Latest Updates & Information on eRx Rules & Programs
The buzzer has sounded.
All “eligible professionals” who did not prove themselves to be “successful electronic prescribers” during January 1st through June 30th of this year are now subject to Medicare payment adjustments (translation: a one percent deduction on Medicare Part B reimbursement) come 2012, according to Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
What’s done is done, and whether you’re left to nurse your wounds or breathe a sigh of relief, there’s always more eRx activity just around the corner. Here’s the latest, for your knowledge.
Comment by July 25th or Forever Hold Your Peace…
As of June 1st of this year, the 2011 eRx Proposed Rule is published in the Federal Register, providing updates to the existing eRx program. Specifics of the updates include modifications to quality measures, provisions for hardship exemption for the aforementioned 2012 payment adjustments, as well as extensions of deadlines for request of hardship exemptions. You may review details at http://ofr.gov/inspection.aspx and select file code CMS-3248-P.
You have until July 25th to submit comments to the rule.
Overview of Incentives—and Penalties—for eRx Going Forward
There’s still benefit to get going with eRx in 2011. If you did prove to be a “successful electronic prescriber” during the first six months of this year, you will avoid the penalty for 2012. However, providers must submit an additional 25 Medicare claims by December 31, 2011 to be eligible for the one percent incentive payment this year and to avoid penalty in 2013. As stated above, noncompliant “eligible professionals” will take a one percent deduction from the Medicare Physician Fee Schedule in 2012, 1.5% deduction in 2013 and two percent in 2014.
For the CMS’ specifics regarding “eligible professionals,” visit the website at http://iren.es/mDF4jA. An overview of the entire program may be accessed via http://www.cms.gov/ERxIncentive/.
Be sure to Crack the Code - Reporting the eRx G-Code
Successful reporting for the eRx Incentive Program requires a single G-code, a quality-data code adhering to parameters stated in the CMS document viewable at http://iren.es/lOmvNP. This reference offers guidelines for your claims-based reporting.
Important to Know: ePrescribing and Meaningful Use
Did you know providers cannot qualify for both Medicare Meaningful Use incentives and electronic prescribing MIPPA incentives?
2011 is the first year that physicians can demonstrate Meaningful Use of a certified electronic health record (EHR) under the American Recovery and Reinvestment Act of 2009 (ARRA). Eligible professionals who meet Meaningful Use can begin to receive up to $44,000 from Medicare or up to $64,000 from Medicaid over five years. Whether you seek eRx incentives or focus on Meaningful Use of EHRs, ePrescribing is an essential and important initiative you should adopt. Emdeon offers an EHR Lite solution with integrated eRx functionality for ease of use and seamless system integration.
To discover more about our ePrescribing and Meaningful Use solutions, contact us at 866.349.1607 or visit us online at www.emdeon.com/meaningfuluse.
Emdeon is on the forefront of knowledge acquisition on eRx issues so that we can bring you practical solutions. Contact us anytime for answers to your specific questions or concerns about ePrescribing.
What's Next for eRx-- and What You Need to Do Now
Efficient Patient Billing & Payment Technology Leads to Reduced Costs and Accelerated Patient Payments
Concord Integrative Health: An Emdeon Customer Success Story
Dr. Jeff Robichaud’s staff in the Chiropractic Medicine Department of Concord Integrative Health was increasingly burdened by the conventional process for generating and sending patient statements. With a growing volume of patients, it became more and more challenging to efficiently deal with billing, as well as the necessary follow up that many bills ultimately require. Just printing the statements would take a full day. By the time a full batch was prepared for mailing and sent, the process stretched across an entire work week, which took a costly toll on staff time and productivity.
The challenges also extended beyond the doctor’s purview. More and more patients began proactively requesting streamlined—and greener—alternatives for making payments. Not only were the paper-based payments not offering patients preferred conveniences, they were extending the amount of time between billing and receipt of payment, affecting cash flow for the practice.
As a customer of other Emdeon products, Dr. Robichaud learned of Emdeon Patient Statements as a viable option for his practice. Emdeon Patient Statements is an automated patient billing service that reduces costs and gets statements to patients faster. Providers can simply upload a file from their desktop and then Emdeon takes care of the processing, printing and mailing. He found the Emdeon Patient Statements solution was robust enough to meet all his practice’s billing needs. It also seamlessly integrated with other administrative systems currently in place. Eventually, Dr. Robichaud also incorporated the Emdeon Patient Pay Online solution to answer patient demand for web-based payments.
