely manual or purely electronic, and a provider's place along the continuum can vary. Stakeholders must understand all the components of healthcare transactions to remove costs and enhance the value of those transactions.

System level cost reduction. Approaching the systemic inefficiencies in healthcare to decrease overall costs is critical to help avoid the continual cost shift among healthcare industry stakeholders that has plagued healthcare for so long.

Clinical and Administrative Convergence. "Meaningful Use" requirements are expected to drive further adoption of electronic claims and eligibility transactions. The inclusion of these administrative transactions as a part of "Meaningful Use" reflects the ongoing convergence of clinical and financial information, which is an important trend in the evolution of health information exchange.

Pragmatic Solutions. Federal healthcare reform provisions enacted this year include some administrative simplification elements, such as a mandate for electronic funds transfer payments. These practical provisions enjoy broad bipartisan support and were scored favorably as "pay-fors" by the Congressional Budget Office.

Reporting. Automating basic administrative transactions and measuring progress on adoption can be an important and impactful first step to real cost savings.

Change is hard. But for the nation's healthcare system, not changing will be much harder. With Medicare Trust Fund Reserves expected to be exhausted by 2017 and 41 states currently facing mid-year budget shortfalls, it is critical to capture tangible savings today wherever possible.

While work continues to expand the data set and analysis, the initial findings in the USHEI National Progress Report provide a new baseline for tracking progress and validation of the data collection methodology. This methodology can now be scaled for a more complete set of payers and then beyond to other healthcare stakeholders.

Plans are already underway for later phases of the USHEI, including development of a Pharmacy Efficiency and Adherence Index.

"Monitoring the progress of healthcare efficiency through channels like the National Progress Report only stands to increase awareness of this vitally important issue," said Miriam Paramore, Emdeon senior vice president of corporate strategy and government services. "Today's report shows that electronic adoption in healthcare is trending upward, but opportunities for significant cost savings still exist. As we move towards a more efficient healthcare system, it will take everyone in the industry working together to achieve this goal. That is real healthcare reform."

The USHEI National Progress Report on Healthcare Efficiency is available for free download.

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New Workers' Compensation & Automobile Medical portal now available

New workers' compensation portal now available
Emdeon Office EZBill(SM): Electronically submit Workers’ Compensation/ Auto bills and attachments at NO CHARGE

Emdeon recognizes that complex claims and attachments have a direct impact on productivity, accuracy, compliance and providers’ bottom lines. Emdeon Office EZBill overcomes providers’ challenges by providing electronic submission capability for Workers’ Compensation and Auto Medical bills and attachments.

Providers can register for Emdeon Office EZBill and submit Workers’ Compensation and Auto eBills at no charge. Emdeon Office EZBill enables the submission of eBills through direct data entry. You get complete visibility into the claim lifecycle with the Reporting & Analytics tool within Emdeon Office EZBill that allows you to track claims from point-of-submission through payment and upload the necessary attachments.

With Emdeon Office EZBill, providers will have access to Emdeon’s network of Workers’ Compensation and Auto Medical payers. For connectivity to Emdeon’s complete network of over 1,200 government and commercial payers and maximum efficiency for other transactions, providers can upgrade to the Emdeon Office Suite for a low monthly cost.

Enroll for Emdeon Office EZBill
Providers can register for Emdeon Office EZBill at or by contacting Sales at 866.369.8805. To see a complete list of Workers’ Compensation and Auto payers, visit and select Workers’ Compensation or Automobile Medical from the payer type drop down menu.

Download complete brochure
New workers' compensation portal now available

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eHealth educational seminars

eHealth Educational Seminars
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!

Please visit our EDI Transaction Center at to view upcoming dates and locations in your area, register online as well as obtain other information that will help you send more transactions electronically.

Do you know?

• Top reasons claims reject
• 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

Come to the seminar for answers!

