EMDEON REVENUE OPTIMIZATION SERVICES

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1 EMDEON REVENUE OPTIMIZATION SERVICES TRANSFORM PREVIOUSLY WRITTEN-OFF PAYER UNDERPAYMENTS INTO REALIZED REVENUE Simplifying the Business of Healthcare

2 Simplifying the Business of Healthcare Helping increase profitability by reducing bad debt and write-offs for hospitals and healthcare systems Emdeon is transforming the industry with a 360 degree approach to revenue cycle management enabling providers to get paid more, faster. Emdeon does this by automating the five components of the revenue cycle: Patient Access, Claims, Remittance & Payment, Revenue Optimization and Patient Billing & Payment. Our solutions work together across your entire revenue cycle to meet the needs of your healthcare business and simplify almost every aspect of the business of healthcare. 340,000 Providers 5,000 Hospitals 1,200 Payers 60,000 Pharmacies 600 Channel Partners 150,000,000 Patients Emdeon has the solutions providers need to overcome the challenges of managing the complex revenue cycle including helping to increase profitability by reducing bad debt and write-offs. We deliver connectivity to 1,200 Government and Commercial payers as part of the largest Healthcare Revenue and Payment Cycle network in the industry. This allows third-party and patient information to be more easily shared than ever before, which increases efficiency and reduces costly errors. One partner for integrated, end-to-end Revenue Cycle Management Solutions Time is one of the most important resources a provider can give a patient, and at Emdeon, we understand that. Our solutions give you a single relationship that makes your entire healthcare business more efficient and easy to manage. From the initial patient encounter through reimbursement and final payment, Emdeon is Simplifying the Business of Healthcare. Contact Us Today! 877.EMDEON.6 ( ) At Emdeon, we re here to help. To transform the way you run your healthcare business today, call us at 877.EMDEON.6 ( ) for a complimentary review.

3 Emdeon Revenue Optimization Services Technology-enabled services that capture more revenue by reducing write-offs and underpayments Emdeon Revenue Optimization Services, an HFMA Peer Reviewed service, provides both professional services and technology solutions enabling you to transform previously written-off Government Managed Care and Commercial payer underpayments into realized revenue. Coupling industry expertise with sophisticated tools to work with providers as an extension of Patient Financial Services staff, Emdeon Revenue Optimization Services focuses on key areas of the revenue cycle where providers traditionally lack the resources to address payer underpayments including accuracy of payments and collection issues. From contractual underpayments, authorization issues, medical denials, Coordination of Benefits (COB) discrepancies, charge bundling, timely filing denials, Current Procedural Terminology (CPT) coding conflicts to even disparate claim systems, the Emdeon Revenue Optimization Services suite identifies what s missing from your Government Managed Care and Commercial payer revenue bottom line. Whether utilizing our professional services as staff within your facility or technology solutions as part of your workflow, Emdeon Revenue Optimization Services can be tailored to meet your needs. Emdeon Revenue Optimization Services not only identifies root cause, but also collects and prevents underpayments from happening in the future with Audit & Recovery Services, Accounts Receivable Management, Denial & Appeals Services and Performance Improvement & Prevention. Patient Access Management Claims Management Remittance & Payment Management Revenue Optimization Services Patient Billing & Payment Management Easily capture, organize and authenticate patient data Instantly verify billing, benefit and eligibility information Access the most payer connections in the industry Save time and money Create faster, more efficient adjudication Increase first-pass acceptance rates Improve workflow Transparency to track claims every step of the way Receive 100% of third-party payments electronically for complete payment automation More easily manage denied, inaccurate and underpaid claims Streamline processes for easier correction and resubmission Reveal opportunities for denial prevention Access powerful reporting tools that improve staff productivity Recover more than just easy-to-find debt Discover outstanding balances on third-party claims Reduce days in Accounts Receivable Reduce claim denial rates Reduce bad debt write-offs Identify problems to prevent future loss Deliver easy-tounderstand patient statements Accelerate patient payments Integrate physical and electronic payment processes Significantly reduce customer service calls 03

