Best practices for migrating healthcare payments to ACH

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Best practices for migrating healthcare payments to ACH"

Transcription

1 Best practices for migrating healthcare payments to ACH Member FDIC Member FDIC Matt Brodis, MBA, MHA Adventist Health System, Inc. June St. John, SVP, CTP Wells Fargo Treasury Management Member FDIC

2 Healthcare industry overview Why is Healthcare such a hot button topic? 17.6% of GDP in 2009 ($2.5 Trillion), projected to 20.3% of GDP ($4.3 Trillion) by 2018 Has grown faster than the economy since the 1960s 10% of the US population accounts for 63% of healthcare spending Public and private sector healthcare spending is fairly evenly split private sector spent 54% in 2007 CMS projects public sector spending will rise to 51% by 2018 as baby boomers move onto Medicare Source: The Kaiser Family Foundation Trends in Health Care Costs and Spending, March

3 Provider value chain functional view C l i n i c a l V a l u e C h a i n Pre Visit Activities Office and Other Visits Inpatient Activities Surgical Cases Post Visit follow up Admin follow up Admin Responsibilities Clinical Technology Systems financial transaction moving earlier in clinical value chain Patient Eligibility; Fin l Evaluation POS Payments Comm l Insurance Billing Comm l Payment Processing Patient Billing Patient Payment Processing Bad debt, Collections, Refunds F i n a n c i a l V a l u e C h a i n 3

4 Healthcare industry EFT adoption Claims Submission Eligibility Verification Claim Status Inquiries Claims Payment Electronic Transactions Paper Transactions Claims Remittance 0% 20% 40% 60% 80% 100% Source: National Progress report on Healthcare Efficiency

5 Patient vs. insurance payment methods How patients pay P-Cards How insurers pay Debit Cards OLBP P-Card OLBP WT ACH Cash Debit Checks Credit Cards ACH WT Cash Credit Cards Checks Source: Payments Trends in the Healthcare Industry A Survey of Healthcare Providers Fall 2010 IAPP/IARP/TAWPI 5

6 Complexity of processing HC payments Average time to post check payments Average time to post eft payments Days to Post Days to Post All Providers Single Hospital Multi-Hospitals Medical Practices and Clinics Physician Offices All Providers Single Hospital Medical Practices and Clinics Multi-Hospitals Physician Offices Source: Payments Trends in the Healthcare Industry A Survey of Healthcare Providers Fall 2010 IAPP/IARP/TAWPI 6

7 Healthcare industry pressures Revenues Medicare/Medicaid reimbursement pressure Private insurance, high deductible pressure Growing number of uninsured Private insurance reimbursement denials/ delays Lower returns on investments Increasing competition Healthcare Providers Expenses Increased labor costs, labor shortages Manual processing Investments in new treatments/medical technology Malpractice and other insurance costs Aging population increases demand Government regulation and oversight 7

8 The perfect storm Continued recession with historically high levels of unemployment Multiple regulatory mandates with overlapping timelines for compliance 5010 and ICD-10 Final rule issued January 2009 Major changes to 837 (claims), 835 (remittances), (eligibility) and other HIPAA transactions ASC X Implementation Guidelines effective January 1, 2012 (required to support ICD-10 changes) ICD-10 effective October 13, 2013 (more characters, codes and complexity) Extensive testing and coordination required for providers and health plans (payers) 8

9 The perfect storm ARRA HITECH (February 17, 2009) Providers must demonstrate meaningful use of EHR technology to qualify for incentives Incentives start in 2011; Penalties start in 2015 New privacy and security provisions includes business associates (FIs); both civil and criminal penalties may apply Support for regional and state Health Information Exchanges funding is available to states to set up HIEs 9

10 The perfect storm Transaction Comments Adoption Date Effective Date Compliance Penalties Eligibility and Benefits (270/271) Claims Status Inquiry / Response (276/277) Electronic Funds Transfer (EFT) Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA/835) Health Claims or Encounters (837 P and I) Enrollment / Disenrollment (834) Health Plan Premium Payment (820) Referral Certification and Authorization (278) Claims Attachment (275/277) May allow use of machinereadable ID card May allow use of machinereadable ID card Allows for automated reconciliation of payment to remittance advice 07/01/ /01/ /31/2013 4/1/ /01/ /01/ /31/2013 4/1/ /01/ /01/ /31/2013 4/1/ /01/ /01/ /31/2013 4/1/ /01/ /01/ /31/2016 Not specified 07/01/ /01/ /31/2013 Not specified 07/01/ /01/ /31/2013 Not specified 07/01/ /01/ /31/2013 Not specified 07/01/ /01/ /31/2013 Not specified 10

11 Healthcare industry challenges Fragmented world s largest cottage industry Payers frequently change the rules Managing multiple service providers, systems and contracts Changing priorities, slow decision making Complexity of payment structure 11

12 Automation challenges Complexity of remittance detail Lack of standardization across payers Multiple payments for same claim Multiple adjustments and submissions Payments and remittance detail received at different times and on different systems Large size of remittance files 12

13 Impacts to the bank/fi industry ARRA HITECH privacy and security breaches Business associate impacts Need to review and revise BAA agreements Patient Protection and Affordable Care Act (HR 3590) Will depend on final operating rules adopted Tests are underway (NACHA, SWIFT, TCH) to identify any new transaction sets that will enable data and $$ to travel together electronically more efficiently Fewer checks and EOBS; more EFTs and ERAs Will depend if any provisions regarding payments are modified or eliminated 13

