January 1, 2013 is rapidly approaching. This is the date by which HIPAA covered entities must implement the Department of Health and Human Services (HHS) Eligibility and Claim Status Operating Rules mandated under the Affordable Care Act. The Eligibility and Claim Status Operating Rules that HHS adopted by regulation in 2011 comprise the majority of those required for CAQH CORE’s voluntary Phase I and II certification. Emdeon became CORE Phase II certified in 2010, so Emdeon was in a strong position of readiness when HHS adopted these operating rules.
Emdeon has completed a thorough gap analysis in order to be ready by the compliance date. We are now concluding our remediation of any identified gaps.
Trading Partner Support
Emdeon dedicated to help our clients complete this important transition successfully. We have already initiated testing with health plans that are ready to test their operating rule conformance.
In addition, we are actively engaging health plans who utilize our Eligibility and Claim Status Hosted Data Services (HDS). These health plans must:
• Migrate to version 3 of HDS if they are not on that version already; migration efforts for clients on prior versions are actively underway.
• Provide the proper data content in their eligibility files. (There are no data content requirements for the Claim Status transaction)
HIPAA Simplified
Our HIPAA Simplified website, www.hipaasimplified.com, remains the primary resource for information regarding the operating rules and other HIPAA and ACA regulations.
On the Operating Rules pages, you will find the newly updated Operating Rules Playbook. This publication is full of valuable information, including our operating rule program management structure, roles and responsibilities, educational material on the rules themselves, and a new section specific to the upcoming ERA/EFT Operating Rules.
HIPAA Simplified is updated regularly, so check back often!
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Eligibility and Claim Status Operating Rules Update
Setting the Stage for Stage 2. Where We Are Now & What You Need to Know.
(Part 1 of 4)
Stage 2 of the Meaningful Use (MU) incentive program is being billed by some as “a giant leap in data exchange1.” The overriding goal of the program is to advance the secure exchange of information within our health system between all of a patient’s providers as well as the patients themselves —and that is a giant leap from where the system is currently, indeed. Of course, with every giant leap comes the chance for big missteps. That’s why the time is now to prepare for Stage 2 objectives and requirements.
The Biggest Challenges Revealed in Stage 1
According to a recent study published in the Journal of the American Informatics Association, the biggest challenge for hospitals participating in the MU program is Computerized Provider Order Entry (CPOE). Out of 2,475 hospitals in the study that intended to participate in MU, only 313 received incentive payments in 2011 during Stage 1. Half of those hospitals that didn’t meet Stage 1 requirements cited CPOE criteria as a top challenge. As we move to Stage 2, issues related to CPOE will remain as many hospitals are only beginning to adopt EHRs and build infrastructure to meet MU criteria.
For hospitals that were awarded incentive payments, giving patients access to their data in electronic form and generating numerator and denominator data for quality reporting directly from the Electronic Health Record (EHR) were reported to be the most significant challenges. The difficulty of providing electronic data to patients is very important to note and prepare for, as Stage 2 focuses on electronic patient communications and assigns heightened requirements to achieve program incentives.
According to Stage 2 Meaningful Use requirements final rule by Centers for Medicare & Medicaid Services (CMS), providers must achieve meaningful use under Stage 1 criteria before advancing to Stage 2. CMS has announced certain changes to Stage 1 CPOE; details may be found by clicking here.
What is different in Stage 2 as compared to Stage 1
In Stage 2, there are more core objectives for Eligible Professionals, Eligible Hospitals and Critical Access Hospitals (CAHs). Many Stage 1 core objectives have been merged or folded into other requirements. Eligible Professionals have 20 total objectives, including 17 core objectives and 3 (of 6) menu objectives. For Eligible Hospitals and CAHs, there are 19 total objectives comprised of 16 core objectives and 3 (of 6) menu objectives.
Here’s a quick look at core objectives that Eligible Professionals must report on, as well as the six menu objectives they may choose from.
Core Objectives
1. Computerized Provider Order Entry (CPOE)
a. Use CPOE for more than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology.
2. ePrescribing (eRx)
a. Use eRx for more than 50 percent.
3. Demographics
a. Record demographics for more than 80 percent.
4. Vital Signs
a. Record vital signs for more than 80 percent.
5. Smoking Status
a. Record smoking status for more than 80 percent.
6. Interventions
a. Implement 5 clinical decision support interventions + drug/drug and drug/allergy.
7. Labs
a. Incorporate lab results for more than 55 percent.
8. Patient List
a. Generate patient list by specific condition.
9. Preventive Reminders
a. Use Electronic Health Record (EHR) to identify and provide reminders for preventive/follow-up care for more than 10 percent of patients with two or more office visits in the last 2 years.
10. Patient Access
a. Provide online access to health information for more than 50 percent with more than five percent actually accessing.
11. Visit Summaries
a. Provide office visit summaries for more than 50 percent of office visits.
12. Education Resources
a. Use EHR to identify and provide education resources more than 10 percent.
13. Secure Messages
a. More than five percent of patients send secure messages to their Eligible Professionals (EP).
14. Prescription Reconciliation
a. Medication reconciliation at more than 50 percent of transitions of care.
15. Summary of Care
a. Provide summary of care document for more than 50 percent of transitions of care and referrals with 10 percent sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR.
16. Immunizations
a. Successful ongoing transmission of immunization data.
17. Security Analysis
a. Conduct or review security analysis and incorporate in risk management process.
Menu Objectives (select 3 of 6)
1. Imaging Results
a. More than 10 percent of imaging results are accessible through Certified EHR Technology.
2. Family History
a. Record family health history for more than 20 percent.
3. Syndromic Surveillance
a. Maintain successful ongoing transmission of syndromic surveillance data.
4. Cancer
a. Maintain successful ongoing transmission of cancer case information.
5. Specialized Registry
a. Maintain successful ongoing transmission of data to a specialized registry.
6. Progress Notes
a. Enter an electronic progress note for more than 30 percent of unique patients.
For even more details, view the CMS' Stage 2 Tipsheet by clicking here.
