EMDEON PATIENT ACCESS SOLUTIONS AND SERVICES
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EMDEON PATIENT ACCESS
SOLUTIONS AND SERVICES
Healthcare is complex. Getting paid shouldn’t be.
While we offer many solutions and services,
they are all are designed to do just two things.
• Collect patient out-of-pocket expenses
• Optimize third-party payments
As quickly, easily and economically, as possible.
It’s that simple.
Simplifying the Business of Healthcare
Patient Access – Payable claims and patient payments start here.
Removing the barriers In a recent survey, revenue cycle professionals were polled1 to indentify the top challenges faced by their organization. With the complexity of healthcare expanding due to regulatory changes, the movement to ICD-10, healthcare reform and new reimbursement models, let’s just say, it wasn’t a short list. While there were varying responses, most, if not all, of these problems could be boiled down to just two core issues. • Tackling reduced reimbursements • Getting patients to pay It seems that the common denominator is that these changes are making it harder for providers just to get paid. That’s why we’ve been rolling up our sleeves to help. While we offer many solutions and services, they are all designed to help you achieve two key objectives: Maximize your third-party reimbursements. And help you fully collect patient payments. It’s that simple. So, how can you address these challenges in your revenue cycle, specifically patient access? It’s a simple formula, really. 1. Verify patient information to create a solid foundation for a more payable claim 2. Find coverage for those who have too little or none at all 3. Estimate and collect the patient out-of-pocket expense for those with coverage Related to payment barriers, there is some good news. Patient access can be one of the most influential parts of your revenue cycle to address these challenges. What you do before claims are submitted can determine whether you get paid or not. Really. While you may not have complete control, you can substantially move the needle from uncompensated care to getting paid what you deserve by working smarter, not harder. Let’s take a closer look at the types of solutions and services that can be used in patient access to set the stage for more payable claims and more patient payments. 1. 2013 Blinded research performed by Deyta. While healthcare is complex. Getting paid shouldn’t be. Call us at 877.EMDEON.6 (877.363.3666).
Best Practice Patient
Access Workflow
Verify Find Collect
3
Step 1. Verify Eligibility and Patient Profile Starting down the right (revenue cycle) path. Before patient care, it’s important to start laying the foundation for a payable claim. And, get the information you need to triage self-pay and insured patients financially. Similar to treating patients from a clinical perspective, helping them navigate the system financially requires collecting good information to make informed decisions all around. One of the first steps in patient access is verifying patient demographic and benefits information up-front. Why is this step so important? Well, it actually drives the rest of your revenue cycle workflow. Here’s how: • Verifying the patient’s address and benefits information early and often is critical to start building the foundation for a payable claim and reduce your risk of it being denied later • It also impacts if and how much you can collect from the patient before care since you need this to estimate out-of-pocket expenses • For self-pay patients, it can help you understand where to start looking for coverage including charity care, state or county assistance, Medicaid or Medicare based on their financial profile • It can help you understand which patients should be offered prompt pay discounts, enrolled in payment plans or potentially written off to bad debt by evaluating their estimated out-of-pocket expense and credit score There are more than 50,000 unique health plans2 just within the commercial side of healthcare. How can you verify patient benefits accurately and quickly when each offers slightly different versions of benefits? 2. http://www.dol.gov/ebsa/pdf/ACA-ARC2012.pdf While healthcare is complex. Getting paid shouldn’t be. Call us at 877.EMDEON.6 (877.363.3666).
Here’s how Emdeon can help:
Patient Attested Eligibility & Benefits Verification
As a best practice, your eligibility can be scheduled to run in batch in advance of appointments and then automatically rerun to capture recent
changes in coverage and return data from payers that were temporarily unavailable. Our cloud-based solutions also offer real-time eligibility
verification that can be used during the Point-of-Service (POS) to validate collected information or for unscheduled patients. This information
can be presented in a custom interface or Emdeon can simply provide back-end processing to send the information to your Patient Accounting
System (PAS) or Hospital Information System (HIS).
Address Validation
In order to validate addresses for patient billing later down the road and prevent undeliverable mail, Emdeon can automate the process of verifying
patient addresses too. Less returned mail, more patient payments.
Patient Financial Profile
For self-pay patients, Emdeon can help you easily identify which of these might be candidates for Medicaid, federal disability programs, hospital
charity care accounts or accounts that could potentially be written-off. By providing a healthcare payment predictor score, estimated income,
estimated household size and a Federal Poverty Level (FPL) percent, your staff can make informed decisions for appropriate action.