Dr. Robichaud reports many positive results since introducing Emdeon Patient Statements and Emdeon Patient Pay Online to his practice. With Emdeon Patient Statements, the staff no longer loses valuable time lost in the exhaustive traditional billing process.“The staff doesn’t deal with outdated stamps, printing and time consuming billing.They don’t have to leave the office to physically go and mail statements, leaving the front desk unstaffed as they used to do,” states Dr. Robichaud. “This solution took away my staff ’s least enjoyable task!”
As simplifying and effective as Emdeon Patient Statements proved for the doctor and his staff, Emdeon Patient Pay Online has proven to be equally as streamlined and convenient for patients. The online account portal empowers patients to view billing amounts and pay their accounts with ease, online, anytime.
All told, Dr. Robichaud reports a solid return on investment in the Emdeon solutions.“Billing and payment costs were rising, and our AR needed cleaning up. We addressed those issues with these effective, efficient solutions,” says Dr. Robichaud. “It’s really simplified how we do business.”
This is a true success story, as the specific results and Dr. Robichaud’s praise attests. The complete, compelling success story including details about challenges, goals and impressive outcomes can be found in the Emdeon Patient Billing & Payment Case Study.
You can experience your own Emdeon success story! Call us today at 866.349.1607 to find case study-worthy solutions for your business operations.
Introducing Emdeon's Latest Innovations:
Two New Bigger, Faster, Better Solutions to Simplify Your Business...Again!
Have you ever seen a duck gliding on a lake? The image looks so serene, as sunlight gleams on the iridescent feathers of the duck skimming smoothly, seamlessly on the glasslike water. Yet just underneath the surface, the duck’s feet paddle quickly, furiously, relentlessly—in constant, concerted effort to keep moving forward. It takes lots of work to look that effortless.
Emdeon is much like that duck; our systems are ceaselessly working, and our people are endlessly innovating bigger, faster, better ways to simplify the business of healthcare. As our partner, you enjoy the smooth reliability of the more than 100 solutions Emdeon offers. You conduct business with seamless functionality because we’re constantly below the surface—paddling nonstop to save you time, money and effort in managing the revenue and payment cycle.
But at Emdeon, ‘bigger, faster, better’ is never enough, because our goal is to give you the services and support needed to be leaders. We stay in a mode of innovation to advance our existing solutions and pinpoint new ones to enhance your ever-growing, ever-changing business. Now, we’re pleased to report that all the proverbial paddling has paid off again in the form of two major innovations.
Introducing Emdeon’s data center additions and new, best-in-class print technology.
Emdeon Data Centers
On the occasion of the opening of the second of two new data centers, we invite you to look below the surface to get a glimpse of all that goes on to not only keep the single largest financial and administrative information exchange in the U.S. healthcare system going but to take its capabilities to new heights.
Our data centers deftly, reliably and securely transmit the unbelievable number of information exchange points and transactions the business of healthcare demands at any given minute, on any given day. Yet the volume of data exchanged is not nearly as impressive—or important—as what the new centers enable us to do with the data itself.
Rather than keep data chained together through separate business rules and processes as was required in the past, the technology behind our systems allows us to create data mash-ups, combining and aggregating data making information more useful and nimble.
Here’s a quick look at the advanced capabilities our data centers can enable.
For providers:
- Get paid sooner thanks to electronic claims that are auto-corrected and/or enriched with eligibility data to increase auto-adjudication rates.
- Receive remittance advice or estimate of payment within seconds of filing an electronic claim.
- Easily obtain comprehensive, accurate patient medical and prescription history within a collaborative care community.
- Monitor patients’ adherence to disease management protocols over defined periods of time within your collaborative care community.
For payers:
- Decrease call center and other operational costs thanks to minimization of errors or omissions on claims filed by providers.
- Detect insurance fraud prior to claims payment.
- Offer preventative patient care messages to providers based on patient medical and pharmacy histories.
- Eliminate pounds of paper currently received by mail or fax.
By bringing the new data centers online, we have streamlined many of our business processes, reducing the human factor and minimizing the potential for errors. By automating these processes, we can more accurately measure performance and anticipate issues before they become a problem. As a result, since the new centers have been online, calls into our call center have steadily dropped, while customer satisfaction has increased.
Our new, massive data centers live up to their billing as ‘state-of-the-art’ in every sense of the phrase. With hundreds of miles between them, these facilities are redundant yet independent to ensure all data is secure, safe and accessible without interruption. They exchange data at lightning-speed to eliminate downtime issues and further our capabilities as the single largest financial and administrative information exchange in the U.S. healthcare system.•55,000 sq. ft. containing 2,000 servers
•2 petabytes of storage (That’s 2,000 terabytes!)