The Five Percent+ Factor: Focusing on Patient Engagement in Stage 2
Patient engagement—reciprocal communication between patients and providers—is a significant focus that everyone must be prepared for in Stage 2. To be eligible for incentives, providers must achieve the following patient action.
- More than five percent of patients must send secure messages to their eligible providers.
- More than five percent of patients must access their health information online.
For many Eligible Professionals, it may be quite daunting to evoke such engagement from over five percent of patients, as so many factors affect the transition to electronic information sharing. Technological, cultural and organizational barriers exist across communities nationwide. For example, CMS is introducing exclusions based on broadband availability by county, as some areas simply don’t have the Internet access necessary for five percent to take action even if they are willing to do so.
Timing for Stage 2
The final rule has been out since August 2012 and though there is an urgency for Stage 2, there is not the mad rush that surrounded Stage 1. Stage 2 test scripts have not yet been released in full from certification bodies and at this writing only three are out. Test scripts from vendors will be released in phases, with the launch of testing anticipated for December 2012 or January 2013.
For a complete look at Stage 2, visit CMS’ website by clicking here. There you’ll find tables, tipsheets and updates directly from CMS. In addition, continue to follow Emdeon for targeted announcements and interpretation of latest updates as it relates to your business. Emdeon will continuously guide you through Stage 2 so that you are prepared to offer expertise to your customers every step of the way.
Stay tuned for our next article in series, Planning for Certification and Strategies in Testing.
1. http://www.healthit.gov/buzz-blog/meaningful-use/meaningful-use-stage-2/
2. http://www.fierceemr.com/story/cpoe-huge-stumbling-block-meaningful-use/2012-10-02?utm_source=rss&utm_medium=rss
3. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTablesforEP.pdf
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From Politics to Practice
What we learned at MGMA. By Gene Boerger, V.P. of Professional Product Management at Emdeon
On the surface, the agenda for the 2012 MGMA Annual Conference (San Antonio, Oct. 21-24) contained few surprises: Education sessions focusing on ICD-10, ARRA, administrative simplification, Meaningful Use and ACOs.
What was unexpected, however, was the energy invested by the more than 3,000 people in attendance in transforming the politics of these issues into actionable strategies. Attendees and vendors alike were eager to convert the principles of reform into practice. We strategized with numerous provider groups to share how our expertise in care management, clinical information exchange and revenue optimization can transform industry concepts into real, workable scenarios. From our viewpoint, attendee interests fell into four major categories:
1. Solution engineering. We spoke with leaders at medical groups who recognize they need new solutions and new processes to achieve their objectives. Educational sessions, hallway discussions and vendor meetings centered on best practices and lessons learned. Attendees seemed to have a grasp of what they need and were tuned in to asking questions about how to get from here to there. Vendors were on the same wavelength. Countless meetings were held outside of exhibitor hours, where discussions about how to collaborate and integrate technologies to provide a more comprehensive whole abounded.
2. Care Management. Discussions about new care and reimbursement models, such as accountable care organizations (ACOs) and other pay-for-performance arrangements, have progressed from the abstract (“these approaches will help us control costs and improve care”) to the concrete (“who needs to be involved and what precisely will they be doing?”). Attendees explored the structures needed for greater focus on care management, for example, and heightened levels of coordination among providers. These conversations also dug deep into alignments—particularly as they affect community physicians—with hospitals.
3. Data drivers. As quality measures become engrained in emerging reimbursement models, medical groups increasingly need advanced data collection, analysis and reporting capabilities to successfully participate in a pay-for-performance or ACO-type model. Attendees recognized that their EHRs must work harder and that health information exchange (lowercase) is crucial. With a traditional focus only on delivering care—and not necessarily measuring it—providers are now taking a crash course in what tools are available, how they need to be configured and what they can do with the data that’s produced.
4. Business success. Billing professional fees. Proper coding and revenue optimization. Preparing for (and passing) audits. Contract negotiations. Use of outsourcing and technology. Patient collections. All activities that impact the bottom line—with a plethora of “practice proven and time tested” solutions for the challenges many medical groups face—were widely discussed. To arm our providers with information to improve business success, Emdeon held several educational presentations aimed at increasing revenue while effectively managing operations. Attendees agreed these considerations were more important in 2012 than ever before because of the incentive and payment reduction programs payers have adopted.
Emdeon made its presence felt throughout the conference, joining more than 350 other companies on the trade show floor with a dynamic booth that hosted long-time customers and new prospects. Emdeon was joined by the American Academy of Family Physicians for a speaking engagement in the MGMA Innovation Center on Care Management, and Emdeon representatives also delivered a number of in-booth educational sessions on topics ranging from how to remove barriers to submitting clean electronic orders to revving up cash flow by accepting online payments.
Overall, the mood of MGMA seemed to be of anticipation, partly fueled by the impending presidential election. Many attendees seemed to be of the opinion that the trends spurred by healthcare reform legislation would continue—and that they are embracing and preparing for new directions.
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Preparing Your Practice for the Future: A Look Ahead to 2013
You don’t need to be told that the speed of change in healthcare continues to accelerate. From healthcare reform to Medicare reimbursements to technology deployments, you must be ready to move with a quick and effective response to any and all challenges that come your way. The reward? Clinical and financial viability, now and well into the future. Here’s a peek at some market and regulatory forces that you will likely confront in 2013:
The Way is Paved for PPACA
The Patient Protection and Affordable Care Act (PPACA) was passed, the U.S. Supreme Court ruled to uphold the law and the potential Republican reversal to healthcare reform legislation came up short in a bid for the White House. If they haven’t already, physicians should gear up big for changes. PPACA will increase access to care for the millions of Americans who have previously been unable to obtain medical insurance; the expansion of Medicaid alone is estimated to result in up to 15 million new enrollees during 2014i. It’s important for practices to routinely verify information for its Medicaid patients, and with the impending, significant growth in this population, it will be increasingly vital to confirm that patient information is accurate. Whether coverage is obtained through private companies or government programs such as Medicaid, small practices better be ready.
An Adjustment in Income?
As it stands now, physicians may face an adjustment of 27 percent or more in Medicare reimbursements in 2013ii. Congress did implement a temporary patch last year to keep 2012 rates stable, but has yet to apply a permanent fix and replace the current sustainable growth rate (SGR) reimbursement system with a more stable and predictable payment mechanism.
