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eSolutions Newsletter | Q4 2018

Posted by eSolutions on Dec 21, 2018 2:55:47 PM


A Message from our CEO

In just the few short months since coming on board as eSolutions’ CEO, I am truly energized by our dynamic employees and the value our products bring to thousands of providers. Now, more than ever, eSolutions is putting resources and focus behind a growth strategy that enables clients like you to further optimize your performance.

While eSolutions has grown tremendously over the years, our innovative products and committed team position us to evolve into something even greater than our founders could have imagined nearly 20 years ago. After months of comprehensive planning, we know exactly where eSolutions is going and how we’re going to get there.

Our 2019 priorities include:

Strong product portfolio:
We’ll enhance existing products as well as develop new and innovative products to meet clients’ needs and simplify their revenue cycle. Our focus will always be on leveraging analytics, data and process to help providers get paid accurately and quickly.

Customer service excellence:
We’ll work to improve and strengthen customer relationships and the customer experience. We are inspecting our processes, reviewing our delivery methods and measuring our performance to ensure clients receive an exemplary level of care every time.

An accountable, collaborative culture:
We will attract and retain the top talent needed to support growth and innovation. We as a company will continue to foster a collaborative, accountable and highly productive culture.

eSolutions has continued a year of unprecedented growth in the number of customers we proudly serve, the products we offer and the size of our team. With the acquisition of Dorado Systems Inc. in August, we’re equipped with an even more powerful set of platforms and tools to help us deliver better operational and financial outcomes coupled with higher client productivity.

I could not be more excited about what’s in store for eSolutions in 2019, and for the opportunity to work with you, our customers, to help you achieve your goals next year. Stay tuned. In the meantime, all of us here at eSolutions extend warm wishes to all of you for a happy, healthy holiday season full of family and friends.

Best wishes,
Gerry McCarthy, CEO

New Product Validates Medical Necessity

31-percent-manual-claim-denials-process-graphMedical necessity is among the top-five reasons claims get denied, and those denials cost providers millions each year. In fact, medical necessity denials accounted for nearly 3 percent of all denials recorded in eSolutions' TITAN performance insights tool, resulting in more than $8.9 billion in denied billed revenue since TITAN launched in 2011.

eSolutions has proudly launched a new product that automates validation of medical necessity. The product offers a streamlined tool for checking medical necessity, helping to manage medical necessity-related denials, write-offs and claim rework by automating medical necessity checks and creating an Advance Beneficiary Notice (ABN) when it's required.

With Medical Necessity, you can:

  • Save time using workflow automation
  • Eliminate potential of human error
  • Alert patients to self-pay requirements before delivering care
  • Store historical data in case of an audit
  • Receive real-time policy data
  • Prevent denials and write-offs
  • Improve cash flow
  • Look up a policy to handle an appeal

Check out our Medical Necessity product page to learn more!

2018 – A Banner Year for Products

The eSolutions Product and Development teams worked tirelessly in 2018 to enhance existing products and develop new, innovative products.

With the release of the cascading search feature in our Multi-Payer Eligibility tool, it’s now easier for customers to quickly find all their patients’ coverage from one request. Hospitals can now quickly find DRG Grouper/Pricer information in real-time from Medicare with our new MedicareDRG tool.

We seamlessly incorporated Medicare’s new MBI numbers into our products and added crosswalk search capabilities from HICN to MBI. We strengthened our Clearinghouse capabilities with additional reporting capabilities and a Dental Attachments service. In addition, new report packages for post-acute providers were added to our Quality and Compliance tools.

As we head into 2019, our product strategy is firmly grounded in addressing your needs. We’re focused not only on continued product enhancement, but also on adding new products that will simplify your revenue cycle. These products include tools that will strengthen the front end of your revenue cycle to facilitate medical necessity and prior authorization requests. Also in the works is a contract management system that will provide an affordable, viable option for large and small provider organizations alike.


Review Choice Demonstration Delayed

CMS intended to start Review Choice Demonstration (RCD) for Illinois home health providers on December 10, but the program didn't start. CMS is continuing the process for Paperwork Reduction Act (PRA) approval for RCD. eSolutions can help Illinois home health providers get ahead of the game with our new Review Choice Demonstration product, designed to assist providers who choose pre-claim review to affirm their claims. LEARN MORE IN THIS NEW EBOOK

New to Billing Medicare? We've Got a Guide for That!

Sometimes we all need a little help getting started. This is why eSolutions has published a series of Getting Started Guides to quickly help providers new to billing Medicare. These guides cover everything from the lifecycle of a Medicare claim to tracking the most common reason codes and rejection and denial reasons in your industry. Check them out by your provider type:




Home Health


Skilled Nursing Facility


Guide-to-Switching-Clearinghouses-Resource-Library-ThumbnailA Guide to Switching Clearinghouses

Billing claims is difficult work. As the insurance industry continues to grow in complexity, it's no wonder more providers are turning to clearinghouse services than ever before. But with so many choices available for processing claims, how can you make sure your clearinghouse partner is doing everything it can to improve the health of your billing process? This guide will help you evaluate your current service and highlight some of the key logistics of switching to a new clearinghouse. READ OUR GUIDE

eSolutions Celebrates Home Care and Hospice Month

November was National Home Care and Hospice Month, and eSolutions celebrated with several activities to honor those hero caregivers and workers behind the scenes who make a difference in the lives of patients.

We kicked the month off by asking our home health and hospice clients why they were thankful to work in the industry. Check out their heart-warming responses in this blog post.

Our home health and hospice sales teams honored our clients with community service projects. Our Kansas City-based team filled kids' activity bags, made memory keepers and wrote cards to veteran patients. Our Plano, Texas, team sponsored a food drive to help Heart to Heart Hospice provide meals for several families in need this holiday season.



We wrapped up the month with a blog post examining some of the major changes the industry is bracing for in 2019 and 2020. READ OUR BLOG POST

Thank you to all our wonderful clients who participated in celebrating with us this month!

Medicare Advantage Enrollment Surge Presents Challenges & Opportunities for Providers

As the “silver tsunami” of baby boomers aging into Medicare continues, so does enrollment in Medicare Advantage (MA) plans. A staggering 10,000 people are eligible to enroll in Medicare each day. From 2008 to 2017, MA plan enrollment grew from 9.7 million to 19.6 million. This growth represents 34 percent of all Medicare beneficiaries.

With the aging population, enrollment in MA plans will only continue increasing. While this represents a distinct opportunity for many providers to be more profitable if they play their cards right, growing MA enrollment also poses challenges. READ MORE

Happy Holidays from eSolutions!

eSolutions would like to wish everyone a happy holiday season the best way we know how, by helping you with your Medicare billing! Check out our original production, The 12 Days of Medicare Billing.

Visit us at Upcoming Trade Shows

Headed to trade shows in Q1? Be sure to visit the eSolutions booth and let us know what's new with you and your organization.

  • January 14-16 – HFMA Western Region Symposium, Las Vegas, NV – Booth #434
  • January 17-18 – HFMA Revenue Cycle Conference, Foxborough, MA
  • January 24 – PDGM National Summit, Kansas City, MO
  • February 19-22 – Complia CARE, Orlando, FL
  • March 20 – eClinicalWorks Day Show, Chicago, IL
  • March 25-27 – National Council for Behavioral Health - NatCon 19, Nashville, TN
  • March 27-29 – NACHC Policy & Issues Forum, Washington, DC
  • March 27-29 – HFMA North Carolina Annual Conference, Pinehurst, NC


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Topics: News