14 Impacts to the bank/fi industry 5010/ICD-10 Changes revenue cycle management impacts Payer to provider (B2B) Extended lockbox 835 conversion testing EFT/ERA testing (820s) Patient to provider (C2B) Point of service testing Retail lockbox 835 conversion testing Other EDI products capable of creating 835 or 820 formats for providers - need to support testing 14

15 Best practices for banks/fi industry Provide solutions that meet HC industry electronic payments needs Leverage our core competencies of developing standards that facilitate the efficient movement of $$ and remittance data from FI to FI Participate in industry initiatives/pilots: NACHA, SWIFT and TCH Continue to educate HC indsutry on our plans; monitor their progress on these mandates Educate HC industry on any new FI industry solutions that emerge in response to these mandates 15

16 Common bank/fi healthcare products Patient point of service solutions include: Eligibility verification (270/271) Estimation of patient responsibility (co-pays, deductibles) (270/271) EFT (online bill payment or recurring payment plan) credit and debit card acceptance at POS Commercial/government insurer payment solutions include: EFT (CCD+, CTX) ERA receipt from payers (835) Automated and exception reconciliation options 16

17 Adventist Health Systems, Inc. A Best Practice Case 17

18 Florida Sanitarium

19 Florida Hospital

20 Christ Centered: Extending the Healing Ministry of Christ Largest Not-For-Profit, Protestant Healthcare Organization in the US Healthcare Facilities in 10 States 7,700 Licensed Beds 55,000 Employees 8,500 Physicians 2 Hospital Divisions (7 regions, 44 hospital campuses) Long-Term Care Division Total Operating Revenue of $6 Billion Serving More than 4 Million Patients Annually Winter Park, Florida 20

21 $6 Billion 21

22 22

23 KPI Financial Trending 23

24 Upfront Cash Collections Trend 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 2.1% 2.4% 2.6% 2.7% 3.1% 3.1% 3.3% 3.5% 0.5% 0.0%

25 Net Days in A/R Trend * All years - weighted using a full year of revenue & excludes bad debt from revenue 25

26 Patient Payments vs. Insurance Payments 26

27 Additional Reimbursement Strategies 270/271 Eligibility Transactions Ability and Propensity to pay. Price Estimation by service and physician Address Verification and Validation 276/277 Claim Status Inquiry Electronic Refunds 27

28 Completed Clinical Initiatives EHR Computer Assisted Coding Concurrent Scanning CPOE 28

29 How we get paid All AR payments are processed in one of three places Lockbox Client Initiated Payments: Paid via Kiosk, Patient Portal, E-Sig, Payment Manager. All transactions are nightly processed to update AR Remote Deposit Capture 29

30 Lockbox Payments Each facility has 3 lockboxes that may receive payments via: EFT, Check, Cash, Credit Card. Government Commercial Patient Payment Processed at the lockbox facility and deposited to the appropriate DDA. The paper backup is sent to the corresponding billing office to post payments either paper or 835. Credit Cards are processed by Merchant Services Vendor at Lockbox and deposited. 30

31 Paper to EDI Advantages Automation of Posting FTE Reductions Paperless No Shipping Cost Online Archival 100% Payments EDI Image Indexing Online Search Tools Disadvantages Expensive OCR Technology Still Evolving 31

32 Challenges Of Paper to EDI Conversion Multiple Entities paid under shared Tax ID Number Cultural shift in roles Shift from See & Key to Analytical problem solver Paper From My Cold Dead Hands Charlton Heston Conversational remits difficult to capture Reconciliation Challenges 32

33 Paper to EDI Implementation Recommendations Enroll for 80-90% EFT/ERA Direct payments (Transactional Volume) Exhaustive approach to Verification Rules Regularly revisit rules (Payor Mix Changes) Provide 100% Claim Data as baseline Use Pay To Address and NPI Split where applicable Require Banking Institution accountability support 33

34 Patient Payment Methods Credit Card 38.0% Check to AHC 9.3% Paper Checks: 44.5% Cash: 8.3% Credit Card 45.0% Check to AHC 12.5% Paper Checks: 38.9% Cash: 3.6% 34

35 Patient Payment Venue In Person 46.9% Lockbox 45.0% Portal 8.1% Kiosk 0.1% In Person 51.2% Lockbox 40.0% Portal 8.7% Kiosk 0.1% 35

36 Insurance Payment Method Paper Check 85.4% EFT 14.6% Paper Check 23.4% EFT 76.6% 36

37 Recommendations Location, Location, Location Kiosk, Mailed Statements, Online Bill Pay, Cash Drawer, Service Desk Pay their way Credit Card: Visa, MC, Discover, Amex Check Money Order Cashiers Check Travelers Check Catch and Don t Release Payment plans, automatic withdrawal, guarantor billing, reapply not refund 37

38 Questions? 38

39 2011 Wells Fargo Bank, N.A. All rights reserved. For public use

Fundamental Guide to Understanding Healthcare Payments

Fundamental Guide to Understanding Healthcare Payments Fundamental Guide to Understanding Healthcare Payments Monday April 22 nd 9:30 10:30am Stuart Hanson Director, Healthcare Solutions Executive Citi Enterprise Payments Irfan Ahmad VP, Healthcare Payments

More information

INTERMEDIATE ADMINISTRATIVE SIMPLIFICATION CENTERS FOR MEDICARE & MEDICAID SERVICES. Online Guide to: ADMINISTRATIVE SIMPLIFICATION

