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,

• 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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New Payer Transactions Added Recently

New payers on board with Emdeon. Take a look at the new list
We have recently added the following payers:
• AmeriChoice of New Jersey, Inc. (Medicaid NJ) - Claims
• Bay Area Automotive Group - Claims
• Benefit Management Administrators - Claims
• Bridgestone/Firestone - ERA
• CA Home Health & Hospice - Claims
• Cardiovascular Care Providers - Claims
• CBHNP - HealthChoices - Claims
• Christian Brothers Services - Claims
• Crescent PPO, Inc.- Claims
• Delaware Physicians Care, Inc. - ERA
• Dental Management Administrators - ERA
• Fidelio Dental Insurance Company - Claims
• Florida Hospital Waterman - ERA
• Global Excel Management - Claims
• Good Shepherd Hospice Inc. - Claims
• Harrington Health Non-EPO - Claims
• HealthEdge Administrators - Claims
• InterCare Health Plans Inc. - Claims
• Life Pittsburgh - Claims
• LifePath Hospice Inc. - Claims
• Mutual Assurance Administrators - Claims
• New Avenues, Inc. - Claims
• Ohio PPO Connect - Claims
• PacificSource Medicare - Claims
• Partners Benefit Group - Claims
• Sendero Health - Claims

For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/

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See the full list >>