Revenue cycle management tools are in for a busy year

There's a lot going on in the world of clinical financial data interchange. Transitions to HIPAA 5010 and ICD-10 are on the horizon as hospitals and practices stay focused on implementing electronic medical records and qualifying for incentive funds. Lynne Dunbrack, program manager for Health Industry Insights, says electronic data interchange services that emphasize revenue cycle and ease providers’ financial processes are likely to be prioritized.

Additionally, enhanced information and reporting on claims should be a key feature in EDI services. “It’s not just a matter of submitting a claim but it’s being able to use that data for claims status,” Dunbrack said. “There will be a certain amount of volatility in the marketplace as (providers) sort through their needs on the practice management side and as the vendors sort through remediation and sunsetting products.”

THREE TRENDS TO WATCH

Lynne Dunbrack, program manager for Health Industry Insights, sees these trends affecting the EDI clearinghouse services sector in the coming months:

1. REVENUE CYCLE IMPLICATIONS: Investments in EDI that may facilitate revenue cycle management are likely to be favored by providers, Dunbrack said, particularly in the context of the cost-shifting brought on by high-deductible health plans and the ability to facilitate patient deductible services.

2. HIPAA AND ICD-10 UPGRADES: Many hospitals and clinics began using clearinghouse services when HIPAA broke out, Dunbrack said. The upgrade to 5010 and the conversion to ICD-10 are two major upcoming shifts that should stir up EDI technology and use. “In many ways the whole conversion to ICD-10 is somewhat like Y2K ... in the way that Y2K required vendors to make a significant investment in how they handle data,” said Dunbrack.

3. PRODUCT SUNSETTING: As these changes take effect, providers and vendors will undergo some level of EDI overhaul. This could include vendors “sunsetting” some products as they focus on offering a new, comprehensive, compliant solution for EDI.

VENDOR SHOWCASE

BROADLANE
BroadLink
BroadLink® is the healthcare industry’s only provider-centric supply chain e-commerce clearinghouse.  The Broadlane system manages purchase-order transactions for 300 hospitals and processes nearly $1 billion in annual spend with more than 1,700 suppliers. BroadLink is the foundation for automating hospital procurement operations; it minimizes rework, eliminates price discrepancies, expands contract coverage and enables the processing of hospitals’ non- electronic orders and orders to nonintegrated suppliers and trading partners.
Contact: Les Popiolek, senior vice president, procurement services, 972.813.7733, les.popiolek@broadlane.com.

CLAIMLOGIC
Serving clients ranging from the largest medical centers and physician groups in the U.S. to the smaller practices, ClaimLogic’s Web based claims and payment technology solutions offers all-payer claims, 835, PQRI management and reporting, superior denial management and enhanced management reporting, patient eligibility, EOB to 835 conversions, patient statements, paper claims and much, much more.
Contact: Tom Davis, 866.252.4656 or TDavis@ClaimLogic.com.

EMDEON
Emdeon Office
Emdeon is the market leader in revenue and payment cycle solutions and clinical data exchange across all provider segments. We hold the single largest national health information network, process more consumer bills and provider payments than anyone else and are a recognized thought leader within the healthcare industry.
Contact: physicianinfo@emdeon.com.

GATEWAY EDI
Gateway EDI, one of the nation’s largest healthcare electronic data interchange (EDI) providers in the country, takes responsibility for its clients’ revenue cycle from patient to payment. The company combines powerful software tools with an experienced customer service team for the industry’s best solutions.
Contact: 800.969.3666 or salescontact@gatewayedi.com.

HERAE, LLC
HERAE is the leading provider of HIPAA-compliant electronic healthcare payment services. HERAE processes HIPAA 835 transactions, facilitates posting, routing and reporting of explanation of benefits (EOBs) with online workflow tools and automates transactions with direct connections to health insurers, healthcare providers and their banks. HERAE’s unique system offers healthcare providers secure, online access to EOBs and the ability to quickly route claims without photocopying or searching for paper originals. Implementing the HERAE system improves reporting, operation performance and collections, reduces fraud and dramatically improves deposit time. HERAE sees the financial side of healthcare as a rapidly evolving frontier. The intersection of new technologies with online platforms and the increased demand for efficient and cost-effective billing systems to offset healthcare costs will revolutionize billing, re-association, payment processing and deposits.
Contact: John Nabors, 858.866.0144, x149, john.nabors@herae.com.

INSTAMED
InstaMed Online
InstaMed offers America’s largest payer network for clearinghouse transactions. We offer the full suite of revenue cycle solutions, which includes claims, eligibility, remits, patient statements and claims status, and support integrated patient payments processing on a single platform. Our product is a Web-based platform that is used by 50,000 providers. InstaMed’s solutions allow providers to streamline denials and simplify your operational processes.
Contact: Sales Operations, 215.789.3682, salesops@instamed.com.

NAVICURE
Navicure Claims Management
Navicure is a leading Internet-based claims clearinghouse that helps physician practices increase profitability through improved claims reimbursement and staff productivity. The company’s solution is supported by its unique 3 Ring client service. Navicure was named “Best in KLAS” for the clearinghouse services market segment as part of the 2008 Top 20 Best in KLAS Awards report.
Contact: Matthew Halkos, 877.280.3334, sales@navicure.com, www.navicure.com.

RELAYHEALTH
Transaction Service
RelayHealth transaction service provides a streamlined business interaction between patients, providers and payors that improves financial performance and drives productivity while reducing costs. These financial services include eligibility verification, electronic claims submission, electronic remittance advice, claims management with payer and clinical edits, online bill pay and statement processing.
Contact: Brienne Sabers, channel sales associate, 319.465.4467, Brienne.Sabers@RelayHealth.com.
 

USER REVIEWS

“Radiation Medical Group has been using HERAE for about four years with great success. Its Web-based interface is extremely user friendly and eliminates the hassle of paper checks, provides easy access to electronic EOBs and, most importantly, gets the deposits in the bank more quickly.”
Liz Adely, accounts receivable supervisor, Radiation Medical Group.

“Emdeon helps to improve our financial flow of our business because it allows us to electronically bill as many payers as we can possibly sign up with. I have not found any payer who we have a relationship with that Emdeon didn’t have a relationship with. It’s like one-stop shopping. I can e-bill through them, I can see my remittance advice and I can have the money transferred into a bank account. And that just has everything turn around so quickly that it makes us more efficient.”
Terry L., office manager, Alliance Orthopedic Labs.