Increasing Quality Reporting Demands
With the release of the new Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) announced that providers who do not successfully participate in the Physician Quality Reporting System (PQRS) during the 2013 program year will be subject to a one and a half percent payment adjustment in 2015, and a two percent adjustment in subsequent yearsiii. On the flip side, eligible professionals (EPs) who satisfactorily report quality measure data will qualify for a half percent bonus in 2013. To help you avoid reimbursement adjustments, CMS has proposed two additional reporting options. The first is to satisfactorily report at least one PQRS measure or measures group via a claims, registry or EHR-based reporting mechanism. The second option allows you to utilize administrative claims-based reporting for related measures. Be aware, however, that if you elect one of these reporting options, you will not qualify for an incentive payment.
ePrescribing Actions
CMS continues to aggressively push ePrescribing. The goal of CMS’ ePrescribing Program is ultimately to increase patient safety through the reduction of medication errors and adverse drug events. Besides the improvement in efficiency that physicians gain through this program, there is also a financial benefit for being an early adopter. In 2013, the last year of the Medicare ePrescribing incentive system, you can receive a half percent financial bonus for conducting a portion of prescription orders electronically. Considering that you will be subject to a one and a half percent payment adjustment for noncompliance, those easy to use ePrescribing platforms are beginning to look pretty attractive.
EHR Deployment Progress
Better known as “Meaningful Use,” the EHR Incentive Program continues in 2013, with many physicians preparing for their 90-day reporting period that will enable them to prove they are meaningful users of the technology under Stage 1 requirements. While the reporting period for Stage 2 compliance has been pushed back until October 2014, you should take advantage of the additional time and prepare for rising Stage 2 qualification thresholds, including demonstrating that at least 50 percent of your prescriptions are completed through ePrescribing, up from the 40 percent required in Stage 1.
Requirement to Accept Electronic Payments
Expect 2013 to be a watershed year for participation in emerging Medicare payment initiatives that are driving the formation of accountable care organizations (ACOs), shared savings programs, bundled payment pilot projects and value-based payment modifiers. And if Meaningful Use is not enough of an incentive for you to ramp up your EHR deployment efforts, these new initiatives surely demand that you look closely at enabling solutions to access and utilize the data you need to improve care and reduce costs. Additionally, January 1, 2014, is the deadline by which all payments under Medicare must be conducted via electronic funds transfer (EFT). And, while providers will not be required to accept electronic payments from commercial health plans, all payers will be required to have the ability to facilitate these transactions.
To help small practices navigate healthcare reform, Emdeon Office Suite provides many tools to increase accuracy and efficiency while reducing interruptions in the revenue cycle. Online pre-registration, real-time eligibility and benefits verification, and claims and payment management, including the facilitation of electronic funds transfer, are some of the key services this technology offers. Emdeon also provides a convenient and cost-effective way for providers and pharmacies to exchange ePrescribing transactions through its Emdeon Clinical Exchange EHR Lite, an ONC-Certified EHRiv.
ihttp://www.medicaid.gov/AffordableCareAct/Provisions/Downloads/MedicaidEligibilityFinalRule_Regulatory-Impact-Analysis.pdf
iiMedicare Physician Fee Schedule; http://www.beckersasc.com/media/CMSFinalRule2013MPFS.pdf; Page 15
iiiMedicare Physician Fee Schedule; http://www.beckersasc.com/media/CMSFinalRule2013MPFS.pdf; Page 1195
ivThis Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. Emdeon Inc, 01/19/12, Emdeon Clinician 7.6, 0119201230701, NQF0064/PQRI128, NQF0041/PQRI110, NQF0024, NQF0028, NQF0038, NQF0059/PQRI1, NQF0064/PQRI2, NQF0061/PQRI3.
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Make it easy and convenient for patients to pay their healthcare bills
Part 2 of a 4-part series designed to offer small practice providers tips on improving their administrative and clinical operations.
Few people enjoy paying their bills—it’s just no fun to watch hard-earned money end up in someone else’s bank account.
No matter how well you take care of your patients, they’re just as hesitant to open their wallets. It stands to reason, then, that you need to make the process as painless and convenient as possible. Online portals can be the perfect solution. Consumers have grown accustomed to managing their affairs via the Web and expect this level of service in all areas of their lives—including healthcare.
The healthcare industry, however, has yet to make patient-facing, Web-based payment tools a universal option. Small practices must pay especially close attention to cash flow, so encouraging timely and accurate payment by bringing the process online is crucial.
Optimizing the online advantage begins well before a patient encounter. Web-based registrations tools, for example, allow patients to sign in prior to their arrival and the practice to capture important information. Patients are free to register at their convenience days before their appointment, instead of arriving at the doctor’s office early just to fill out paper forms. The practice benefits, as well, because it has access to legible, accurate information to streamline the claims and billing process.
Then, after the visit, patients can conveniently—and promptly—settle their accounts via the secure portal. Not only is cash flow improved, practices can reduce administrative expenses by removing some of the burden of collections from their office staff.
When introducing online capabilities to their patients, practices must promote the portal to ensure it’s used. A “multi-touch” campaign offers the best approach. Posters in the lobby, hallways and exam rooms can announce the new payment option. Registration and check-out staff should mention the availability of the portal and maybe even hand out postcards, refrigerator magnets or other tchotchkes. An additional reminder can be printed on billing statements still being mailed.
It’s important to promote the portal on the practice’s website, as well, preferably on the home page. This serves as a constant reminder for current patients and might attract individuals looking for a new doctor.
Other ways to encourage use of an online payment option include:
• ensuring the portal features easy-to-use instructions and simple navigation;
• making sure the portal displays contact information prominently in case patients need help; and
• assuring patients that the portal is secure and all private information is protected.
One final note: Keep in mind that patients of all ages might use online tools. They should include the full-bodied features the younger generation has come to expect, but be simple enough so those less technology-savvy can navigate the process easily as well.