•20+ Load Balancers (10+ Redundant Clusters)
•900 Microsoft Windows Servers
•350 IBM AIX Unix Servers
•500+ VMWare Virtual Guests
•450 databases
•100% future growth potential
Unparalleled Printing Advancements
We have introduced the Pitney Bowes® IntelliJet™ 30 Printing System to herald the next generation in on-demand printing technology and patient communications production. As one of only three such systems in the world, Pitney Bowes IntelliJet™ takes the idea of “fast and high quality printing” to stratospheric levels. With amazing 1200x600 dpi output of 1,380 pages per minute, there is virtually no limit to what you can create, design and produce for your patient communications.• Advanced print quality for razor sharp, vibrant patient statements
• Full-color statements in an extremely high resolution—1200 x 600 dpi
• Capable of four-color printing on both sides of the statement
• 1,380 pages per minute (400 feet of paper per minute)
With this new printing capability, Emdeon ExpressBill now has extreme capacity to handle patient statement production responsively in whatever quantities you need. We’re able to quickly update your statement design and content and print on demand—as needed, eliminating costs and waste associated with traditional, pre-printing methods.
Most impressively, this new printing system ensures statements enter the mail stream significantly sooner through logical presorting that combines postal codes prior to printing. This advanced capability eliminates the delays associated with the traditional USPS sorting process. Now we print your batches of statements in full color, in the presorted manner, allowing statements to hit the mail immediately upon print completion. Statements that get mailed sooner often lead to faster payment.
At Emdeon, we know we’re doing our job if you only see “the duck gliding on the water” with not so much as a worry about what must happen to keep things moving smoothly. Hopefully, this brief view beneath the surface deepens your appreciation for the innovations we’ve created. Now you can go about your business even more simply, while we keep ‘paddling’ to our next round of innovative solutions.
To learn more about Emdeon’s innovations and to view a video tour, please visit www.emdeon.com/innovation.
HIPAA Simplified Update
We are pleased to announce that Emdeon has received notification that we have met the requirements of the EHNAC 5010 Readiness Assessment Program. Emdeon received a score of 100%, which further evidences Emdeon’s commitment to ensure compliance with HIPAA 5010.
In addition to this industry recognition, Emdeon continues to guide our customers successfully through the migration to the X12 5010 and NCPDP D.0 versions of the HIPAA transaction standards. We have updated our gap analysis documents to include the recent 5010 Errata changes and we have enhanced our 5010 systems and products to support the Errata version of HIPAA transactions. The Errata versions of the gap analysis documents are available at the HIPAA simplified website under downloads.
We strive to provide you with the most updated and accurate information regarding our readiness for HIPAA 5010. Please see answers below to the most commonly asked questions regarding HIPAA 5010.
What is Emdeon’s current state and plans for HIPAA 5010 testing?
Emdeon is currently testing and implementing 5010 with submitters and payers. The late release of the Errata changes to the 5010 transaction standards further constricted the already narrow 5010 testing and conversion window. Nevertheless, as you can see in the list below, Emdeon has initiated submitter and payer testing on all 5010 transactions.
Errata Beta testing in process:
• 837 Professional claims
• 837 Institutional claims
• 837 Dental claims
• 835 ERAs
• 270/271 Eligibility verification
Emdeon is also testing the Final Rule version with submitters and payers for the HIPAA X12 transactions that were not included in the Errata revisions:
• 276/277 Claim Status
• 278 Referral/Authorization
What Emdeon solutions are impacted by 5010?
5010 impacts eligibility, claim, claim status and remittance transactions. The associated Emdeon solutions impacted by 5010 include our clearinghouse, as well as:
Emdeon Office:
Effective January 1, 2012, HIPAA requires that you update the manner in which you submit claims, eligibility and other health care transactions to use the new HIPAA 5010 standard format. For status inquiries such as eligibility, Emdeon Office has completed the baseline development needed to be able to convert information entered on our request pages to the new format, and to render responses received in the new format in the familiar display to which you are accustom. We continue to work with each insurance company to update our request screens according to the payers’ needs, as each insurance company becomes ready to handle the new formats.