INTERMEDIATE ADMINISTRATIVE SIMPLIFICATION CENTERS FOR MEDICARE & MEDICAID SERVICES. Online Guide to: ADMINISTRATIVE SIMPLIFICATION 02 INTERMEDIATE¬Ľ Online Guide to: CENTERS FOR MEDICARE & MEDICAID SERVICES Last Updated: February 2014 TABLE OF CONTENTS INTRODUCTION: ABOUT THIS GUIDE... i About Administrative Simplification... 2 Why

More information

Administrative Simplification Operating Rules

Administrative Simplification Operating Rules Administrative Simplification Operating Rules April 8, 2014 Geanelle Herring Policy Analyst, Administrative Simplification Group Centers for Medicare & Medicaid Services Priscilla Holland, AAP, CCM Senior

More information

HFMA Treasury Program. Revenue Cycle Discussion: Scenarios for the Future. December 15, 2011

HFMA Treasury Program. Revenue Cycle Discussion: Scenarios for the Future. December 15, 2011 HFMA Treasury Program Revenue Cycle Discussion: Scenarios for the Future December 15, 2011 0 Agenda Healthcare Reform Landscape Scenarios for the Future Next Steps 1 Bundled Payment Highlights Model Episode

More information

Federal Operating Rules for Healthcare Administrative Simplification

Federal Operating Rules for Healthcare Administrative Simplification Federal Operating Rules for Healthcare Administrative Simplification Gwendolyn Lohse, Deputy Director CAQH Ann Brisk, VP Health Care Transaction Services, OptumHealth Financial Priscilla Holland, Senior

More information

Electronic funds transfer. A toolkit for navigating the ins and outs of EFT

Electronic funds transfer. A toolkit for navigating the ins and outs of EFT Electronic funds transfer A toolkit for navigating the ins and outs of EFT Introduction Want to save over $2,000* per physician annually? Use this toolkit to learn how to use electronic funds transfer

More information

WHITE PAPER GROW REVENUE WITH HEALTHCARE LOCKBOX SERVICES

WHITE PAPER GROW REVENUE WITH HEALTHCARE LOCKBOX SERVICES WHITE PAPER GROW REVENUE WITH HEALTHCARE LOCKBOX SERVICES 2013 WAUSAU FINANCIAL SYSTEMS, INC. All Rights Reserved. All other copyrights cited herein are the property of their respective owners. TABLE OF

More information

Healthcare Revenue Cycle and Collection Considerations

Healthcare Revenue Cycle and Collection Considerations Healthcare Revenue Cycle and Collection Considerations Vince Marzula, BNY Mellon Paul Ishizuka, University of Washington January 30, 2012 UW Medicine School of Medicine, 4 hospitals, 30 primary care clinics,

More information

HIPAA: AN OVERVIEW September 2013

HIPAA: AN OVERVIEW September 2013 HIPAA: AN OVERVIEW September 2013 Introduction The Health Insurance Portability and Accountability Act of 1996, known as HIPAA, was enacted on August 21, 1996. The overall goal was to simplify and streamline

More information

Dispelling the Myth that Regulatory Compliance is Inherently Addressed within Existing Controls June 27, 2012

Dispelling the Myth that Regulatory Compliance is Inherently Addressed within Existing Controls June 27, 2012 Dispelling the Myth that Regulatory Compliance is Inherently Addressed within Existing Controls June 27, 2012 Lee Barrett, Executive Director, EHNAC Panelists: John Casillas, SVP, HIMSS Medical Banking

More information

Trends in Healthcare Payments Fifth Annual Report: 2014

Trends in Healthcare Payments Fifth Annual Report: 2014 Trends in Healthcare Payments Fifth Annual Report: 2014 Published: May 2015 consumers want to pay healthcare bills online page 23 The U.S. healthcare payments market is expected to reach an estimated $5

More information

The Receivables Race to Maximize Control and Automation Nina Hanselmann Cheryl Lehotyak. MN AFP April 28, 2015

The Receivables Race to Maximize Control and Automation Nina Hanselmann Cheryl Lehotyak. MN AFP April 28, 2015 The Receivables Race to Maximize Control and Automation Nina Hanselmann Cheryl Lehotyak MN AFP April 28, 2015 Every race consists of key milestones 6. Finish 1. Prepare 5. Pit Stops 2. Know the Course

More information

CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format

CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format Overview The Claims department partners with the Provider Relations, Health Services and Customer Service departments to assist providers with any claims-related questions. The focus of the Claims department

More information

HIPAA. Health Insurance Portability & Accountability Act Administrative Simplification FIVE THINGS YOU SHOULD KNOW ABOUT PAYMENTS AND HIPAA

HIPAA. Health Insurance Portability & Accountability Act Administrative Simplification FIVE THINGS YOU SHOULD KNOW ABOUT PAYMENTS AND HIPAA HIPAA Health Insurance Portability & Accountability Act Administrative Simplification FIVE THINGS YOU SHOULD KNOW ABOUT PAYMENTS AND HIPAA Steve Stone PNC Bank, N.A. October 14, 2009 Five Things You Should

More information

Maximizing Healthcare Payment Automa6on. Arvella Hill, Healthcare Business Analyst

Maximizing Healthcare Payment Automa6on. Arvella Hill, Healthcare Business Analyst Maximizing Healthcare Payment Automa6on Arvella Hill, Healthcare Business Analyst What Will We Learn? The Four Barriers in Revenue Cycle Management The Claims Process The Payment Challenge The 835 Standard

