Expands Leadership Position in Revenue Cycle Management Solutions
Emdeon announced recently that it completed the acquisition of Chamberlin Edmonds & Associates, Inc., a leading provider of government program eligibility and enrollment services to over 200 acute care facilities in 31 states. Chamberlin Edmonds’ technology-enabled services assist hospitals in lowering the incidence of uncompensated care, reducing bad-debt expense and increasing overall cash flow.
Chamberlin Edmonds offers hospitals a unique service model that combines highly-trained professionals located on-site at hospitals, sophisticated workflow technology, regional resolutions centers and a centralized back office infrastructure to deliver cost-efficient, comprehensive and scalable eligibility and enrollment services for government programs. These services track the patient from initial intake through post-enrollment application resolution and offer hospitals the ability to screen, qualify and enroll patients into government, charity and community benefit programs.
“The acquisition of Chamberlin Edmonds provides Emdeon with an enhanced revenue cycle management solution to better address the reimbursement challenges our hospital customers face,” said George Lazenby, Chief Executive Officer for Emdeon. “As the government further increases its role in reimbursable care, we believe we will have significant opportunities to cross-sell these value-added products and services to the existing base of 5,000 hospitals already in our network.”
Chamberlin Edmonds' professional staff utilizes its technology systems and repetitive, manufacturing-like processes to help maximize eligibility yield and improve cash flow for hospitals. This model, developed over more than twenty years, can be integrated with current Emdeon solutions to produce powerful technology-enabled solutions for hospital customers.
“We believe the healthcare market will benefit tremendously from the combination of Emdeon and Chamberlin Edmonds,” said T. Ulrich Brechbühl, president and chief executive officer for Chamberlin Edmonds & Associates. “Together, we offer a comprehensive technology-enabled revenue cycle management service from one single strategic partner equipped to address the current and future challenges associated with Medicaid and other government sponsored programs.”
For more information about this acquisition or to discover Emdeon’s comprehensive Revenue Cycle Management Solutions, visit us online or call 877.EMDEON.6 (877.363.3666) today!
Emdeon Completes Acquisition of Chamberlin Edmonds
The Impending Patient Experience Movement
Revenue Cycle Management Solutions to Address Financial Aspects of the Patient Experience
“Patient Experience.” The term itself may be fairly new in the healthcare industry, but the meaning behind it has been around a long while.
Fifteen years ago or more, providers referred to it as “patient satisfaction” and conducted phone and fill-in surveys to gauge how those who received care in hospitals and health systems felt about their treatment. Next the industry took up the cause of “customer service,” directing staff to perceive patients as customers and to employ the tenets of great guest assistance. Turns out, those previous incarnations of this concept were just stepping stones on a path that is, at last, becoming a paved highway within the healthcare industry.
Today, the idea of “patient experience” is more important and meaningful than ever. Many providers are addressing the totality of patients’ interactions with their institutions, from pre-registration to discharge and beyond, as a paramount issue. Even after all the surveys, customer service programs and pep talks, the patient-institutional provider relationship remained less than satisfactory, and as the market has morphed to become a more consumer-driven arena, there’s no denying the essential nature of great patient experience in every point of contact and care as well as policy and procedure.
A new focus in the healthcare industry is making the patient experience a formally organized, institutional priority. In 2010, the industry experienced the inaugural Patient Experience Summit, as well as the launch of the first Association for Patient Experience. An October 2010 study on the topic by HealthLeaders Media indicates that 72% of providers have heightened the priority of patient experience from just a year ago. These milestones herald an industry-wide awakening. Patient experience is now officially a C-suite standard, a guiding mindset for every decision made and a defining differentiator for an institution in its field.
In the past, patient satisfaction programs were often maintained by the marketing department, perhaps supported by an interdepartmental committee that fielded inquiries, complaints and survey results. In today’s patient experience movement, the entire institution is involved and fundamental, foundational changes are occurring in all corners of hospitals and healthcare systems. There’s simply no stone that can be left unturned when seeking to provide the best experience for patients.
One important area that could be overlooked when improving the patient experience is the financial side of healthcare. Both insurance plan coverage and patient billing and payment are areas that should be highly impacted by the new movement, especially in light of the nationwide shift to Consumer-Directed Health Plans (CDHP). Because increasing numbers of patients have greater responsibility for the compensation for their care, if not all the responsibility, the industry has already started evolving to accommodate today’s consumer-patients. Providers are relying on responsive innovations to make financial communications and payment alternatives more patient-friendly, with the ultimate goal of better experiences all around.