Similarly, in the case of claim submission, Emdeon Office is already prepared to accommodate the 5010 format for many of our claims customers and very close to completing the necessary enhancements for the remainder. While Emdeon encourages all providers to be ready to submit claims using the new standards in advance of the deadline, we want you to be aware that Emdeon Office can make your claims comply with 5010 standards without requiring you to upgrade your practice management system. As part of our enhancement to convert your claims to the new HIPAA 5010 format, a number of significant new features will become available to you within the Emdeon Office Suite for no additional charge. These enhancements eliminate the need to budget significant amounts of money towards an upgrade specifically or exclusively due to the HIPAA 5010 claim format regulations.
Please be sure to check the Flash Message section of the Office home page for new messages providing detailed guidance on the transition and any actions that may be required of you.
To learn more about the HIPAA 5010 readiness plan for Emdeon Office customers, please email your questions to emdeonoffice5010@emdeon.com.
What is the timeline of events?
Emdeon is committed to fully support 5010 standards prior to the compliance date of January 1st, 2012; however the precise dates on which Emdeon will support 5010 standards will vary based on the product, transaction, payer readiness and client readiness. Our goal is to have all Emdeon products modified with testing completed by the end of 2011 in order to be ready for the January 1st, 2012 compliance date.
Where can I obtain additional information about HIPAA 5010?
Emdeon created a valuable web resource available to all industry stakeholders titled HIPAA Simplified, which may be found at www.hipaasimplified.com. HIPAA Simplified is a one-stop online resource that features gap analyses, business level documentation, webinars, timelines for the transition and testing information for our customers.
Thanks for trusting Emdeon as your source for HIPAA readiness. We are working diligently to deliver solutions that enable our customers to seamlessly meet these industry regulatory requirements.
How to Spot a Unicorn -or- The Accountable Care Organization Identified and Explained
What You Need to Know about ACOs
In a January 2011 news report, National Public Radio journalist Jenny Gold likened accountable care organizations (ACOs) to “the elusive unicorn: everyone seems to know what it looks like, but no one has actually seen one.”
The ACO has been a relatively hot topic since it was introduced as a provision in the new health law last year. The acronym fast achieved industry buzz phrase status as many in our industry began to eagerly hunt the proverbial unicorn without benefit of details or a roadmap. Most are aware ACOs fit in context with a better model for delivering care to Medicare beneficiaries; otherwise specifics are sketchy.
Here is the key information you need to know about ACOs—the corralling of the unicorn so you can have a better view.
Accountable care organization
əˈkountəbəl | ke(ə)r | ˌôrgəniˈzā sh ən
noun1 a type of payment and delivery reform model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients* *—as defined on Wikipedia
2 a recognized legal entity under State law and comprised of a group of ACO participants (providers of services and suppliers) that have established a mechanism for shared governance and work together to coordinate care for Medicare fee-for-service beneficiaries*
*—as defined by the Centers for Medicare & Medicaid Services
An ACO is an organized network of healthcare providers (hospitals, physicians, specialists) and is accountable to patients and payers, specifically Medicare. Provider participants collectively share responsibility for the healthcare of a group of patients for a set period of time. Specifically under the new law, an ACO must commit to care for at least 5,000 Medicare patients for a minimum of three years. The goal of an ACO is to improve the quality of care for patients while achieving cost savings, beyond the ACO’s historic national benchmark.
The intended benefit for patients is coordinated, well-rounded and more thoughtful care. Rather than receiving disjointed snapshots of care through referrals and provider visits, patients in the fold of an ACO would be part of a broader network. It’s kind of a “why buy the ingredients when you buy the cake already baked?” approach to healthcare.
The intended benefit for providers is the ability to give more efficient, results-oriented care while achieving cost savings that may then be shared amongst provider participants. Though still earning fees for service, ACO participants have the incentive of sharing in the savings, without full-blown capitation.
The intended benefit for everyone is aligned with the goals of ACOs in general: measurably better care and lower costs. Medicare is beleaguered, lumbering and struggling as an entity; those in positions of national leadership in health reform are banking on ACOs to achieve cost reductions and enhance care now while making the system viable for the longer term.
Under the provision of ACOs, providers will continue to receive fees-for-service, and patients will be free to select physicians outside the ACO network. The latter point is a key differentiator of ACOs from HMOs or health management organizations. This structural nuance is intended to avert possible control of patient referral patterns that some see as the bane of the HMO model (e.g. adverse selection). Additionally, antitrust reviews are to be expedited and coordinated by both the Federal Trade Commission and the U.S. Justice Department to ensure that no ACO is able to wield market power that drives prices up while keeping competition down, at least in theory.