More information

The ROI of IT: Best Billing Practices

The ROI of IT: Best Billing Practices The ROI of IT: Best Billing Practices 1 R O S E M A R I E N E L S O N M G M A H E A L T H C A R E C O N S U L T I N G G R O U P The information and materials provided and referred to herein are not intended

More information

Practice management system criteria checklist

Practice management system criteria checklist Practice management system criteria checklist The American Medical Association (AMA) and Medical Group Management Association (MGMA) have created the following checklist as a starting point for assessing

More information

Electronic Payments & Statements (EPS) Frequently Asked Questions (FAQs)

Electronic Payments & Statements (EPS) Frequently Asked Questions (FAQs) Electronic Payments & Statements (EPS) Frequently Asked Questions (FAQs) Note: EPS features contained within these FAQs may not be applicable to all Payers. General Questions 1. What is Electronic Payments

More information

HIPAA as Strategy. Optimizing Financials via Standardized e-commerce. Miriam J. Paramore President & CEO PCI: e-commerce for healthcare

HIPAA as Strategy. Optimizing Financials via Standardized e-commerce. Miriam J. Paramore President & CEO PCI: e-commerce for healthcare HIPAA as Strategy Optimizing Financials via Standardized e-commerce Miriam J. Paramore President & CEO PCI: e-commerce for healthcare President, HIPAA Action Work Group of Kentucky (HAWK) www.hawkonline.org

More information

The benefits of electronic claims submission improve practice efficiencies

The benefits of electronic claims submission improve practice efficiencies The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer

More information

Optimizing Business Office Operations. Presented By D. Paul Davis, CPA, CMA

Optimizing Business Office Operations. Presented By D. Paul Davis, CPA, CMA Optimizing Business Office Operations Presented By D. Paul Davis, CPA, CMA ASC Challenges Declining reimbursement Increasing costs Increased competition More government regulations Changing technology

More information

VIRTUAL CARDS: Healthcare s New Electronic Payment Revolution

VIRTUAL CARDS: Healthcare s New Electronic Payment Revolution VIRTUAL CARDS: Healthcare s New Electronic Payment Revolution Healthcare is truly an 800-pound gorilla. Accounting for approximately one-sixth of the entire U.S. economy, industry spending totals more

More information

Challenges and Opportunities for Payers in the Changing Healthcare Payments Landscape

Challenges and Opportunities for Payers in the Changing Healthcare Payments Landscape Challenges and Opportunities for Payers in the Changing Healthcare Payments Landscape Published: June 2014 CONTENTS 3 Executive Summary 4 Enhancing the Consumer Payment Experience 6 Maximizing the Value

More information

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols 200 Old Country Road, Suite 470 Mineola, NY 11501 Phone: 516-294-4118 Fax: 516-294-9268 www.businessdynamicslimited.com

More information

Health Plan Certification of Compliance with HIPAA Electronic Transaction Standards

Health Plan Certification of Compliance with HIPAA Electronic Transaction Standards Issue 1 2014 Health Plan Certification of Compliance with HIPAA Electronic Transaction Standards The Department of Health and Human Services ( HHS ) issued proposed regulations that will require a controlling

More information

Preventive Treatment for the Provider s Back-office

Preventive Treatment for the Provider s Back-office Preventive Treatment for the Provider s Back-office A Closer Look at Administrative Simplification and the Key Strategies Healthcare Providers Can Take to Prepare By some estimates, nearly a third of every

More information

Trends in Healthcare Payments Annual Report: 2012

Trends in Healthcare Payments Annual Report: 2012 Trends in Healthcare Payments Annual Report: 2012 Published: March 2013 CONTENTS 3 Executive Summary 4 Trends in Payer Payments 7 Trends in Patient Payments 9 Provider Sentiment 12 Payer Sentiment 14 Patient

More information

Optum Health Payment Solutions

Optum Health Payment Solutions Optum Health Payment Solutions Today s competitive health care market demands that payers like you meet cost containment objectives and administrative simplification goals set out in the Affordable Care

More information

Consumer Bill Payments Shifts & Strategies

Consumer Bill Payments Shifts & Strategies Consumer Bill Payments Shifts & Strategies Jim Gilligan, CTP, FP&A Assistant Treasurer, Great Plains Energy Incorporated Kansas City Power & Light Company Kellie Thomas VP, Product Management, Wells Fargo

More information

Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information

Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information Please refer to Carta Normativa 15-0326 Re Transicion for details regarding the ASES-established Transition of Care and Reimbursement

More information

How can Banks Influence the. How can Banks Influence the. Landscape

How can Banks Influence the. How can Banks Influence the. Landscape How can Banks Influence the How can Banks Influence the Healthcare Healthcare Payments Payments Landscape Landscape Presenter: Lester Monteiro, VP TD Bank, NA Topics Discussed What are the issues facing

More information

THE VALUE PROPOSITION FOR BANK OWNED DIRECTORIES. GACHA Solutions Conference September 20, 2013

THE VALUE PROPOSITION FOR BANK OWNED DIRECTORIES. GACHA Solutions Conference September 20, 2013 THE VALUE PROPOSITION FOR BANK OWNED DIRECTORIES GACHA Solutions Conference September 20, 2013 TOPICS The Clearing House UPIC Electronic Bill Presentment (EBIDS) Healthcare Payments P2P Emerging Payments

More information

Housekeeping. - Next Event St. Louis - January 27, 2012. - Marketing Stuff - Surveys