Emdeon’s Patient Pay Online Express is a patient-facing application designed to help small providers enjoy success with Web-based portals. As an example, Concord Integrated Health, a chiropractic medicine practice located in Concord, Massachusetts, was increasingly burdened by the conventional process for generating and sending patient statements. At the time, it was generating between 250 and 300 statements per month. Along with implementing an automated billing service, Concord Integrated Health began using the Emdeon Patient Pay Online Express solution to answer patient demand for Web-based payments. With individuals able to view billing amounts and pay their accounts online, at anytime, the amount and promptness of payments greatly increased. Dr. Jeff Robichaud, Chief of Concord Integrated Heath’s Chiropractic Medicine Department, summarizes that “by allowing patients to pay their bills online, we are seen as a practice that is providing the most up-to-date solution for them. Patient Pay Online drives patients to our website as well, so we can have a presence with them beyond the in-person office visit.”i
With a secure system accessible to patients 24 hours a day, seven days a week, the Emdeon Patient Pay Online Express solution improves collections and data accuracy, while offering patients greater convenience. Emdeon helps speed up the billing and payment cycle, improving finances, reducing staff time invested in administrative tasks and giving you more time to spend with patients.
Nothing will remove the sting of paying a medical bill completely, of course. But by reducing the hassle and offering an option that fits into the patient’s lifestyle, practices eliminate some resistance—resulting in timely payments and improved cash flow.
For more information on how Concord Integrated Health has experienced increased payments and patient satisfaction through the use of Emdeon’s Patient Pay Online Express, please click here.
(Note: Stay tuned for an in-depth look at other ways to improve customer relations to enhance patient billing and collections in the next issue of this newsletter.)
i “Emdeon Patient Billing & Payment Solutions: Efficient technology for reducing costs and accelerating patient payments,” Emdeon Business Services LLC, July 2011
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Get to know Emdeon better. Join us online.
Follow Emdeon on Facebook and Twitter to learn about innovative new solutions and special offers or to provide feedback on Emdeon products and services you use. Emdeon regularly posts updates and offers valuable resources to keep you on top of industry trends and current information, including healthcare reform, emerging technology, best practices and more. Use your computer or mobile device to receive Emdeon updates on free webinars, new product launches, important news articles and upcoming tradeshows. You can also visit our YouTube channel to watch inspiring customer testimonials and insightful product videos, or join Emdeon on LinkedIn to connect with colleagues. Click the icons below and get social with Emdeon today!
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New Payer Transactions Added Recently
We have recently added the following payers:
• Health Alliance Medical Plans (HAMP), ERA
• Mediture, Claims
• Medico Insurance Company, Claims
• Wellcare, Claims
• North American Benefits Network (Cleveland, OH), Claims
• Trellis Health Partners, Claims
• CNIC Health Solutions Inc., Claims
• AmeriChoice of New Jersey, Inc. (Medicaid NJ), Claims
• CareOregon, Inc., Claims
• Blue Cross of Arkansas, ERA
• MED3000 CMS TITLE 19 REFORM, Claims
• Hawaii Medical Service Association (HMSA), ERA
• Merchants Benefit Administration, Claims
• Cook Children STAR Plan, Claims
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
See the full list >>
HHS Announces FINAL Rule for ICD-10 Compliance Date and HPID
Health and Human Services has announced a Final Rule that confirms the proposed extension of the ICD-10 compliance date to October 1, 2014.
The Final Rule also establishes a unique health plan identifier (HPID), as well as a unique identifier for other entities (OEID), and modifies the NPI Rule to include pharmacy prescribers.
The Final Rule establishes these important dates:
• Health plans, with the exception of small plans, must obtain an HPID by November 5, 2014
• Small health plans must obtain an HPID by November 5, 2015
• Covered entities must use HPIDs in the standard transactions on or after November 7, 2016
The changes to the NPI rule become effective May 6, 2013.
HIPAA Simplified Expanded to Include ICD-10, other upcoming HIPAA and ACA Regulations
Emdeon’s HIPAA Simplified website (www.hipaasimplified.com) has been expanded to address ICD-10, as well as other upcoming regulations enacted by HIPAA and the Patient Protection and Affordable Care Act of 2010 (ACA).
New Section added for ICD-10:
We have added a new section for ICD-10 that includes Emdeon Clearinghouse FAQ’s. Emdeon’s ICD-10 Program Playbook will also be published in the near future, offering our customers an in-depth look at Emdeon’s ICD-10 strategy. The playbook will include:
• An overview of ICD-10, important facts and key changes between ICD-9 and ICD-10
• Guiding principles and governance of our ICD-10 program
• Emdeon’s ICD-10 implementation timeline
• Plans for customer messaging and communications
• Information on trading partner testing
To access the ICD-10 page, click the ICD-10 link from the HIPAA Simplified home page. Alternately, you can go directly to the ICD-10 page using the URL http://www.emdeon.com/5010/icd10.php.
Operating Rules:
The Patient Protection and Affordable Care Act (ACA) of 2010 requires The Department of Health and Human Services (HHS) to adopt operating rules for the HIPAA transactions. The first of these regulations, concerning the health plan Eligibility/Benefit and Claim Status transactions was issued in July 2011, with a compliance date of January 1, 2013.
The Operating Rules page of HIPAA Simplified presents frequently asked questions about the regulation and Emdeon’s readiness to keep you updated regarding this important milestone.
As an industry leader, we are committed to helping our trading partners successfully navigate the HIPAA and ACA regulatory timeline. Emdeon intends for HIPAA Simplified to be an evolving site and valuable resource for our customers.
Bookmark HIPAA Simplified and check back often!
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Medicare Payment Reduction on Tap for Physicians Who Don’t ePrescribe
Providers who have yet to participate in Medicare’s Electronic Prescribing (eRx) Incentive Program better get moving.
The program (authorized under the Medicare Improvements for Patients and Providers Act of 2008) provides for payments to eligible professionals, including physicians and group practices, equal to one percent of their total estimated Medicare Part B Physician Fee Schedule-allowed charges. However, it also called for a payment adjustment for covered providers who are not yet successful ePrescribers.