The highly anticipated proposed rules were released on March 31, 2011 with a 60 day comment period. CMS received more than 1,200 comments, many of whom found ACOs bearing too many requirements with too few rewards. At the first ACO Learning Development Session on July 21, CMS Administrator Donald Berwick acknowledged the proposed rules caused debate and discourse and believes the final rule will take into account the thoughts and opinions of those who commented. Nonetheless, ACOs are part of the health reform structure and are poised to play a major role in our healthcare system moving forward.
Some of the comments from nationally recognized healthcare opinion leaders include:
• The American Academy of Family Physicians—“…The AAFP is concerned that the Medicare ACO program as currently proposed will fail to offer the potential benefits of better care for individuals, better health for populations, lower per capita costs for Medicare beneficiaries and improved coordination among physicians…"
• The Mayo Clinic—“…it (the rule) creates a sense of mistrust toward providers in a manner that suggests that CMS would not be a trustworthy and effective partner in the innovation that is necessary for us to really make progress in reform…"
• The Medicare Payment Advisory Commission (MedPAC)—“…Providers may be reluctant to commit time and money to reorganize the delivery system to better coordinate care and improve quality, if rewards are uncertain and difficult to calculate…"
Unicorn Sightings: ACO Dates and Milestones
Implementation deadline for ACOs is January 1, 2012.
In March 31st of this year, the federal government published proposed rules to guide the operation of ACOs. These rules establish comprehensive structural and quality requirements. HHS also released information for patients and providers to lay groundwork for ACO implementation. Upon release of proposed rules, many called for immediate review and modification.
On May 17th of this year, Centers for Medicare & Medicaid Services (CMS) unveiled three ACO initiatives to guide ACO structure and approach: the Pioneer ACO Model, Accelerated Development Learning Sessions and the Advanced Payment ACO Model.
Recent and upcoming ACO deadlines include:
June 6, 2011- NPRM comments closed
June 17, 2011- Cut-off for comments about advanced payment initiative to The Innovation Center
June 20 - 22, 2011- Training for Accelerated Development Learning
Session 1 in Minneapolis, also viewable by webcast
Session 2 September (TBA); San Francisco Bay, CA area
Session 3 October (TBD); Philadelphia, PA area (tentative)
Session 4 November (TBD); Atlanta, GA area (tentative)
June 30, 2011 - Due date for Letter of Intent for organizations interested in participating in the CMS’ Pioneer ACO model
August 19, 2011 - Application deadline for the Pioneer ACO Model
January 1, 2012 - Deadline for ACO implementation
Get Social with Emdeon
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New Payer Transactions Added Recently
• AETNA; Claims
• AIG; Claims
• America First; Claims
• Bay Area Delivery Drivers; Claims
• Central SeniorCare; Eligibility Inquiry and Response
• Combined Benefits Administrators; Claims
• Dreyer Health; Claims
• Federated; Claims
• Fresenius Medical Care; Eligibility Inquiry and Response
• Generations Healthcare; Eligibility Inquiry and Response
• Golden Triangle Physician Alliance/SelectCare of Texas(GTPA); Eligibility Inquiry and Response
• Hartford; Claims
• HEALTHe Exchange; Eligibility Inquiry and Response
• HealthSCOPE Benefits Inc; Claims
• IlliniCare Health Plan; Eligibility Inquiry and Response
• Katy Medical Group; Eligibility Inquiry and Response
• Liberty Mutual; Claims
• MED PAY; Claims
• Memorial Clinical Associates/SelectCare of Texas (MCA); Eligibility Inquiry and Response
• MORRIS ASSOCIATES; Claims
• Nebraska Medicaid; Claims
• Northwest Diagnostic Clinic/SelectCare of Texas (NWDC); Eligibility Inquiry and Response
• Omnicare Medical Group (OMNI); Claims
• Pinnacle Physician Management Org; Eligibility Inquiry and Response
• Secura; Claims
• Select Senior Clinic; Eligibility Inquiry and Response
• SelectCare of Texas (Kelsey-Seybold); Eligibility Inquiry and Response
• Summit America Insurance Services Inc.; Claims
• Texan Plus (North Texas Area); Eligibility Inquiry and Response
• Texan Plus (Southeast Texas Area); Eligibility Inquiry and Response
• Texas First Health Plan (TOPA); Eligibility Inquiry and Response
• Today's Health; Eligibility Inquiry and Response
• Today's Options; Eligibility Inquiry and Response
• Travelers; Claims
• Tribute/SelectCare of Oklahoma; Eligibility Inquiry and Response
• Village Family Practice; Eligibility Inquiry and Response
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