Housekeeping. - Next Event St. Louis - January 27, 2012. - Marketing Stuff - Surveys Housekeeping - Next Event St. Louis - January 27, 2012. - Marketing Stuff - Surveys Implementation Considerations for ICD-10. What does is really take? Deanna Peterson MHA, RHIA First Class Solutions,

More information

OVERVIEW DATA SHEET. MedAct Overview Data Sheet

OVERVIEW DATA SHEET. MedAct Overview Data Sheet MedAct Overview Data Sheet MedAct delivers an integrated solution for your HME/DMEPOS that provides end-to-end coverage of all your business needs. From patient intake and purchasing to inventory management,

More information

Securing Patient Portals. What You Need to Know to Comply With HIPAA Omnibus and Meaningful Use

Securing Patient Portals. What You Need to Know to Comply With HIPAA Omnibus and Meaningful Use Securing Patient Portals What You Need to Know to Comply With HIPAA Omnibus and Meaningful Use September 2013 Table of Contents Abstract... 3 The Carrot and the Stick: Incentives and Penalties for Securing

More information

Case Study: Automating Healthcare Supplier Payments

Case Study: Automating Healthcare Supplier Payments Case Study: Automating Healthcare Supplier Payments Robert Raucci, Director-Treasury Operations Thomas Jefferson University June St. John, SVP, CTP Wells Fargo Treasury Management 2 Overview Today s healthcare

More information

2/17/14 PRACTICE MANAGEMENT SOFTWARE AND OTHER OFFICE AUTOMATION TOOLS. Disclosures. Objectives

2/17/14 PRACTICE MANAGEMENT SOFTWARE AND OTHER OFFICE AUTOMATION TOOLS. Disclosures. Objectives PRACTICE MANAGEMENT SOFTWARE AND OTHER OFFICE AUTOMATION TOOLS Linda D Green, MD, FAAAAI Disclosures Stocks: Merck, Pfizer, Google, Intel, Apple, IBM Hardware Used in My Practice: Various PC / Mac computers,

More information

Improving Small Business Payments Processing

Improving Small Business Payments Processing Improving Small Business Payments Processing ASBDC State Directors Conference March 19, 2012 Claudia Swendseid Senior Vice President Federal Reserve Bank of Minneapolis 2012 Federal Reserve Bank of Minneapolis.

More information

Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule

Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Many physician practices recognize the Health Information Portability and Accountability Act (HIPAA) as both a patient

More information

Practice Management Software Solution

Practice Management Software Solution Practice Management Software Solution Toll Free: 800.759.1321 Fax: 770.456.5049 Email: info@medipro.com www.medipro.com You have challenges We have answers If your practice is like most, it s a challenge

More information

Trusted Partners for. Revenue Cycle Solutions

Trusted Partners for. Revenue Cycle Solutions Trusted Partners for Revenue Cycle Solutions for over 25 years! 44 Stelton Road Suite 315 Piscataway, NJ 08854 1.800.682.5749 732.752.7052 Fax: 732.424.0084 Revenue Cycle Management Outsourcing Ensuring

More information

our group Mission Overview Offering

our group Mission Overview Offering ABOUT OUR COMPANY Mission Infrahealth is dedicated to offering cost-effective infrastructure solutions tailored to achieve maximum results for healthcare professionals. We are focused on delivering medical

More information

Electronic data interchange and proactive services for customers using revenue cycle management solutions from the Centricity portfolio

Electronic data interchange and proactive services for customers using revenue cycle management solutions from the Centricity portfolio GE Healthcare Electronic data interchange and proactive services for customers using revenue cycle management solutions from the Centricity portfolio imagination at work Accelerate revenue cycle performance

More information

Proven Practice Management and EHR Solutions

Proven Practice Management and EHR Solutions Proven Practice Management and EHR Solutions The Smart Choice to Enhance Office Productivity, Profitability and Care Quality Your small practice faces big challenges. Finding time and resources to prepare

More information

Or What makes Canadian Banking different?

Or What makes Canadian Banking different? CANADIAN BANKING Sharing a Border Or What makes Canadian Banking different? Ray Kohler Senior Relationship Manager, US Markets RBC Royal Bank 1 Agenda Understand the basic differences between Canadian

More information

Provider Revenue Cycle Management (RCM) and Proposed Solutions

Provider Revenue Cycle Management (RCM) and Proposed Solutions Provider Revenue Cycle Management (RCM) and Proposed Solutions By: Ranjana Maitra General Manager, Manufacturing & Healthcare Vertical Executive Summary It takes more than world-class service to be competitive

More information

Chapter 4: Electronic Data Interchange

Chapter 4: Electronic Data Interchange Electronic Billing NOTE: ELECTRONIC CLAIM SUBMISSION IS REQUIRED UNDER SECTION 3 OF THE ADMINISTATIVE SIMPLIFICATION COMPLIANCE ACT (ASCA), PUB.L. 107-105, AND THE IMPLEMENTING REGULATION AT 42 CFR 424.32.