Emdeon’s related services are excellent examples of current innovations to assist providers with the financial aspects of the patient experience. As a leader in Revenue Cycle Management Solutions, Emdeon has developed an array of services to boost providers’ administrative capabilities in the CDHP era. Just as the patient experience movement addresses the full circle of care, from pre-access to post-discharge issues, Emdeon’s solutions offer 360°, end-to-end solutions to help providers improve their patients’ overall financial experience at their facility.
• Emdeon Pre-Encounter Analytics: Enables providers to help "triage" patients' financial situations before they arrive by quickly and accurately obtaining eligibility and benefits information. Batches of patient data for the next day's scheduled patients are sent to Emdeon before the start of business thereby eliminating any manual work and delays at the time of patient registration.
• Emdeon Assistant: Simplifies patient registration through real-time automation of patient eligibility and benefits information verification tasks. Emdeon Assistant easily interfaces with most existing registration systems and channels efficient search requests to contracted carriers with responses generally returned in seconds minimizing patient registration wait times.
• Emdeon Patient Responsibility Estimator®: Delivers quick access to estimates of patients' out-of-pocket expenses so providers can clearly inform patients of expected costs and collect or hold funds during scheduling, registration, at time-of-service or at check-out.
• Emdeon Quick Pay: Provides convenient, real-time processing of physical and electronic patient payments during Patient Access to collect and process co-payments, deductibles, pre-payments, financial responsibility estimates or even outstanding balances before service.
• Emdeon Patient Connect: Allows providers to leverage integrated patient billing solutions, print, online and point-of-service collection tools, to simplify, clearly communicate and automate remaining patient balances.
These Emdeon solutions represent the financial side of a more deeply integrated approach now being employed to achieve better patient experiences before, during and after service is rendered. Going far beyond initial customer service strategies, these patient-focused solutions extend fundamentally practical, compassionate support and true empathy for patients. Adding these kinds of services within the revenue cycle, providers are able to incorporate the concept of “patient care” beyond the clinical environment, into what was once perceived as impersonal, administrative interactions.
Discover Revenue Cycle Management Solutions to enhance the financial side of the patient experience by visiting us online or calling 877.EMDEON.6 (877.363.3666) today!
Want to get more involved in the patient experience for the industry? Join the Association for Patient Experience, a non-profit, multidisciplinary think-tank of healthcare representatives committed to advancing patient experience within their organizations. Email patientexperience@ccf.org for additional information.
Emdeon Steps In to Address CMS Outages
An Update on Proactive Leadership to Find Resolution for The Centers for Medicare & Medicaid Services (CMS) Medicare Part A & B Processing Issues
Emdeon CEO George Lazenby certainly does not make it a habit to call meetings with Centers for Medicare & Medicaid Services (CMS). Suffice to say, he would only be motivated to do so by the need to address extreme circumstances that greatly affect his clients and the provider community as a whole.
Lazenby recently journeyed to CMS headquarters to sit directly across the table from key leaders at CMS to heighten the resolution of alleviating recent Medicare Part A & B processing issues being experienced industry-wide during eligibility and benefits verification. Emdeon recognizes that the frequent downtime for Medicare A & B eligibility and benefits verification processing costs provider staff valuable time and productivity. As a leader in Simplifying the Business of Healthcare, Emdeon is compelled to actively address these issues and offer aid to CMS in achieving resolution.
Many likely received email updates about Lazenby’s meeting and subsequent responses. Here’s a quick recap of the events to date:
October 14: Lazenby traveled to CMS headquarters to meet with CMS officials and was informed of CMS’s plans to install a new application later in the month that would improve speed and reliability of transaction processing. To demonstrate both scope and breadth of processing issues, Emdeon invited other major eligibility and benefits verification vendors to attend this meeting and share their common concerns. Lazenby offered Emdeon’s IT and network resources to supplement CMS’s efforts.
October 23: CMS installed the Q3 release of the HETS 270/271 application. After post-release testing, CMS opted to revert to the previous version of the application and providers continued to report processing issues. Emdeon accepted CMS’s request for assistance in load testing the new application prior to reinstallation attempts. Emdeon conveyed CMS’s directive to providers to shift all non-immediate response eligibility and benefits verifications to off-peak hours (peak hours defined as Mondays and Tuesdays between 9 a.m. and 4 p.m. Eastern time) to optimize system performance.
November 10: CMS made significant changes to their HETS 270/271 application and conducted overnight testing of their revised application on November 8 through November 12. CMS Technical Staff is working around the clock to prepare for full release. Emdeon continues to remain engaged with CMS during this time and will publish the planned release date as soon as possible following successful testing. A follow-up meeting is in process of being scheduled by Lazenby with CMS to continue to highlight the Medicare Part A & B processing issues and the need for continuous attention until resolution is achieved for the provider community. This meeting should be held in Q4.