It’s not just the incentives and payment reductions that should propel providers into action (see chart). ePrescribing provides a host of benefits, such as driving greater efficiency by reducing paperwork and increasing medication dispensing accuracy. ePrescribing also provides additional patient safety measures missing from manual processes. The Journal of the American Medical Informatics Association reported in a 2007 article that more than one million serious drug errors occur in U.S. hospitals annually. Many ePrescribing technologies include medication reconciliation modules that allow providers to see prescription histories and reconcile medications at the point of care. Enabled ePrescribing systems can capture up to 95 percent of patient medication information, far more than what is revealed during patient interviews.
As a side note, CMS does realize that while a majority of physicians will easily comply with the incentive program, some will find it more difficult to ePrescribe. As a result, CMS will exempt individual eligible professionals and group practices participating in the ePrescribing program from the 2014 payment adjustments if requirements for becoming a successful electronic prescriber would result in a significant hardship. Providers will qualify for the exemption if they:
• are unable to submit electronic prescriptions due to local, state or federal law, or regulation;
• will prescribe fewer than 100 total prescriptions during the January-to-June reporting period;
• practice in a rural area without sufficient high-speed Internet access; or
• practice in an area without sufficient available pharmacies for electronic prescribing.
To request the hardship, individual eligible professionals and group practices must submit their significant exemption requests through the CMS Quality Reporting Communication Support webpage (https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234). CMS will review the requests on a case-by-case basis.
Fortunately, eligible providers considering their next steps towards becoming ePrescribing compliant have access to many enabling tools such as Emdeon Clinical Exchange EHR Lite, a component of Emdeon’s Office Suite. As a certified EHR Lite, this solution combines routine administrative health information exchange with consolidated ePrescribing as well as electronic lab ordering and results distribution.
These tools are specifically designed not only to help providers qualify for Meaningful Use and the eRx incentive, but to drive clinician efficiency and improve patient safety—two of the most important and compelling objectives healthcare has been challenged to address.
To learn more about tools for achieving eRx compliance, please review information about Emdeon Clinical Exchange EHR Lite on the Emdeon website.
1 “Evaluation of Outpatient Computerized Physician Medication Order Entry Systems: A Systematic Review,” Journal of the Medical Informatics Association (JAMIA), July 2007.
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Look What’s New in Emdeon Office Suite!
Reporting & Analytics Update
Emdeon has added four new updates in Reporting & Analytics to help you better manage and evaluate your practice’s analytics data.
1. Improved Exporting of Large Reports—When pulling reports over 20,000 rows in Reporting & Analytics, you can export the report based upon the segment of the report you want. A pop up box will appear that allows you to click which segment you would like to export. To export multiple segments, click on each segment.
The following reports include this new functionality:
• Claim Summary
• File Summary
• Insured Detail
• Summary By Payer
• Summary By Payer By Day
Please note that the standard download save/print process for reports with less than 20,000 rows remains available.
2. Column Sorting—A new column sorting functionality is available in Reporting & Analytics reports. By clicking on the column header, you can sort columns in ascending and descending order. Similar to Microsoft’s Excel®, the report is sorted on the column in which the sort arrows appear in the column header. The new sorting functionality is available on most Reporting & Analytics reports.
3. File Status on Landing Page—An Acceptance/Rejection status column has been added to the Landing Page File Summary Status Report in Reporting & Analytics. If the file is rejected, you can click on the File ID link to view the Reject File report.
4. File Level Rejection Alerts on Landing Page—A new alert with File Status information is displayed on the Reporting & Analytics Landing page. This alert shows the number of rejected files for your user account for the specified date range. You are able to click the link to view the File Summary Report in more detail.
Learn more about these new features and more in one of our Emdeon Office Reporting & Analytics Informational Webinars held every Tuesday at 11am EDT/10am CDT.
Webinar Details:
Every Tuesday: 10am Central / 11am Eastern
Web access: www.emdeon.com/office-webinar
Audio access: 877.345.2580
Meeting number: 62791804
New Payers Added to Workers’ Compensation and Automobile Medical Bill Network
Emdeon Office Suite now has access to over 400+ Workers’ Compensation and Automobile Medical insurance payers. This increased access allows you to submit more Workers’ Comp and Auto Medical bills and attachments electronically, further reducing the need for paper attachment handling while improving the accuracy in your claims process.
Electronic submission of Workers’ Compensation and Automobile Medical claims helps you comply with applicable state mandates as well. Texas and Minnesota have already adopted legislation that requires electronic Workers’ Compensation and Automobile Medical claims submissions; other states are considering similar legislation. Emdeon Office Suite also enables electronic submission of required attachments to simplify the process even further.
Start processing your Workers’ Compensation and Automobile Medical claims electronically today and see how you can simplify your claims process.
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Five Top Tips for Improving Payment Collections
A Small Practice Whitepaper
Are you struggling with keeping your practice financially sound? It’s no wonder. Practices today are facing financial burdens never seen before in the healthcare industry. Medicare payments have decreased in favor of incentive-based programs and commercial payers are gradually shifting financial responsibilities to the patient, making it harder for you to collect on what you are owed.
Get the information you need to increase your collections in our latest Emdeon whitepaper, “Time-tested and practice-proven: Top tips for collecting payments”. We share our five best tips to keep your practice running successfully, encompassing all aspects of your patient’s visit from the first scheduled appointment to the final patient payment. We also offer insight into how to utilize today’s technology to measure and analyze your practice to keep you on track and your cash flow healthy.
The “Time-tested and practice-proven: Top tips for collecting payments” whitepaper is available now. Download it today!
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Get to know Emdeon better. Join us online.
Follow Emdeon on Facebook and Twitter to learn about innovative new solutions and special offers or to provide feedback on Emdeon products and services you use. Emdeon regularly posts updates and offers valuable resources to keep you on top of industry trends and current information, including healthcare reform, emerging technology, best practices and more. Use your computer or mobile device to receive Emdeon updates on free webinars, new product launches, important news articles and upcoming tradeshows. You can also visit our YouTube channel to watch inspiring customer testimonials and insightful product videos, or join Emdeon on LinkedIn to connect with colleagues. Click the icons below and get social with Emdeon today!