Medicare Medical Necessity Evaluation
To reduce write-offs caused by procedures deemed medically unnecessary by Medicare, Emdeon can identify those that may potentially be
denied for reimbursement and automatically create the Medicare Advance Beneficiary Notice (ABN).
Features Benefits
• Eligibility and benefits verification performed in batch and real-time • Lays a solid foundation for more payable claims and more
• Web-based solution patient payments
• Interfaces with most HIS and PMS • Reduces bad debt and the risk of denied claims by providing
• Automates address validation access to the most Government and Commercial payer
• Creates a patient financial profile to assist staff in making connections in the industry for benefits verification
informed decisions • Reduces the risk of undeliverable patient statements by
• Evaluates Medicare medical necessity guidelines and ABN generation automating address validation
• Identifies errors in registration records • Enhances staff efficiency with an intuitive workflow and prompts
• Generates reports for appropriate financial triaging of patients
• Automates pre-authorizations • Reduces the risk of denied Medicare claims
• Customizes work queues to fit your needs • Improves your ability to get paid on-site
• Increases cash flow
• Reduces the risk of denied claims due to errors
5
Step 2. Triage Self-Pay with Solutions and Services Find more coverage with low to no financial risk. So, how should you handle patients that originally present as self-pay? Did you know that some patients actually do have coverage, but simply don’t offer that information at the time of registration? Also, how do you handle the truly uninsured? It’s a double-edged sword to say that with healthcare reform there will be more options for the under and uninsured but that eligibility does not automatically equal enrollment. Right now, there are at least 4.5 million adults3 in the U.S. that are eligible, but not enrolled in Medicaid. And that’s before the Medicaid expansion driven by the Affordable Care Act (ACA). In addition, with approximately 48 million Americans uninsured, there will be considerable opportunity for a large portion to find coverage using Health Insurance Exchanges (HIX). How are you addressing this revenue cycle uncertainty? The good news is there are solutions and services that can help. And, most are provided on a contingency fee basis so if there is no recovery opportunity, you pay nothing. Here’s how Emdeon can help: Self-Pay Eligibility & Benefits Search Did you know that you might even be able to find coverage for self-pay and charity designated patients that don’t provide information about existing benefits? Emdeon can automatically screen uninsured patients looking for undiscovered existing coverage from government funded and commercial payers. With advanced analytics, Emdeon isn’t limited to self-attested information from patients. It leverages Emdeon’s unique access to ‘Big Data’ within the nation’s largest healthcare revenue and payment cycle network to help you find previously undiscovered coverage. Eligibility & Enrollment Services If coverage still isn’t found after running an automated search to ping Emdeon’s expansive network, your self-pay patients can be referred to on-site professionals to walk them through the entire application process for federal, state and local benefits programs. Chamberlin Edmonds, an Emdeon company, acts as your patients’ advocate by helping patients complete the necessary applications and provide follow-up services. As advocates for self-pay and indigent patients, Chamberlin Edmonds works efficiently to help recover cash that would otherwise be lost to your hospital. With new regulations, processes and complexities in qualifying patients for Medicaid and commercial health insurance, hospitals are facing challenges in maximizing their financial opportunity. Chamberlin Edmonds, one of America’s leading patient eligibility and enrollment firms, is offering an ACA specific solution designed to drive results and target your unique challenges. Since 1986, Chamberlin Edmonds’ experts have been providing eligibility determination services for all types of programs, including the most difficult and complex federal disability cases. Regardless of the program, state or federal, Chamberlin Edmonds has the expertise to track every application through a maze of regulations, assuring a high rate of successful outcomes. State-of-the-art workflow technology enables the collecting and processing of eligibility information faster and more accurately than ever before. 3. http://www.ncbi.nlm.nih.gov/pubmed/23230704 While healthcare is complex. Getting paid shouldn’t be. Call us at 877.EMDEON.6 (877.363.3666).
Chamberlin Edmonds is approved by the Centers for Medicare and Medicaid Services (CMS) to be a multi-state Certified Application Counselor
Designated Organization (referred to by CMS as a CDO). This designation provides Chamberlin Edmonds with the prerequisite organizational
status to facilitate Certified Application Counselor training for Chamberlin Edmonds staff in all states. On behalf of hospital customers, Chamberlin
Edmonds will be able to provide services that help individual patients understand, apply and enroll for health coverage through all of the
newly-established ACA marketplaces.