Of course, Emdeon will keep you posted regarding this important issue through resolution. Stay tuned for more update emails and information in the Spring edition of the Emdeon Compass.
Strategies for Payer Contract Adherence and Payment Integrity
The following is an important excerpt from the recent HFMA Executive Roundtable titled Monitoring and Managing Payer Performance.
Reform-related regulatory changes are bringing greater complexity to the payment landscape, including shifts in coverage. Faced with these changes, hospitals need to intensify their strategies to ensure that valid healthcare claims are paid accurately, quickly, and efficiently. With this in mind, this HFMA Executive Roundtable, sponsored by Emdeon, explores ways healthcare executives are using process change and technology to support contract adherence and payment integrity.
How does your organization monitor payer performance?
Philip Hardin: Monitoring should be done in two ways: One is by claim in real time, so you are able to follow up on issues and resolve them immediately. Second is monthly and quarterly reports to assess your overall control of the process and to follow up with payers on overall issues.
Julie Tipps: We do an annual satisfaction survey of about 500 employees who work with managed care payers on registration, billing, care coordination, or collections. We use this information to detect and track process issues, such as problems with eligibility, authorizations, mistaken denials, and discharge planning, and we measure the administrative cost per claim filed. The results of this survey are shared with payers annually. The other half of the report card is ongoing financial analysis, which includes administrative costs of billing and collecting per case, dollars tied up in clinical denials, and late payments and underpayments as a percentage of cases and as a percentage of net revenue. Because the information is used to improve performance, and not to be punitive, the report card is “blinded” meaning no payers names are used. In addition, we meet with payers monthly or quarterly to review performance. FY09 was the first year we appealed outpatient denials, which resulted in $3.7 million in recoveries. In all, more than $10 million of the $12 million denied by all payers was recovered on appeal.
Jason Adams: At MultiCare, we share a structured scorecard with payers in hopes it sparks competition to improve their operations. We monitor denied claims, A/R turnaround time, and the quantity of denied claims that have been overturned. For the past three years, we have met monthly with our top 10 commercial payers, who make up about 95 percent of our commercial revenues. We have seen A/R days drop by about four to five days over the past couple of years. This improvement has had significant effect on cash flow; a day amounts to about $10 million for us.
Lyman Sornberger: We have a paper scorecard with 26 metrics that we share with payers, as well as the costs of doing business. These monthly payer scorecards are presented internally at the enterprise, facility, technical, and professional level. This dashboard shares with the payers all of the metrics that Cleveland Clinic uses to measure ourselves internally, including days in A/R, denials management, payment floor, and aging. The scorecard is shared with the payer in context of the payer’s market competitors with data from other payers blinded. Our intent is not to present the “report card” as a punitive measure. We want to provide the information so we can work together to improve performance and save costs for both parties. In addition, we survey our staff and the payers annually at the payer level and share the results with the payer and health system.
David Wurcel: We model every claim and perform a detailed review of variances between the estimated contractual amount owed and the amount paid. Variances are tagged for daily review by our patient account analysis team. We then use root cause analysis to determine the true cause of variance. Such efforts give us detailed information that we can use to address issues in our own processes and with insurers. When we go to the insurer, we can be very clear on what we need. The efforts are paying off. Our entire denial issue is in the 1 percent range, and we are sitting in the mid- to high-30s on days in A/R. Such performance is all due to having good, productive relationships with our payers.
What can you do to address inadequate payer performance, such as excessive underpayments or mistaken denials?
Tipps: We have a dedicated denial resource center staffed with nurses and clinical representatives. They are versed in the relevant issues; it’s not like someone who is trying to manage these functions on top of regular collection duties. The resource center staff get every claim that has a denial and prioritize it by time and dollar amount. We have an 89 percent denial overturn rate for inpatient claims. We also have a dedicated contract compliance unit that handles underpayments and other issues that have not been resolved through normal collection efforts. They have special training in contract interpretation and work directly with our managed care payers regarding contract issues, interpretation, and enforcement.
Wurcel: If we feel like we’ve done everything we can for resolution and a denial or underpayment is still on the issue list after six months, I will escalate the matter to a managed care senior vice president. Such action isn’t taken lightly. I don’t want to discuss it with an SVP until I’m certain all administrative and clinical review processes have been exhausted. When I do have to speak with an SVP, I’ll say, “No one is right or wrong, but we have a contractual legal issue that is at an impasse, and it is time for a decision.” If discussions at the SVP level don’t bring resolution, then we will issue a notice of violation. But such action happens very seldom.