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New Payer Transactions Added Recently
We have recently added the following payers:
• Arbor Health Plan – Claims
• Arbor Health Plan – ERA
• Centene LA Healthcare Connection - ERA
• CNA - Claims and ERA
• Dallas Independent School District – Claims
• Dallas Independent School District - ERA
• Greater Covina Medical Group - Claims
• Harris County - Claims
• Harris County - ERA
• Innovative Healthware Systems – Claims
• Integrated Medical Solutions, LLC – Claims
• Martins Point Health Care - Claims
• Meadowbrook Insurance Group - Claims
• Meadowbrook Insurance Group - ERA
• Medical Associates Health Plan - Claims
• Mediview, Inc. – Claims
• Michigan Medicaid – ERA
• Network Health Plan of Wisconsin, Inc. - Claims
• Resolve Health Plan Administrators, LLC - Claims
• Security Health Plan - ERA
• Summit Administration Services, Inc. - Claims
• Wyman-Gordon Companies – ERA
• Xchanging, Inc – ERA
• Xl Environmental, Inc. – ERA
• Zachry Construction - ERA
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
See the full list >>
HIPAA 5010 - The end of the journey in sight
The healthcare industry continues its march to achieve 5010 compliance and we are beginning to see the light at the end of the tunnel. Emdeon along with other industry stakeholders is completely vested in helping its customers reach this very important mandate.
We all know that this transition has not been an easy one and has created financial pain throughout the healthcare industry, but the constant struggle is finally paying off. Emdeon is the single largest clinical, financial and administrative health information network in the nation. In 2011, we processed more than 6 billion health information exchanges and our numbers show significant insight into the industry. Our HIPAA 5010 insight and transition experience shows us that:
• Payer acceptance / rejection rates are stabilizing to pre-5010 levels
• Production issues are down 145 percent from record highs in January
• Claim support cases are down 64 percent since peak of 5010
• Overall payer rejections which peaked at over five percent are down to less than four percent
• New file acknowledgement reporting issues have dropped significantly
• Medicare claim status tie-out rates improved from post conversion low of 82 percent to a current rate of more than 99 percent (two percent higher than pre-5010 rate)
• Eighty three percent of inbound claims to Emdeon are received in 5010 format
• Eighty percent of claims outbound from Emdeon are being sent to payers in 5010 format
Overall, a lot has been achieved but there is still work to do until a successful and complete 5010 transition has been realized. The transition to HIPAA 5010 may continue to impact cash flow for some time and therefore we recommend that our providers continue to prepare for potential impact. Emdeon continues to execute toward a complete and successful transition to 5010, which is a goal we share with all industry stakeholders.
One item still impacting the transition is a result of post 5010 production behavior not being concurrent with 5010 test results. Our industry has experienced that test platforms with some payers did not fully represent production systems or were unable to test full production volume. Also, some payers were unable to produce valid file acknowledgement or claim status reporting during testing. As a result, the healthcare industry has experienced the following substantial impacts:
o File acknowledgment report rejecting entire batches due to one “bad” claim
o Payer rejection spikes with vague rejection messaging
o Claim Status transaction issues
o Issues with Electronic Remittance Advice (ERAs) without Tax IDs or having ERAs sent in both 4010 and 5010
If your organization is still experiencing some of the issues, utilize Emdeon Reporting and Analytics available to you through Emdeon Office, to assist with solving your issues prior to opening a case via Emdeon ON24/7. You can also consult the HIPAA 5010 - Top rejection reasons document to educate yourself more about specific issues.
Emdeon has focused on multiple key initiatives within our organization to assist providers.
• Emdeon added resources throughout the last two years in preparation of 5010
• Our Operations and Information Technology departments have been re-engineered and personnel have been realigned to continuously identify the root cause of issues and recognize behavioral traits in transaction processing and reporting feedback within payers and fiscal intermediaries
• We have revamped our industry communications across all submitter and payer channels and created a “catastrophic rejection” team that conducts outreach to our providers with same day identification, root cause and training for all catastrophic daily rejections
• Emdeon has held 5010 specific webcasts for all channels to take part in. These webcasts describe specifically what is being identified and resolved while focusing on how the healthcare industry needs to partner together in order to continually resolve all 5010 related issues
• Key industry stakeholders – Emdeon is continuing to facilitate communication and connect CMS, payers, submitters and third party vendors
• Emdeon is very involved with industry level communications such as:
o Becker’s Hospital Review, News article on preparing hospitals for ICD-10, Meeting the Deadline: A Timeline for Hospitals' ICD-10 Transition
o Debbi Meisner, Part B News, Feature article on the 5010 transition, 5 HIPAA 5010 edits to avoid when testing claims (clip available offline)
o Debbi Meisner, Healthcare IT News, by lined commentary on 5010 preparedness, HIPAA 5010: Are You Ready for the New Transaction Standard?
o Debbi Meisner, AAFP News, News article on the state of 5010 and how doctors can help, http://www.aafp.org/online/en/home/publications/news/news-now/practice-professional-issues/20120215compliance5010.html
o Debbi Meisner, enforcement delay, the actual transition and the benefits to those on the other side on the Government Health IT news site,
http://www.govhealthit.com/news/commentary-how-hipaa-5010-has-fared
• Emdeon is holding regular meetings with CMS, WEDI and other Industry leaders in the payer, clearinghouse and submitter space to identify issues and share best practices on resolution
• Where possible, Emdeon is standardizing vague or un-actionable payer rejection messages to allow Providers to correct and re-file in a timely manner
Our healthcare industry is multi-dimensional and constantly evolving. Emdeon is committed to advance with it while helping our customers evolve too. For additional information about HIPAA 5010 transition and ICD-10 compliance, please visit hipaasimplified.com.
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Best Practices in Patient Billing and Collections: Effective Approaches and Tools for Patient Communications
Part 1 of a 4-part series designed to offer small practice providers tips on improving their administrative and clinical operations.
Consider how long it takes to pay your energy bills. Every month, the bill comes in. You are expecting it. You know your service will be cut off if you fail to send a check. So you promptly pay the bill. The time from service delivery to payment collection for utility companies is only a matter of weeks, even with customers who continue to pay through the mail. It’s hard to imagine anything longer than that.