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New payers on board

New payers on board with Emdeon. Take a look at the new list
The Emdeon network of payers continues to grow
New payers added recently:

• Americas 1st Choice Health Plans of North Carolina, Inc.-Claims
• Aetna Better Health-PA Medicaid-Claims
• Aetna Encounters-Claims
• Afinity Medical Group-Claims
• American National Ins. Co. (ANICO)-ERA
• American National Property and Casualty Company (ANPAC)-Claims
• AmeriChoice of New Jersey, Inc. (Medicaid NJ)-Claims
• Auto Club Insurance Association-Claims
• Blue Cross Blue Shield of Kansas City MO-Claims
• Blue Cross Blue Shield of Kansas City MO-ERA
• Blue Cross Blue Shield of Louisiana-ERA
• Blue Cross of Nebraska-ERA
• C&O Employees Hospital Association-Claims
• CAP Management Systems-Claims
• Carolina Crescent Health Plan Inc.-ERA
• Carpenters Health and Welfare Fund of Philadelphia-Claims
• CeltiCare-ERA
• Cenpatico Massachusetts-ERA
• Cigna Encounters-Claims
• Claims Management Services-ERA
• Community Health Electronic Claims/CHEC/webTPA-ERA
• Contractors Laborers Teamsters & Engineers-Claims
• Correctional Medical Services-Claims
• CT Medicare Part A (J13 - NGS)-ERA
• Delta Dental of Arizona-ERA
• Delta Dental of Illinois-ERA
• Deseret Mutual-ERA
• DiaTri, LLC-Claims
• District of Columbia Medicaid-ERA
• Edwards Claim Administration-Claims
• First Administrators, Inc.-Claims
• Great American (GAFRI)-Claims
• Guardian Life Insurance Company of America-ERA
• Harpeth IPA/SRRIPA-Claims
• Health Partners of Minnesota-Commercial-ERA
• Health Partners of Minnesota-Medicaid-ERA
• Health Right-Claims
• Independence Medical Group-Tulare-Claims
• Integral Quality Care-Claims
• InterCare Health Plans Inc.-Claims
• J1 MAC Medicare Part A (CA,HI,NV)-ERA
• Louisiana Medicaid-ERA
• MI Medicare Part A (J8)-ERA
• Mississippi Medicaid-ERA
• Molina Healthcare of New Mexico-Salud-Claims
• Motion Pictures Industry-Claims
• NC Medicare Part A (J11)-ERA
• Nebraska Medicaid-ERA
• New Hampshire Medicaid-ERA
• New York State Insurance Fund (NYSIF)-Claims
• NJ Medicare Part A (J12-Highmark)-ERA
• North American Benefits Network (Cleveland, OH)-Claims
• North Dakota Medicaid (Hospital)-Claims
• NYS DOH UCP-Claims
• Physicians Care Repricing-Claims
• Premera Blue Cross-ERA
• QuikTrip-ERA
• Sanford Health Plan-ERA
• Scan Encounters-Claims
• SelectHealth-ERA
• Southeast Dental Associates-Claims
• State Farm (Casualty & Property Claims)-Claims
• Sun Life and Health Insurance Company (U.S.) (formerly GLHIC)-ERA
• Touchstone Health PSO-ERA
• Triple-S, Inc.-ERA
• UCARE of Minnesota-ERA
• United Health Plan Encounters-Claims
• Utah Medicaid-Claims
• VI Medicare Part B (J9-First Coast)-ERA
• WEA Insurance Group-Claims
• WPS Tricare TriWest-ERA

For a complete list of the payers in our network, visit our website at

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Resolve to lose 'wait' and get the bottom line in shape this year

Lose 'wait' and get the bottom line in shape

It hasn’t been 2010 very long, but the year’s already feeling less than new for professional practices that have yet to hone their patient access and cash flow processes.

The first of the year brings changes to benefits plans and renewed deductibles, and though this happens predictably every year, some practices have not learned practical solutions to welcome such changes with preparedness and ease. And beyond those expected annual changes, the healthcare system is in constant flux as Consumer-driven Health Plans (CDHPs) gain prominence and patients take on more payment responsibilities for their healthcare. For busy practices, being unprepared for changes of any kind can ultimately add “wait” to patient access processes and make the bottom line less than fit. That’s no way to start the new year!