More information

MEDICAID TEXAS (TMHP1) ERA ENROLLMENT INSTRUCTIONS

MEDICAID TEXAS (TMHP1) ERA ENROLLMENT INSTRUCTIONS MEDICAID TEXAS (TMHP1) ERA ENROLLMENT INSTRUCTIONS WHAT FORM(S) SHOULD I DO? Electronic Remittance Advice (ERA) Agreement WHERE SHOULD I SEND THE FORM(S)? Fax form to 512-514-4228; or Mail form to: Texas

More information

POWERFUL CHANNEL PARTNER SOLUTIONS

POWERFUL CHANNEL PARTNER SOLUTIONS POWERFUL CHANNEL PARTNER SOLUTIONS Simplifying the Business of Healthcare ONE PARTNER CAN HELP YOU OFFER YOUR CLIENTS MORE COMPLETE REVENUE CYCLE SOLUTIONS... ENHANCE YOUR PARTNERSHIPS TABLE OF CONTENTS

More information

Revenue Cycle Management

Revenue Cycle Management ELIGIBILITY AND VERIFICATION Revenue Cycle Management Are you or your staff tired of waiting on the phone or jumping from website to website to verify patients insurance eligibility? Being able to verify

More information

E-Commerce, Merchant Processing, EMV and General Best Practices for Municipalities

E-Commerce, Merchant Processing, EMV and General Best Practices for Municipalities E-Commerce, Merchant Processing, EMV and General Best Practices for Municipalities T.C. Kennedy. CTP Senior Vice President Treasury & Payment Solutions SunTrust Bank Electronic Commerce Defined Segment

More information

AR MANAGEMENT FOR THE LTC PROFESSIONAL

AR MANAGEMENT FOR THE LTC PROFESSIONAL 1 AR MANAGEMENT FOR THE LTC PROFESSIONAL LEADINGAGE MICHIGAN 2015 LEADERSHIP INSTITUTE Carolyn Lookabill Notice of Disclosure 2 Richter Healthcare Consultants has produced this material as an informational

More information

Legislative & Regulatory Information

Legislative & Regulatory Information Americas - U.S. Legislative, Privacy & Projects Jurisdiction Effective Date Author Release Date File No. UFS Topic Citation: Reference: Federal Various Louis Enahoro 2/20/14 LI-485 HIPAA, Electronic Commerce

More information

Streamlining Revenue Cycle Processes

Streamlining Revenue Cycle Processes Bank of America Merrill Lynch Case Study Streamlining Revenue Cycle Processes September 2014 Innovative patient and commercial receivables for Executive summary At (MDRH), a team of 40 orthopedic specialists

More information

Revenue Cycle Management Best Practices. Presenter: Rich Flaherty, VP of Sales

Revenue Cycle Management Best Practices. Presenter: Rich Flaherty, VP of Sales Revenue Cycle Management Best Practices Presenter: Rich Flaherty, VP of Sales RCM Best Practices Overview Patient engagement Front office processing Managing your provider s credentialing and enrollment

More information

University Healthcare Administrative Policy

University Healthcare Administrative Policy Page 1 of 6 APPROVED BY: Signatures on File FINANCIAL POLICY (UH) is a not-for profit teaching hospital committed to providing quality health care services. In order to provide necessary medical services

More information

Intelligent EDI Next-Generation Revenue-Cycle Management Capabilities All within the EDI Data Stream

Intelligent EDI Next-Generation Revenue-Cycle Management Capabilities All within the EDI Data Stream White Paper Intelligent EDI Next-Generation Revenue-Cycle Management Capabilities All within the EDI Data Stream Optum www.optum.com Page 1 White Paper The health care industry s transition to the 5010

More information

Moving to E-payments, Part Two: Are Electronic Collections Right for Your Business?

Moving to E-payments, Part Two: Are Electronic Collections Right for Your Business? Moving to E-payments, Part Two: Are Electronic Collections Right for Your Business? Written by: Linda Coven Head of Online Banking and Channel Management 408.654.7308 lcoven@svb.com Susan Merrill Sr. Product

More information

Meaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs

Meaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs Meaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs Providence Health & Services is committed to using technology and evidence-based practices to deliver the highest quality care in

More information

What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs

What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs Don t just trust that your staff is maximizing time and revenue. It is up to you to monitor, analyze

More information

Health Informa.on Technology Audits: "Meaningful Use" and HIPAA. January 23, 2015 Eli Poliakoff Gary Capps

Health Informa.on Technology Audits: Meaningful Use and HIPAA. January 23, 2015 Eli Poliakoff Gary Capps Health Informa.on Technology Audits: "Meaningful Use" and HIPAA January 23, 2015 Eli Poliakoff Gary Capps 1 HITECH - Related Audits Health Informa.on Technology for Economic and Clinical Health Act ("HITECH")

More information

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Matt Seefeld CEO & Co-Founder mseefeld@interpointpartners.com www.interpointpartners.com (404)446-0051

More information

Healthcare Banking 101. Donald Kohlhafer Senior Client Manager Bank of America Merrill Lynch December 4, 2014

Healthcare Banking 101. Donald Kohlhafer Senior Client Manager Bank of America Merrill Lynch December 4, 2014 Healthcare Banking 101 Donald Kohlhafer Senior Client Manager Bank of America Merrill Lynch December 4, 2014 Treasury Management Revenue Cycle Management Liquidity Management and Funds Investment Disbursement

More information

MyCare Ohio Skilled Nursing Facility Orientation

MyCare Ohio Skilled Nursing Facility Orientation MyCare Ohio Skilled Nursing Facility Orientation Demonstration/Pilot Area Demonstration/Pilot Area 2 Health Plan Options Northwest Southwest West Central Central East Central Northeast Central Northeast

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Santa Rosa Presents Webinar Series Electronic Health Records & Meaningful Use Incentives: Medicare & Medicaid

Santa Rosa Presents Webinar Series Electronic Health Records & Meaningful Use Incentives: Medicare & Medicaid Santa Rosa Presents Webinar Series Electronic Health Records & Meaningful Use Incentives: Medicare & Medicaid February 11, 2011 Chris Apgar, CISSP President Overview ARRA & Meaningful Use Rule Overview

More information

ECR. Electronic Claims Reimbursement. EFT/ERA trends from the payer s perspective. Featured Solution Profile: InstaMed. www.paystreamadvisors.