In contrast, the time between a patient visit and full remittance is typically much longer—often dragging on for months.
This is a major pain point for most practices. When you don’t get paid in a timely manner, your cash flow suffers. Often, the longer it takes to receive patient remittance, the less likely you will get paid in full. Discounts may be negotiated, for instance, and you may be forced to write off balances you have no hope of settling.
The bad news is that the problem is expected to get worse. Patient responsibility—out-of-pocket payments—rose nearly 50 percent between 2000 and 2010 to an all-time high of $299.7 billion. This trend is likely to continue as payers look to relieve their own financial pressures, including increased competition and rising costs for medical care.
Physician practices can achieve a certain degree of control over the situation, however, by recognizing contributing factors, managing “patient-responsible” balances more proactively and communicating with patients more effectively. Here are some tips and tactics to keep in mind.
1. Ensure the information you have about your patients is current and accurate. This information is provided by the patient through registration forms at the time of the visit or through online forms that the patient can submit prior to arriving at the doctor’s office. Companies such as Register Patient offer affordable, secure solutions for online patient registration, without requiring practices to invest in—and learn—new technology. Whether you use a third-party resource or your own technology to capture patient registration, it is important to verify this information with your commercial and Medicare patients at least once a year to keep records up to date. Medicaid patients are the exception: because of the generally transient nature of this population, information should be checked at the beginning of each month.
2. Traditionally, physician practices have not asked, and thus often choose not to, bill their patients at the end of the visit. They know insurance will pay some of the charges and prefer to wait until they receive insurance reimbursement to then calculate the patient’s portion. You can close this gap by verifying benefits and eligibility before patients arrive at your office for their appointment. Emdeon is connected to the largest group of commercial and government payers in the industry through which accurate eligibility information can be verified in real-time or high-volume batches. And easy-to-read benefits statements enable you to see an estimate of what your patients will owe at check-in. This allows you to educate them about what’s covered and what’s not—and, ultimately, what they owe and should pay at the time of service.
3. Use the phrase “final bill” liberally on patient statements. Patients pay more quickly when they understand their balance is really and truly due NOW. After you have received insurance reimbursement, generate a final bill—even if it’s the first statement you’ve sent. This will alert patients that the amount presented is final and creates a sense of urgency to send payment. Patients may also be more inclined to pay in a timely manner if given a secure online payment option.
Because of the “caring” nature of medicine, some practices in the past have found it difficult to pursue payment from patients. But by utilizing the approaches outlined above, you can be better equipped to adopt a process to discuss charges openly and encourage timely payment that will allow you to stay competitive as the trend in patient payment responsibility continues to grow.
Emdeon’s suite of services simplifies the everyday tasks of physician practices by integrating eligibility and benefits verification, claims and payment management, patient billing and payment, as well as clinical tools all into one easy-to-use application. Emdeon Office Suite gives you everything you need to get paid quickly, accurately and efficiently while eliminating manual processes and paperwork. By using our innovative reporting, analytics and payment tools, you can see where your revenue is at all times. Our combined approach of strong communication and technology services will cut costs, and speed up the billing and payment cycle giving you more time to spend with your patients.
(Note: Stay tuned for an in-depth look at online strategies to enhance patient billing and collections in the next issue of this newsletter.)
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From Patient Visit to Payment: It's All about Teamwork.
The top priority at your practice, of course, is taking care of patients—doing whatever you can to help them get well and stay healthy.
Your practice’s financial health is nearly as important, but can be much more difficult to manage. You want to be around to take care of patients 10, 15, 20 years into the future—and that means you must have a strong foundation. Optimizing revenue, managing your cash flow and keeping a close eye on costs are key to success for any practice. It’s a challenging task—and one that requires an “all-hands-on-deck” approach.
Let’s start with the reception desk staff. The team that greets and registers patients are the “front line” in more ways than one. Not only are their shining faces the first ones patients interact with, they represent the first opportunity to collect payment. Front desk staff members verify coverage, insurance and demographic information—all of which support fair and timely payment. In addition, they make sure co-pays, deductibles and balances are collected. It’s not an easy job—patients may be ill or worried, and are often accustomed to paying only after they receive a bill stamped FINAL—but it’s nevertheless an important one.
Asking a patient for money is not always easy—and can even seem poorly timed when that patient is not feeling well. However, it’s in the best interest of the practice to train the reception desk team so they are comfortable explaining the amount due, and understand how to handle patients who may be resistant or reluctant to pay at the time of service. Healthcare has allowed patients to pay after the fact for years—and is virtually the only industry that does. Can you imagine your server at a restaurant letting you walk out of the door and allowing you to pay for your meal weeks later?
Don’t forget how important general customer service training is, too. Patients who are greeted warmly and with respect, who aren’t kept waiting, and who are made to feel like they are important to the practice will be inclined to pay their bills willingly and quickly. That translates to money in the bank.
Clinicians. All of those involved in the patient’s well being—whether physician, nurse or medical assistant—determine the type and level of charges that can be billed. They must understand how to record and document the visit with the patient to ensure all charges are captured. Historically, American Medical Association and Medicare data indicate that physicians tend to under-code, leaving money on the table and shortchanging their practices of income rightfully earned. Using an electronic health record system can guide clinicians through documentation so they don’t overlook or dismiss services and procedures that represent revenue. In addition to technology, practices can improve charge capture by making sure clinicians are kept up to date on constantly changing documentation requirements so they are aware of revenue potential and pitfalls.
Coding staff. These important team members are the linchpin in transforming care to cash. Practices with the strongest revenue stream rely upon coders who are credentialed, demonstrating a solid understanding of their practice’s medical specialty as well as ever-changing coding policies. They should have access to current information, such as ICD-9 (and soon, the much anticipated and dreaded, ICD-10 code set!), CPT, HCPCS and CCI edits resources. Professional training at workshops, webinars and conferences such as those offered by the American Academy of Professional Coding is invaluable. The most successful practices also conduct periodic audits of their coding practices. This allows leadership the practice to identify episodic or ongoing errors, evaluate clinician documentation effectiveness and even measure productivity.