Where does your practice stand? Is your patient check-in process sputtering in the wake of changes and slowing your cash flow?

It’s not too late to make amends for twenty-ten. Make a resolution to incorporate new solutions for optimum processes and greater success and you won’t even be spending more money because you will be saving money on the back end. Here’s a starter list:

• Incorporate affordable, interactive technology to guide frontline staff to success in the check-in process, saving time and money. Not only will such tools help capture accurate patient contact information, leading edge technology automates the entire access process and ensures all changes to benefits plans are accounted for in the system. This makes patient verifications quick and accurate and the registration process less stressful for patients and staff alike. Less wait time all around!

• Prioritize patients’ need for clear communications regarding payment responsibility and collections. As more patients are required to participate in payment for their care, it’s imperative that practices ease them into this new role. Upfront estimates, easy-to-read statements and collections alternatives empower patients, encourage point-of-service collections and ultimately improve both patient experience and cash flow.

• Invest in frontline staff, training them to treat patient access as a pivotal point of contact rather than a passive administrative function. When your practice obtains the best, most complete patient data during check-in, long term communications, patient interactions, collections and cash flow are improved.

Emdeon’s Patient Access Management Solutions incorporate leading edge technology for fast, accurate eligibility verifications and integrated patient data acquisition. Learn more about Emdeon Office– a web-based solution for eligibility and benefits verification, claim submission and tracking from point-of-submission through payment– all at an affordable price.

By committing to resolutions backed by real solutions, you’ll shed ‘wait’ and get that bottom line in shape in 2010. Contact your Emdeon representative today to get started!


Making a referral is a very rewarding experience

Refer someone to Emdeon products and be rewarded

At Emdeon, we know your time is valuable and your opinion counts. That’s why we’re ready to reward you for both.

If you find yourself singing Emdeon’s praises to colleagues, make the process a little more official, and you could be rewarded to the tune of $50 in an American Express Gift Check. That’s a tangible expression of our appreciation for your time and influential recommendation. Simply submit referrals to us online and encourage your colleague to sign up, then we’ll send you a $50 gift check.

Of course, your good word— shared by word of mouth— is the ultimate endorsement for us. We acknowledge there’s no advertising or marketing campaign more persuasive than your authentic approval shared directly with colleagues and coworkers. For our part, we hope to earn your good word every day with each service, solution and point of contact we provide.

Don’t hold back, and we won’t either! Share contact names with us, tell colleagues about our exceptional solutions (such as electronic claims, processing eligibility inquiries and claims status checking— we know you rely on those services!) and we’ll gladly reward you when sign up and implementation are complete.

While your satisfaction with Emdeon is truly priceless, hopefully $50 per signed referral is a good start. Log on today!


HIPAA Simplified

Go to our site specifically designed to help transition you to HIPAA 5010

On January 16, 2009, the U.S. Department of Health and Human Services (HHS) published rules that require updated versions of the standards for electronic transactions under the authority of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These updated standards (Versions 5010 and D.0) are designed to replace the current standards (Versions 4010/4010A1 and 5.1) and are designed to promote greater efficiency in electronic transactions. Compliance with the new HIPAA 5010 and NCPDP D.0 standards is required by January 1, 2012.

This transition poses a number of challenges for covered entities which are defined as businesses that are required to achieve compliance in large part because these changes affect all healthcare segments: hospitals, physicians, dentists, pharmacies, PBMs, payers and vendors.

In December 2009, Emdeon Senior Vice President of Corporate Strategy and Government Services, Miriam Paramore, testified before the National Committee on Vital and Health Statistics (NCVHS). During her testimony, Paramore said, “Emdeon is committed to supporting our customers and leading the industry in compliance and adoption of the new standards and code sets.” She continued, “Our goal is to be ready in advance of the government mandated deadlines to ensure a smooth and successful transition.”