Patient Enrollment
Opt-In States
• Customized outreach strategy for your market to enroll patients into the Medicaid expansion group
• On-site Medicaid eligibility & enrollment
Opt-Out States
• On-site Medicaid eligibility & enrollment
• Federal disability enrollment (SSDI & SSDIB)
Health Insurance Exchange Enrollment
• Approved by CMS to be a multi-state Certified Application Counselor Designated Organization
• Patient facing staff are Certified Application Counselors
• Wireless enrollment technology enables our team to submit applications at point of care with future access to portals/Health
Insurance Exchanges
• Customized outreach strategy for your market to assist patients in accessing insurance affordability programs including Qualified
Health Plan enrollment
Presumptive Eligibility
• Eligibility expertise to assure accurate eligibility and enrollment determinations
• Reporting capability to support Presumptive Eligibility work and outcome
Features Benefits
• Experienced healthcare representatives screen patients, identifying • Increase revenue and reduce bad debt through the discovery
and qualifying many self-pay admissions traditionally written off to of existing third-party coverage of patients who initially present
bad debt as self-pay
• Offers on-site enrollment specialists for Supplemental Security • Positive community relations
Income (SSI), Social Security Disability Insurance Benefits (SSDIB), • Professional guidance through difficult federal, state and
Medicaid (all programs), Crime Victims Compensation, community benefit program applications and newly-established
State Children’s Health Insurance Program, Charity Care, ACA marketplaces
County indigent healthcare programs, various other benefit • Supportive of compliance with charity care guidelines
programs targeting indigent, under or uninsured • Patients served by experts dedicated to patient advocacy
• Certified Application Counselor Designated Organization • Diligent and meticulous follow-up through the application process
• Long successful track record of patient advocacy: Dedicated solely • Bilingual assistance
to eligibility services since 1986
• Market share leader with academic medical centers and large urban
safety net providers
7Step 3. Collect Patient Receivables at POS Patient billing was your focus. Now, it’s all about collecting early. According to a recent survey, patients are now responsible for over two thousand dollars in out-of-pocket expenses per visit on average.4 What does that mean for you? Since your chances of collecting diminish after care is rendered, you should really be focusing on providing an accurate estimate and collecting that up-front. Then use an integrated strategy to automate the back-end billing, payment acceptance and payment posting processes. This is becoming more important with the rise in High Deductible Health Plans (HDHP). With 44 percent of employers5 reporting they will likely only offer high deductible health plans in 2014, the trend is likely to continue. If patient receivables now account for roughly 20 percent of hospitals’ revenue cycles…BUT only 10¢ on the dollar is collected at the time of service,6 what are you doing to fix that? 4. http://www.healthcarefinancenews.com/news/patient-payment-responsiblity-increases 5. http://www.pwc.com/en_US/us/health-industries/behind-the-numbers/assets/medical-cost-trend-behind-the-numbers-2014.pdf 6. Self Pay/Point of Collections Survey, Healthcare Financial Management Association (sponsored by Visa), December 2009 While healthcare is complex. Getting paid shouldn’t be. Call us at 877.EMDEON.6 (877.363.3666).
Here’s how Emdeon can help:
Patient Responsibility Estimation
As a best practice, Emdeon can begin the process of creating an estimate of the patient’s out-of-pocket expenses before care is provided. How
does this work? Well, first eligibility is processed and the procedure is cross-referenced in the Medical Code Finder database to produce the
estimated amount due. At this point, the staff selects the patient’s insurance plan, determines whether the patient is in or out of network and the
specific service category for that procedure. To create the final patient estimation, the user simply selects ‘Next’ to review the Calculation Detail
which is helpful in explaining the estimate to patients. Our solution leverages a combination of provider contract information, fee schedules and
current benefit and accumulator information to identify the patient’s financial responsibility. The estimation can also be provided in real-time
during scheduling, registration or check-out.
Physical and Electronic Payment Collection Online and at the POS
Emdeon can help with up-front collections and improve your POS workflow with real-time processing of various payment methods such as
credit cards, check cards, eChecks and ACH transactions in addition to physical payments such as cash, checks and money orders. Your staff
will not only be able to collect owed amounts earlier in the revenue cycle, but they will also have the ability to manage and analyze all payments
received from patients through available dashboard tools and reporting. Automatic posting of each day’s payment activity directly into host
financial systems is also provided. This saves time by eliminating the need for manual posting and reconciliation processes.