ECR. Electronic Claims Reimbursement. EFT/ERA trends from the payer s perspective. Featured Solution Profile: InstaMed. www.paystreamadvisors. SOLUTION SURVEY PROFILE REPORT ECR Electronic Claims EFT/ERA trends from the payer s perspective Featured : www.paystreamadvisors.com Q4 2011 Electronic Claims Profile With decades of experience in the

More information

Basics of the Healthcare Professional s Revenue Cycle

Basics of the Healthcare Professional s Revenue Cycle Basics of the Healthcare Professional s Revenue Cycle Payer View of the Claim and Payment Workflow Brenda Fielder, Cigna May 1, 2012 Objective Explain the claim workflow from the initial interaction through

More information

Treasury 3.0 The Time Is Now To Make It A Reality

Treasury 3.0 The Time Is Now To Make It A Reality Treasury 3.0 The Time Is Now To Make It A Reality April 2011 Presented by: Dave Robertson 2011 Treasury Strategies, Inc. All rights reserved. Contents Growth Limits Of A Payments Only Strategy Where Are

More information

Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I

Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I Your Revenue Cycle It s not just billing anymore Presented by: Candy Edie, MBA, CRCE-I POSITIONS Staff Accountant Chief Financial Officer Financial Systems Analyst Patient Access Director Patient Financial

More information

How to select a practice management system

How to select a practice management system How to select a practice management system New challenges and opportunities are impacting your practice today The physician practice environment is changing dramatically. The transition to ICD-10-CM and

More information

HIPAA Transactions and Code Set Standards As of January 2012. Frequently Asked Questions

HIPAA Transactions and Code Set Standards As of January 2012. Frequently Asked Questions HIPAA Transactions and Code Set Standards As of January 2012 Frequently Asked Questions Version 20 Rev 11222011 Frequently Asked Questions: HIPAA Transactions and Code Set Standards One of the most prominent

More information

ON PATIENT PAYMENTS. This Web version may be reproduced for individual use.

ON PATIENT PAYMENTS. This Web version may be reproduced for individual use. Perspective With $1 out of $4 coming from patients, MGMA research reveals the dynamics of practices billing and collections and the latest cause of your sleepless nights. ON PATIENT PAYMENTS In October

More information

EMDEON PATIENT ACCESS SOLUTIONS AND SERVICES

EMDEON PATIENT ACCESS SOLUTIONS AND SERVICES 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

More information

Qtr 2. 2011 Provider Update Bulletin

Qtr 2. 2011 Provider Update Bulletin West Virginia Medicaid WEST VIRGINIA Department of Health & Human Resources Qtr 2. 2011 Provider Update Bulletin West Virginia Medicaid Provider Update Bulletin Qtr. 2, 2011 Volume 1 Inside This Issue:

More information

Top Ten Questions. Time and Energy. Robin Bradbury 800-355-0410 robin@ereso.com

Top Ten Questions. Time and Energy. Robin Bradbury 800-355-0410 robin@ereso.com Robin Bradbury 800-355-0410 robin@ereso.com Top Ten Questions 1. What are the key measures for the Revenue Cycle? 2. How do you document and share this information with the Revenue Cycle staff? 3. What

More information

Health Information Technology (IT) Simplified

Health Information Technology (IT) Simplified Health Information Technology (IT) Simplified A glossary of all things Health IT Accountable Care Organizations (ACO) - A group of health care providers who give coordinated care, chronic disease management,

More information

Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23, 2015

Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23, 2015 Revenue Cycle Best Practices to Increase Collections, Reduce A/R and Increase Patient Satisfaction Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23,

More information

EMDEON PATIENT CONNECT TM

EMDEON PATIENT CONNECT TM EMDEON PATIENT CONNECT TM Patient Billing & Payment Solutions for Channel Partners Simplifying the Business of Healthcare Discover the Power of an Emdeon Partnership A seismic shift is underway. Patients

More information

Electronic data interchange and proactive services for Centricity revenue cycle management customers

Electronic data interchange and proactive services for Centricity revenue cycle management customers GE Healthcare Electronic data interchange and proactive services for Centricity revenue cycle management customers Accelerate revenue perf Key features Tight alignment with payers ensures mandates, updates

More information

EFT and ERA Enrollment Process White Paper

EFT and ERA Enrollment Process White Paper WEDI Strategic National Implementation Process (SNIP) WEDI SNIP Transactions Workgroup EFT Sub workgroup EFT and ERA Enrollment Process White Paper Enrollment Process for Healthcare Claim Electronic Funds

More information

ELECTRONIC PAYMENT PROCESSING NEW TOOLS AND TECHNOLOGY

ELECTRONIC PAYMENT PROCESSING NEW TOOLS AND TECHNOLOGY ELECTRONIC PAYMENT PROCESSING NEW TOOLS AND TECHNOLOGY Matt Fluegge Dean Middleton Dan Sollis National Acct. Executive President, UTA Executive VP TODAY, YOU WILL LEARN ABOUT: ACH GATEWAY CREDIT CARD GATEWAY

More information

The HIPAA Standard Transaction Requirements: How do Health Plans Comply?