4 COMPREHENSIVE ACCOUNTS RECEIVABLE EVALUATION Emdeon Audit & Recovery Services Receive an accurate reimbursement from payers virtually every time Get the most out of your processes, procedures, contract structures and levels of payer penetration Emdeon Audit & Recovery Services enables you to ensure that reimbursements received from payers meet negotiated, contracted reimbursement rates. With Government Managed Care and Commercial payer underpayments accounting for a loss of three to five percent of net managed care revenues, Emdeon Audit & Recovery Services, part of the Emdeon Revenue Optimization Services suite, offers comprehensive accounts receivable evaluation, analysis and collection of undetected underpayments. In addition to addressing underpayments, contractual denials and zero-balanced third-party accounts, chronic problem payers as well as how to prevent systemic underpayment issues are also identified. The end result is collecting and preventing underpayments to receive an accurate reimbursement from payers virtually every time. With Emdeon Audit & Recovery Services, an initial interview with management and staff is conducted evaluating processes, procedures, contract structures and levels of payer penetration. From there, a thorough and complete reconciliation of billing and payment information is performed. The reconciled patient account information is then compared to an expected payment generated from our proprietary contract management system. When complete, a detailed report is provided outlining the variance of reimbursements received to your negotiated, contracted reimbursement rates as well as the percentage of your accounts with potential variances for specific payers. Moving beyond the audit to the recovery process, payment variances are calculated and investigated to eliminate any false claims due to patient responsibility and cross registrations. True payer underpayments are then documented and presented to payers with Emdeon continuing to follow-up until resolution. Features Accounts Receivable evaluation, analysis and collection Professional Revenue Optimization Services team with extensive experience in both payer contracting and patient accounts Proprietary contract management system Results-driven service that is unique to each client Benefits Demonstrate recovery of more than just easy-to-find debt Receive customized reporting Identify problems to prevent future loss Fee contingency-based on net recovery amount At Emdeon, we re here to help. To transform the way you run your healthcare business today, call us at 877.EMDEON.6 ( ) for a complimentary review.

5 EFFECTIVE AGING OR PROBLEMATIC PAYER ACCOUNT COLLECTION Discover outstanding balances and missed payment opportunities Emdeon Accounts Receivable Management Resolve even difficult, aging accounts to ensure payment Emdeon Accounts Receivable Management provides you with support services focused on the collection of aging or problematic Government Managed Care and Commercial payer accounts acting as an extension of your staff. Steps can be taken to minimize the effects of inappropriate contractual adjustments, denials and bad debt write-offs which subtract from your profitability and cash position. Emdeon Accounts Receivable Management, part of the Emdeon Revenue Optimization Services suite, can prevent these problems from adding up to incrementally help improve your bottom line. Emdeon Accounts Receivable Management empowers you with accounts receivable clean-up to discover outstanding balances on third-party claims. Separating un-posted contractual adjustments and patient responsibility from unpaid payer dollars, the remaining amount can then be collected and resolved on virtually any outstanding accounts. Our professional Revenue Optimization Services team successfully handles your aging Government Managed Care and Commercial payer accounts enabling your staff to focus on accounts that are most collectible. If needed, we can provide support to your legal staff when a payer refuses to honor a claim based on contractual terms or your patient s benefit plan. All in all, Emdeon Accounts Receivable Management helps resolve even difficult, aging accounts to ensure payment. Features Professional, experienced Revenue Optimization Services team Support services focused on the collection of aging or problematic Government and Commercial payer accounts Accounts receivable clean-up Assistance to legal staff as needed Benefits Optimize patient financial services staff Discover outstanding balances on third-party claims Reduce days in Accounts Receivable Reduce cost of collections Increase cash collections Reduce bad debt write-offs 05

