Unfortunately, with today’s healthcare system, sometimes providers have to chase payments, just to collect even a portion of what is owed to them.
While undesirable, it’s understandable how this inverted standard took hold. With the industry’s complicated fee structures, multilayered services and contracted relationships with multiple payers, providers are constantly challenged to achieve payment integrity.
Emdeon is aiming to change all that by infusing the principle—and practice—of payment integrity into the healthcare revenue cycle one hospital system at a time with Emdeon Payment Integrity Services. These targeted services help providers identify and collect underpayments, aging receivables and denied claims from payers.
Already deeply integrated into providers’ businesses, Emdeon knows the first step in achieving this goal is to meet providers where they are now—down in the trenches trying to get paid. The more revenue that can be collected, the healthier and stronger a hospital system will be to make the shift to true payment integrity.
To that end, Emdeon Payment Integrity Services offers comprehensive, responsive solutions to help collect what’s owed.
• Emdeon Audit & Recovery Services: provides actionable analysis and customized solutions that allow providers to make sure reimbursements from payers meet contracted rates to reduce the risk of underpayments
• Emdeon Accounts Receivable Management: extends the capabilities of providers’ staffs, with focus on collecting payment on aging receivables from payers
• Emdeon Denial & Appeals Services: gives providers practical, tactical support to successfully appeal denied claims and reduce write-offs
Often during the process of audit and recovery and through implementation of effective accounts receivable management, providers are able to identify and address patterns of problems, and methodically eliminate them from their infrastructure. Though responsive tactics are likely required on an ongoing basis, providers are eventually able to look ahead to integrate integrity into their processes in order to prevent future issues and improve performance. Emdeon has a solution for prevention for providers ready to move forward with ‘great expectations’ of getting paid.
Emdeon Performance Improvement & Prevention Services: integrates integrity initiatives into providers’ overall processes to prevent payment problems and repetitive issues related to denials in the long term.
Of course, providers must be active participants on the journey to payment integrity. Even when backed by services like those offered by Emdeon, provider leadership and team members must take substantive strides to make the shift. Here are some items that should be on the To Do lists of every provider seeking to integrate payment integrity.
• Internal audit: a thorough self-examination to determine organizational strengths and weaknesses and assess potential system improvements
• Clinical component: infusion of clinical standards into the billing process to better address issues of medical necessity, etc. that often lead to denied claims
• External observation: connect with other provider organizations that have achieved payment integrity to gain applicable insights and ideas
• Staff training: investments in internal staff to ensure they are knowledgeable, engaged and equipped to best identify and address payment issues
• Open communications: integrated methods for keeping all internal team members informed and interconnected, so that all departments work cohesively toward a common goal
Want help identifying and collecting underpaid, late and denied claims? Call 877.EMDEON.6 (877.363.3666) or visit us online to learn how Emdeon Payment Integrity Services can protect your bottom line.
The Great Expectations of Payment Integrity: Practical Solutions to Take You from Anticipation of Write-offs to Expectation of Full Payments