Billing staff. Tasked with making sure claims are submitted and patient statements are generated, billers must keep track of thousands of pieces of information. Lose track, and the practice potentially loses money. Advanced technologies assist these professionals and streamline the critical process of getting paid. The Emdeon Office Suite, for instance, enables practices to create claims online or upload them directly and seamlessly from the practice management system. Claims management features help practices scrub claims prior to submission to reduce rejections. The software can also generate statements and expand patient options, by offering online payments or credit card processing.
This level of automation delivers great value. Fewer coders and billers are needed to prepare and submit claims, freeing them to pay closer attention to outstanding payments and overdue balances. They can also monitor payer compliance with contracts and fee schedules, further stabilizing the revenue, and ultimately the practice.
Management and leadership. Last but not least is your management team. They set the stage for a financially stable environment. They hire capable staff to assume responsibility for various administrative and operational tasks. They communicate the need to support exemplary care giving with smart business practices. They identify new opportunities—like meeting Meaningful Use criteria—and implement the tools necessary for success. And they provide robust training and technology to make sure the bottom line is as healthy as you want your patients to be.
Do you have a winning team? Take some time to make sure each player has the right training and equipment to do the job. If you find opportunities for improvement, take a look at how Emdeon professional services can help.
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Cash flow important? Get paid TWO (even three) times as fast!
With Emdeon ePayment, you can eliminate the hassle of paper-based claims payments – replacing checks with payments from Emdeon ePayment enrolled payers that are directly deposited into your bank account. There is no cost to you to use Emdeon ePayment and enrollment is free!
Did you know that on average, it can take up to 15 days to receive a check in the mail and wait for the funds to clear? Using Electronic Funds Transfer (EFT), Emdeon ePayment directly deposits your claims payments, usually making them available in less than five business days.
In addition to helping you get paid faster, Emdeon ePayment streamlines the enrollment process. Instead of enrolling separately for each payer, you can simply select each and every participating payer all at once. And with Emdeon ePayment, you can quickly locate Electronic Remittance Advices (ERAs) and Explanation of Payment (EOP) information with the click of a mouse instead of digging through mounds of paperwork. Using an online application which is FREE for Emdeon ePayment users, you can easily search, view, print and download the ERA.
Enroll today with Emdeon ePayment to get your claims payments more quickly. Call 800.446.8279 or visit http://www.emdeon.com/epayment/enrollment/ to enroll today. Emdeon’s customer service team can help you transition seamlessly and easily. Remember, there is no cost to you to use Emdeon ePayment and enrollment is free
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Look What is New in Emdeon Office Suite!
Free, Live Reporting & Analytics Training Webinars every Tuesday
Emdeon now offers free, live training webinars to help you become an expert in the Reporting & Analytics tool. Every week, one of our product gurus will host an informational webinar that will keep you up to date, whether you are new to Emdeon Office or just want to hear the latest updates. Get the knowledge you need to become an expert of your claim management through our free, live webinars!
Here’s what you can expect to learn in these weekly webinars:
• New features or services in Reporting & Analytics
• Multiple ways to search for claims
• How to print a Timely Filing letter
• How to print and export search results
• How to indentify rejected claims
• How to find payment information
• How to use the Dashboard to reduce claim rejections
• How to use the claim Quick Search feature to quickly find claims
• Much more…
Every Tuesday: 10:00am CT / 11:00am ET
Web access: www.emdeon.com/office-webinar
Audio access: 877.345.2580
Meeting number: 62791804
New Feature – Advanced Eligibility added to the Eligibility Tab
A new feature has been added that helps you avoid disruptions in your day from missing patient eligibility information. Advanced Eligibility, found in the Eligibility Tab, is a smarter, more sophisticated way to search for eligibility and benefit information, allowing you to enter all the data you have on-hand to execute multiple searches through a comprehensive, standardized search screen.
Advanced Eligibility automatically cascades through the additional data provided from one search option to the next until the patient is found or all search options are exhausted. To save you even more time, Advanced Eligibility does not clear patient demographic fields when you change payers, making it far easier to search for one patient’s demographics against multiple insurance plans.
While Advanced Eligibility offers more capabilities when searching, it functions differently from the standard eligibility transaction and offers less on-screen guidance, requiring a greater level of user experience. A Quick Reference Guide is available in the Online Training section under Customer Support if needed.
This new feature is added to your current package at no cost and will not affect how you are currently being billed.
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LIVE Webinar - "Time-Tested & Practice-Proven: Top Tips for payment & collections efforts"
May 23rd at 12:00pm ET
Looking to increase net collections? Struggling with keeping cash flow healthy and sound? What practice isn’t?
Maintaining a healthy cash flow is important for your practice but how do you know if you’re collecting everything you are owed? Yesterday’s methods of trying to collect payments and reimbursements are time-consuming and can be ineffective. To keep up with today’s changing healthcare environment, you need up to date tools and tactics that will keep your practice financially sound.
This free, 60-minute webinar on May 23rd at 12:00pm ET will help you do just that. Our billing and AR expert, Betsy Nicoletti M.S., CPC, will explore important topics that can improve your payment and collections cycle such as:
• The knowledge and skills front-desk and AR staff need to develop
• The systems, processes and tools that can optimize payment results
• How to engage your patient in sensitive financial discussions
• Why pre-visit verification is important
• Identify time of service collection and opportunities
• How to calculate base-line performance key indicators
Who should attend? Anyone in a small to mid-sized practice who wants to improve their payments and collections, especially practice administrators, office managers, physicians and billing staff.
There are only so many spots available so don’t delay! Register NOW.
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Discover new ways to simplify your business when you connect with Emdeon
Follow Emdeon on Facebook, Twitter and Google+ to learn about innovative new solutions and special offers or to provide feedback on Emdeon products and services you use. Emdeon regularly posts updates and offers valuable resources to keep you on top of industry trends and current information, including healthcare reform, emerging technology, best practices and more. Use your computer or mobile device to receive Emdeon updates on free webinars, new product launches, important news articles and upcoming tradeshows. You can also visit our YouTube channel to watch inspiring customer testimonials and insightful product videos, or join Emdeon on LinkedIn to connect with colleagues. Click the icons below and get social with Emdeon today
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