On January 22, 2010, Emdeon launched HIPAA Simplified to be a one-stop resource for the information that covered entities needed for HIPAA readiness. HIPAA Simplified will be a communications focal point as Emdeon helps its customers adopt the 5010 and D.0 standards prior to 2012. The website offers technical gap analyses, simplified business-level downloads, trading partner transition strategy information, frequently asked questions and testing tools.

HIPAA Simplified

Additionally, HIPAA Simplified is divided by business units across the entire healthcare industry, eliminating the need for complex web navigation or surfing multiple sites. Visitors simply select their line of business and all available resources are located on the page to browse and download. For free.

What really sets HIPAA Simplified apart from other resources, however, is its analytical tools that are designed to propel the transition strategies of covered entities. Only HIPAA Simplified offers informational and analytical tools, from high-level FAQs, to documents that explain the transition in business-level language, to in-depth technical analyses.

As the nation’s largest health information network, Emdeon is the healthcare industry’s most comprehensive source for HIPAA readiness. Just as with HIPAA 4010 and the National Provider Identifier (NPI), Emdeon is working diligently to deliver solutions that enable its customers to seamlessly meet the new requirements for HIPAA 5010, NCPDP D.0, and ICD-10.

Make sure to spread the word and bookmark–it will be updated often as the compliance deadline approaches.


Have you seen the new Emdeon website?

Check out the newly designed Emdeon website. Designed for better customer experience.

The Emdeon website has been redesigned to improve the customer experience and keep customers engaged. Improved ad space with enhanced video capabilities will allow us to post customer testimonials and current promotions so we can keep you informed on what is going on.

Visit us online at
• New, innovative design
• Improved customer experience
• Improved navigation
• Distinct call-to-action

The new look of


Emdeon podcast series

Emdeon produces free monthly Physicians Practice podcasts for your review

Industry leading publication 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 this month’s podcast, you’ll learn from industry leaders as they discuss optimizing the revenue cycle from eligibility to payment.

Listen to the monthly podcasts or find us on iTunes.

eHealth educational seminars

eHealth educational seminars

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!

• March 16, Los Angeles, CA
• March 18, Phoenix, AZ
• March 23, Monroe Township, NJ
• March 25, Cherry Hill, NJ

Please visit our EDI Transaction Center online to register online and obtain other information that will help you send more transactions electronically.

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

Come to a seminar for answers!


New payers on board

New payers on board with Emdeon. Take a look at the new list

The Emdeon network of payers continues to grow
New payers added recently:

• 21st Century Insurance and Financial Services-ERA
• Americas 1st Choice Health Plans of South Carolina, Inc.-Claims
• Boulder Administration Services-Claims
• Bravo Health-ERA
• Brown and Toland Medical Group-Claims
• Capstone Health Plan, Inc.-Claims
• Care Wisconsin Health Plan (Trizetto)-Claims
• CO Medicare Part A (J4-Trailblazer)-ERA
• Columbia United Providers-ERA
• Connecticut Blue Cross (Anthem)-ERA
• First Administrators, Inc.-Claims
• HAA Preferred Partners-Claims
• Healthplex, Inc.-ERA
• Kentucky Medicaid-ERA
• Louisiana Medicaid (Adult Dental)-ERA
• Louisiana Medicaid (EPSDT)-ERA
• Lovelace Salud-Claims
• MA Medicare Part A (J14-NHIC)-ERA
• Medicaid South Carolina-ERA
• MedStar Family Choice-Claims
• Mennonite Mutual Aid Association and Affiliates (MMA)-Claims
• New Hampshire Medicaid-ERA
• North Carolina Medicaid-Claims
• Optimum Healthcare, Inc.-Claims
• Personal Insurance Administrators (PIA-Eligibility Inquiry and Response
• Planned Administrators, Inc.-Claims
• Select Health of South Carolina-Claims
• Tethys Health Ventures-Claims
• University of Utah Health Plans-ERA
• WRHN Beechstreet-Claims

For a complete list of the payers in our network, visit our website at

See the full list >>