The HIPAA Standard Transaction Requirements: How do Health Plans Comply? The HIPAA Standard Transaction Requirements: How do Health Plans Comply? April 17, 2014 As most employers are aware, the federal government has released a good deal of guidance related to various provisions

More information

Transform Accounts Payable Into a Revenue Center. Supplier Payments Optimization

Transform Accounts Payable Into a Revenue Center. Supplier Payments Optimization Transform Accounts Payable Into a Revenue Center Supplier Payments Optimization Supplier Payments Optimization With Virtual Cards Is your p-card program optimizing payments to your suppliers? Does your

More information

Healthcare Information Technology (HIT)

Healthcare Information Technology (HIT) Healthcare Information Technology (HIT) Why State Governments Must Help Create a National Health Information Network Ian C. Bonnet Deloitte Consulting LLP October, 2005 State Leadership in developing a

More information

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013 Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Conifer Health Solutions Tenet Investor Webinar

Conifer Health Solutions Tenet Investor Webinar Conifer Health Solutions Tenet Investor Webinar May 16, 2012 Stephen Mooney President, Conifer Health Solutions 1 2012 Conifer Health Solutions, LLC. All Rights Reserved. Forward Looking Statements Certain

More information

Impact of Meaningful Use and Healthcare Transformation On Patient Access

Impact of Meaningful Use and Healthcare Transformation On Patient Access Impact of Meaningful Use and Healthcare Transformation On Patient Access Copyright 2011 BluePrint Healthcare IT. All rights reserved NAHAM Northeast Conference October 2011 Stamford, CT Introduction 1.

More information

Insurance 101. Infant and Toddler Coordinators Association. July 28, 2012 Capital City Hyatt. Laura Pizza Plum Plum Healthcare Consulting

Insurance 101. Infant and Toddler Coordinators Association. July 28, 2012 Capital City Hyatt. Laura Pizza Plum Plum Healthcare Consulting Insurance 101 Infant and Toddler Coordinators Association July 28, 2012 Capital City Hyatt Laura Pizza Plum 1 Agenda Basics of Health Insurance Frequently Asked Questions Early Intervention and working

More information

Healthcare & ACH Be Prepared for 2014. Kevin Olsen, AAP, MCSE Director of Education. 2013 EastPay. All Rights Reserved EASTPAY

Healthcare & ACH Be Prepared for 2014. Kevin Olsen, AAP, MCSE Director of Education. 2013 EastPay. All Rights Reserved EASTPAY Healthcare & ACH Be Prepared for 2014 Kevin Olsen, AAP, MCSE Director of Education Teamwork Respect Passion Integrity Trust EASTPAY Not-for-profit Regional Payments Association Educational Programs Member

More information

Compensation and Claims Processing

Compensation and Claims Processing Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance

More information

How Regulatory Changes Continue to Impact Revenue Cycle Management

How Regulatory Changes Continue to Impact Revenue Cycle Management How Regulatory Changes Continue to Impact Revenue Cycle Management Indiana Rural Health Association Annual Conference June 2015 Fifth Third Bank All Rights Reserved Member FDIC 1 Agenda Rural Health Healthcare

More information

HFMA MAP Keys Patient Access Measure:

HFMA MAP Keys Patient Access Measure: HFMA MAP Keys Patient Access Pre-Registration Rate Trending indicator that patient access processes are timely, accurate, and efficient Indicates revenue cycle efficiency and effectiveness N: number of

More information

GE Healthcare. Electronic data interchange and proactive services for Centricity revenue cycle management customers

GE Healthcare. Electronic data interchange and proactive services for Centricity revenue cycle management customers GE Healthcare Electronic data interchange and proactive services for Centricity revenue cycle management customers Accelerate revenue perf Key features updates and other payer-specific adjustments are

More information

To start the pre-approval process, providers must fill out a short online survey, available at: https://www.surveymonkey.com/s/hrszft2.

To start the pre-approval process, providers must fill out a short online survey, available at: https://www.surveymonkey.com/s/hrszft2. Maryland Medicaid EHR Incentive Program Attestation Form for Eligible Providers to Meet Program Requirements Under the Certified Electronic Health Record (CEHRT) Flexibility Rule for Program Year 2014

More information

Have you contacted your financial institution to arrange for the delivery of the CORE required Minimum CCD+ Reassociation Data Elements

Have you contacted your financial institution to arrange for the delivery of the CORE required Minimum CCD+ Reassociation Data Elements Instructions for Electronic Funds Transfer (EFT) Enrollment/Change/Cancellation Page 1 Please use this guide to prepare/complete your Electronic Funds Transfer (EFT) Authorization Agreement Form. Missing,

More information

New ACA Mandate: HIPAA Health Plan Certification Proposed Rules. Christy Tinnes Groom Law Group February 21, 2014

New ACA Mandate: HIPAA Health Plan Certification Proposed Rules. Christy Tinnes Groom Law Group February 21, 2014 New ACA Mandate: HIPAA Health Plan Certification Proposed Rules Christy Tinnes Groom Law Group February 21, 2014 HIPAA Transaction Rules Background Issued in 2000 and updated since that time Apply to HIPAA

More information

BILLING COMPANY STANDARDS

BILLING COMPANY STANDARDS BILLING COMPANY STANDARDS ASSESSING PRACTICE VALUE OF OUTSOURCING Cost Saving Efficiencies gained Improved collections Compliance Once a decision to out source is made the following due diligence should

More information