6 EFFICIENT DENIED CLAIM RESOLUTION Emdeon Denial & Appeals Services Navigate the complex appeals process to overturn denied claims Emdeon can handle your appeals with expert staff, including follow-up support Emdeon Denial & Appeals Services, part of the Emdeon Revenue Optimization Services suite, helps providers overturn denied claims with a full service appeals offering. With 10 to 15 percent of a hospital s Government Managed Care and Commercial claims resulting in full or partial medical denials and 67 percent of these denials being recoverable through the filing of effective appeals, Emdeon Denial & Appeals Services navigates the complex appeals process to overturn denied claims for payment reducing unnecessary write-offs. From thoroughly reviewing medical records to effectively preparing and filing appeals, Emdeon Denial & Appeals Services manages your denied claims appeal processes from the start to resolution. As a licensed InterQual review agency, Emdeon Denial & Appeals Services provides you access to our experienced Revenue Optimization Services team consisting of registered nurses. Working as an extension of your Patient Financial Services staff, our team handles your appeals using their working knowledge of various payer authorization requirements, medical criteria and protocols necessary to make the case for successful appeals. In addition to clinical experience, our team offers follow-up and support during the arbitration process as needed to overturn even difficult denied claims. Features Licensed InterQual review agency Professional, experienced Revenue Optimization Services team Support services focused on effective appeals for acute care, skilled nursing, mental health and substance abuse denied claims Assistance to legal staff as needed Benefits Optimize patient financial services staff Receive customized reporting Fee contingency-based on net recovery amount Reduce claim denial rates Reduce bad debt write-offs Contact Us Today! 877.EMDEON.6 ( ) At Emdeon, we re here to help. To transform the way you run your healthcare business today, call us at 877.EMDEON.6 ( ) for a complimentary review.

7 PROACTIVE DENIAL PREVENTION STRATEGIES 90 percent of denials are preventable, and Emdeon can help with customized, preemptive steps Emdeon Performance Improvement & Prevention Services Overcome common Government Managed Care and Commercial payer challenges Emdeon Performance Improvement & Prevention Services assists providers in overcoming common Government Managed Care and Commercial payer challenges with performance improvement initiatives based on the development of baseline measurements, documentation of chronic problems and identification of systematic payment issues. As part of the Emdeon Revenue Optimization Services suite, Emdeon Performance Improvement & Prevention Services uses detailed reporting and analytics to improve processes now and proactively prevent issues from occurring with Government Managed Care and Commercial payer payments. With evidence showing that 90 percent of denials are preventable through improved execution of eligibility and benefits verification, authorization and clinical documentation efforts, it s clear that preventive measures offer the best long-term strategy for recovering denied revenue. Furthermore, significant recovery costs can be avoided altogether through effective denial prevention efforts. The data developed through assisting with your current or historical medical denials will support your focus on prevention. Customized reporting with Emdeon Performance Improvement & Prevention Services allows you to identify problem areas by denial reasons, diagnoses, physicians, payers and procedures which can be used to prevent these denials from recurring in the future. Features Data-driven performance improvement initiatives Service that is unique to each client Benefits Reduce claim denial rates Reduce bad debt write-offs Identify problems to prevent future loss 07

8 Discover the Difference of More from One Partner Automation. Security. Simplicity. Efficiency. Centralization. With Emdeon you get more than just solutions, you get a partner. Our solutions are designed to work together to improve your entire revenue cycle. We re constantly striving to stay a market leader in business efficiency and Healthcare Information Exchange for the long-term. That means we deliver the best solutions to the market today, and they re solutions designed to evolve and improve as the industry changes. Once you start an Emdeon partnership, our highly trained staff are ready to work with you to ensure a smooth installation and training process. Should issues occur down the road, you can rest assured that Emdeon will be ready to help: Emdeon ON24/ 7, our online customer service and support tool, allows you to communicate and monitor issues via the Internet any time, day or night so you stay informed on what s being done to help. Emdeon solutions automate key tasks and simplify what you do every day so that you can focus on what s really important: your patients. * HFMA staff and volunteers determined that this product has met specific criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guaranty the use of this product. 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 Emdeon Business Services LLC. All rights reserved. EMDA rev Lebanon Pike, Suite 1000 Nashville, TN USA 877.EMDEON.6 ( )

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