Market is moving forward
WHILE THE claims management market is mature and industry vendors have mastered its complexity, the market is moving toward adjusting to three main drivers, said Sheila Schweitzer, CEO of CareMedic. “There are so many point solutions in claims that we’ve created silos of information that aren’t interoperable,” she said. At a time when healthcare providers need claims information transparency and actionable data, the ability for solutions to tie the processes together is critical. Also creating enormous disruption and challenges are the various government mandates of the past two years, including UB40 changes, National Provider Identifier and taxonomy codes, Recovery Audit Contractors audits for Medicare and now the ICD-10 conversion deadline slated for 2011. With patients paying out the first dollars in high-deductible health plans, the Centers for Medicare and Medicaid Services needs to incorporate patients as primary payers into the process to service the providers, Schweitzer said.
THREE TRENDS TO WATCH
Sheila Schweitzer, CEO of CareMedic, identifies three claims trends:
1. Expansion: Data has to be expanded to give healthcare service providers visibility into claims information and into the revenue cycle to provide actionable data through
dashboarding, business intelligence and decision support.
2. Vomplexity: Government mandates are creating more complexity to claims.
3. Coordination: The patients themselves have become integral pieces in the submission and payment of claims to the service provider.
VENDOR SHOWCASE
AdvancedMD Software
AdvancedMD Practice Management and Billing Software
http://www.advancedmd.com/medicalpractice/advancedmd.asp
AdvancedMD is the highest-rated and most widely used medical practice management and billing software on the Web, featuring exclusive Revenue Cycle Automation Tools that helps clients accelerate return on investment through maximizing billing revenue, streamlining claims and accelerating the payment processes.
Contact: 800.825.0224, info@advancedmd.com
Alpha II
ClaimStaker
http://www.alphaii.com/ClaimStaker.html
A complete and highly customizable “claim scrubber,” ClaimStaker accelerates cash flow by verifying professional and institutional claim validity prior to claims submission.
Contact: Alpha II, 800.476.8477 (Tallahassee), 888.889.6777 (Montgomery), info@alphaii.com
athenahealth
athenaCollector
http://www.athenahealth.com/our-services/athenaCollector.php
athenaCollector includes Web-based practice management software that simplifies every step of the process – patient registration, scheduling, eligibility verification, check-in, coding, referral management, check-out, appointment follow-up, collections, accounting and reporting.
Contact: product manager, athenaCollector, 888.652.8200
CareMedic Systems
RAC Management
http://www.caremedic.com/RAC_Management.aspx
The RAC Management solution provides the critical functionality to prepare for, track and manage the entire Recovery Audit Contractor (RAC) process. Working in combination with CareMedic’s MedicareRT direct entry solution, RAC Management offers new claim edits specifically addressing known RAC targets, data-mining tools to gain visibility into audit exposure, along with reporting, detailed analysis and tracking tools to manage and streamline the audit process. In addition, a multi-layered dashboard provides CFOs a consolidated view of all claims involved in the audit, and informs of deadlines and progress. The solution is available with subscription-based pricing and Web-based hosting.
Contact: Jose Miranda, sales analyst, 800.508.8494, http://www.caremedic.com/eFR.aspx
Emdeon Business Services
Emdeon Claim Master
http://www.emdeon.com/ProviderSolutions/claimmaster/index.php
Emdeon Claim Master is a web-based billing management solution that can save time and money by providing one interface for managing claims for virtually all government and commercial payers from start to finish resulting in improved efficiency and increased revenues.
Contact: 877.363.3666, instsales@emdeon.com
HealthPort
HealthPort Revenue Cycle Management
http://www.healthport.com/RCM_overview.aspx
HealthPort Revenue Cycle Management (RCM) is designed to improve your bottom line by simplifying the claims management and payment process. Intuitive and easy-to-use ASP model automates and streamlines claims submission, eligibility, claims status, remittance, denial management and reporting.
Contact: sales and marketing, 800.737.2585, marketing@healthport.com
Ingenix
ClaimsManager Professional
http://www.ingenix.com/Products/Physicians/RevenueManagementSolutionsPhy...
Ingenix ClaimsManager is a powerful and proven tool that enables physician practice groups to review claims before submission to reduce claim denial rates, shorten accounts receivable cycles and increase the rate of collection. ClaimsManager is part of the Physician Revenue Cycle Management Solution providing an end-to-end, whole-systems-engineering approach to automating critical clinical and operational processes.
Contact: Ingenix Response Management, 800.765.6613, info@ingenix.com
Navicure
Navicure Claims Management
www.navicure.com
Serving thousands of physicians in practices nationwide, Navicure’s award-winning Web-based account receivables management solutions automate receivables processes, including patient eligibility verification, primary and secondary claims reimbursement, rejected and denied claims management, electronic remittance posting, claims and remittance reporting and analysis, and patient statement processing.
Contact: Matthew Halkos, 877.280.3334, sales@navicure.com
PCG Software
Virtual Examiner
http://pcgsoftware.com/software_solutions_ve.htm
The user-friendly, scalable automated cost containment software tool monitors an organization’s internal claims process to identify unclean claims and reduce payment for improper or erroneous coding to conserve important premium dollars.
Contact: 877.789.1291, info@pcgsoftware.com
USER REVIEWS
“By implementing ClaimStaker, we have improved the efficiency of our coders, reduced a tremendous amount of rework, and lowered our Medicare rejections rate by over 40 percent.”
Lesson learned: “While the implementation was a smooth process, it really forced our coders to refocus and spend time to learn the required medical necessity for services. This extra effort now allows them to accurately code based on signs and symptoms or findings on their initial entry.”
Pat Kinsley, coding and compliance manager, Suburban Radiologic Consultants
“Emdeon Claim Master is one of the most important revenue cycle tools we have installed in Patient Financial Services at Martha Jefferson Hospital. This claim management solution automates the import of bills from our patient accounting system and sends clean claims to the clearinghouse without any staff intervention. Staff only have to review and touch claims that failed an edit and Emdeon maintains an extensive and updated listing of payer edits. These benefits allow us to resolve potential claim issues before they are presented to the payer. As a result, our claims are acknowledged by payers as good claims upon initial receipt which significantly improves the turnaround time to remit.”
Albert Payne, revenue cycle manager, Martha Jefferson Hospital
“AdvancedMD has completely eliminated denials resulting from global period problems thanks to the Claim Inspector and the Global Period warning feature.”
Lesson learned: “Even though we now send most secondary claims electronically, it still requires a lot of employee training to get the accounting right.”
Dan Williams, president, Great Acclaim LLC
“By helping us reduce claims denials, and increase productivity, Ingenix ClaimsManager has done more than just allow us to operate more effectively. Ultimately, we pass along those savings, so our customers are the ultimate beneficiaries.”
Tracy Essing, director of coding and compliance, Dreyer Medical Clinic
“After having a bad experience with our previous clearinghouse, our practice – especially our physicians – were very impressed with how smoothly the Navicure implementation went. In addition, we’re already seeing the technology’s positive impact on our claims facilitation process.”
Trina Scott, director of Accounts Receivables, SouthCoast Medical Group, LLC