Sornberger: We provide feedback on a regular basis to our payers. Our meeting frequency varies based on current contracting timing and performance issues by either party. We also will address inadequate performance in contractual negotiations. Finally, we have worked with payers and continue to collaborate through various project alignments. These meetings are more strategic in nature and both parties strive to improve the metrics and decrease the cost of doing business. The outcome is a host of metrics that we agree the two entities will use to measure the success of the collaborative effort.
Participants in this HFMA Executive Roundtable:
Jason Adams
Vice President of Revenue Cycle, MultiCare Health System
Lyman Sornberger
Executive Director of Patient Financial Services, Cleveland Clinic
Julie Tipps
Strategy Consultant, Office of Managed Care, Baylor Health Care System
David Wurcel
Vice President, Corporate Business Services, Yale New Haven Health
Philip Hardin
Executive Director of Provider Services, Emdeon
Read this HFMA Executive Roundtable in its entirety to find out more on strategies for monitoring and managing payer performance. Discover Emdeon’s suite of Payment Integrity Services today! Call us at 877.EMDEON.6 (877.363.3666).
New Payer Transactions On Board
The largest healthcare revenue and payment cycle network continues to grow!
Emdeon connects you and 340,000 other providers to 1,200 payers, the nation’s largest health information network. We’re constantly adding new payers and transactions to this network, giving you even greater reach for real-time eligibility and benefits verification and electronic claims submission. View our complete payer list to make sure you’re taking advantage of Emdeon’s connectivity for all available transactions today. The more payer connections you access through our network, the quicker you can begin receiving accurate reimbursements, reducing write-offs and improving first pass acceptance rates.
We have recently added the following payers:
• American Behavorial-LifeSynch- Claims
• Banner Medisun- Claims
• Blue Cross Blue Shield of Louisiana- Claims
• Blue Cross Blue Shield of Tennessee Network H- ERA
• Bridgestone/Firestone- Claims
• Brown and Toland Medical Group- Claims
• CAP Management Systems- Claims
• CO, NM, OK, TX Medicare Part A (MAC J4) Legacy WPS- Claims and ERA
• Dart Container Corporation- Claims
• Dunn and Associates Benefits Administrators, Inc- Claims
• Employee Benefit Systems- Claims
• FamilyCare, Inc- Claims
• First Medical Health Plan PR- Claims
• Gemcare Health Plan- Claims
• Gemcare IPA- Claims
• Guarantee Life- Claims
• HealthNet-First Choice- Claims
• Humana Military– Tricare South- ERA
• Indiana Department of Health-Childres’s Health- ERA
• Innovante Benefit Administrators- Claims
• Insurance Administrative Solutions- Claims
• Interactive Medical Systems- Claims
• JMH Health Plan Medicaid HMO- Claims
• Jopari Careworks- Claims
• Kern County CDCR- Claims
• Landmark Healthcare, Inc- Claims
• Medical Reimbursements of America- Claims
• Network Health- ERA
• NHI Billing Services, Inc- Claims
• Total Broker Benefits- Claims
• Trihealth Physician Solutions- Claims
• United American Insurance Company- Claims
• WPS Commercial- ERA
Don't miss out! View our complete payer list online today! Put in your Emdeon ON24/7 request to map to any new payers or transactions available to take advantage of Emdeon’s connectivity!
Emdeon ON24/7
24/7 Access to Support and Critical Information for Healthcare Providers
Emdeon is well known as a market leader, and that means we go further giving you not only the best Revenue Cycle Management Solutions for your healthcare business, but we also give you more support to help you achieve your business goals. With Emdeon ON24/7 you’ll have access to highly trained support personnel via the Internet. Our support services cover all our customers and we deliver the familiarity, transparency and accuracy you need for issues to be solved clearly and quickly across multiple facilities. You’ll be connected with people who understand your systems, your business and your staff.
Always On, Always Available
Emdeon ON24/7 means just what it says: support tools and services are available to you 24 hours a day, seven days a week. Simply log on to initiate a service request. Your web-based, remote access connections are secure and easy to use. Emdeon ON24/7 lets you learn and connect at your own pace, and at times that work for your facility.
Transparency Eliminates Confusion and Frustration
A key feature of Emdeon ON24/7 is our commitment to keeping you informed of the status of your request. You’ll be able to clearly see who is working on your inquiry and where it is in the support cycle at any given time. We’ll send alerts to confirm that your initial inquiry was received so that you aren’t left wondering if anyone is paying attention to your needs. When one of our service representatives updates the status of your request, you’ll get an email notification immediately, letting you know the new status. We’ll provide you with timely status updates throughout the process, not just when the work is done.
Emdeon ON24/7 is backed by some of the best service personnel in the industry, and they are ready to help you get the most out of your Emdeon experience. To discover more or to get enrolled in Emdeon ON24/7, contact our Customer Service Department at 877. 271.0054 today.