Features Benefits
• Generates an estimate of patient financial responsibility • Decreases A/R days and bad debt by collecting early
• Processes and accepts most forms of electronic payments • Reduces back-end patient billing expenses
(credit card, check card and eCheck) and physical payments • Increases staff efficiency
(cash, check and money order) • Increases up-front patient collections to accelerate the
• Offers a comprehensive cash management system through payment cycle
standard and custom reporting and analytics
9Patient Access Solutions and Services Claim Payments Solutions and Service Patient Payments Solutions and Services
VERIFY patient information early and often to start building more payable claims
• Run batch eligibility at scheduling and again real-time at the Point-of-Service
• Confirm patient demographic information such as address, date of birth and social security number
• Evaluate Medicare Medical Necessity
TRIAGE under and uninsured to get paid what you earn
• Triage self-pay to find existing coverage with advanced data mining
• Identify patients who likely meet guidelines for charity care or government coverage
• Increase Medicaid and federal disability program enrollment with on-site professional patient advocates
ESTIMATE and collect patient financial responsibility up-front to reduce bad debt risk
• Estimate and collect the patient financial responsibility at the Point-of-Service
• Review the patient’s propensity to pay score to identify appropriate payment options
GET MORE first pass clean claims to reduce follow-up work
• Reduce your risk of denied claims with a dedicated team that applies network-wide claim edits
• Easily track all of your claims throughout the lifecycle
CORRECT denied and underpaid claims with technology and services
to get paid what you deserve
• Easily correct and resubmit government and commercial claims with an exception-based workflow
• Recover revenue from wrongfully denied and underpaid claims with outsourced services
• Identify systemic problems to prevent future loss from denied and underpaid claims
DIGITIZE and AUTOPOST payments and remittance advice to get paid faster
• Covert paper based payments and remittance to electronic
• Auto-post 100 percent of third-party payments and remittance electronically to get paid faster
USE a digital strategy for patient billing to lower expenses and call volume and expedite payment
• Deliver digital statements linked to your payment portal to patients with an email on file
• Quickly mail easy-to-understand paper statements if electronic statement isn’t opened, payment isn’t received within
30 days or if email is not on file
• Automate skip tracing process for undeliverable mail which finds the corrected address and resends the statement
• Easily access a digital archive of statements in an online portal to expedite patient billing inquiries
AUTOMATE payment acceptance to reduce manual processing
• Automate the collection of payments over the phone, through the mail and at the Point-of-Service
DIRECTLY deposit payments and automate posting to get paid faster
• Quickly post payments to your patient accounting system or HIS with an 835-formatted payment file
• Get paid more quickly with patient payments direct deposited to your bank account
11Emdeon’s Solutions Throughout the Patient Encounter and Revenue and Payment Cycle
Remittance
Patient Clinical Claims Patient Billing
Management/
Access Information Management & Payment
Denial
Exchange
Management
• Eligibility & • Lab Orders & Results • Claim Scrubbing • Electronic Remittance & • Patient Statements
Benefit Verification Payment Processing
• ePrescribing • Claim Formatting • Online Billing &
• Address • Denial Management Payment
Verification • Hospital – Physician • Claim Submission
Data Exchange • Payment Posting • Voice Pay
• Patient Responsibility • Claim Inventory/Tracking Automation
Estimation • Interactive Care • Return Mail
Management • Full Claim Lifecycle • Automated/Accelerated Management
• Medicaid, SSA, Charity Visibility Secondary Billing
Enrollment Services • Consumer/Patient
• Milestone Tracking • Lockbox with Paper to Payment Automation
• Payment Risk • Management Electronic Conversion
Assessment • Document Archive
Dashboards • Payment Integrity
• POS Payment • Merchant Services
• Revenue Optimization • Revenue Optimization
Collection Services • Lockbox
Services
• Medical Necessity
• Registration QA
Authorization Manager
• Revenue &
Reimbursement
Analytics
Discover the Difference of More from One Partner
Emdeon is transforming the industry with a comprehensive, yet highly focused approach to address two revenue cycle objectives that matter
the most. Maximize third-party reimbursements. And help you fully collect patient payments. As quickly, easily and economically as possible.
It’s that simple.
Leverage one partner
There are unavoidable costs associated with managing multiple revenue cycle vendors – contract management, support/training needs,
implementation requirements, etc. Managing multiple vendors can be complicated and time consuming. By establishing a relationship with one
trusted vendor, you can substantially accelerate future implementations of additional solutions by having a solid, experienced team already in place.
Emdeon has a wide array of solutions and services that span the entire revenue cycle, not just patient access.
Emdeon is a leading provider of revenue and payment cycle management and clinical
information exchange solutions, connecting payers, providers and patients in the U.S.
healthcare system. To learn more, visit our website at www.emdeon.com.
3055 Lebanon Pike, Suite 1000
Nashville, TN 37214 USA
© 2015 Emdeon Business Services LLC. All rights reserved.
EMDA1010348 rev 12.14 877.EMDEON.6 (877.363.3666)
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