New Regulation May Impact Eligibility Verification
A new CMS regulation effective April 1, 2019, will require Medicare Part A providers checking beneficiary eligibility to have a registered a valid National Provider Identifier (NPI) in the Medicare Provider Enrollment and Chain/Ownership System (PECOS) database.
When providers submit a Medicare HIQA/HIQH search request for beneficiary eligibility, the NPI will now be verified against information in the PECOS database. The Common Working File (CWF) will reject eligibility requests when the NPI is either not present or is not active in PECOS.
We suggests you review the PECOS status for any NPIs your organization uses to check eligibility. If your NPIs are not registered in PECOS, you will not be able to query eligibility after April 1, 2019.
Check out these helpful links to learn more:
If you have further questions about this regulation, please don’t hesitate to contact your eSolutions account representative.
What is PDGM and What Will it Mean for Your HHA?
If you’re a home health agency (HHA), the Patient-Driven Grouping Model (PDGM) and its January 1, 2020, deadline have probably been on your mind a lot lately. And for good reason – analyst and investment firm TripleTree has called it “the most significant regulatory and reimbursement reform since the creation of the Prospective Payments System (PPS) 20 years ago.”
PDGM will present both challenges and opportunities for HHAs, as the new rules will drive them to better align their operating model with a U.S. healthcare industry that is quickly evolving toward more value-based rather than volume-based care initiatives. The countdown is on to the PDGM deadline. So what is PDGM and how will it change the game for your organization?
Improving Your Hospital Intake Game
You’ve heard the statistics: The average claim denial rate across the healthcare industry falls between five and 10 percent, according to an American Academy of Family Physicians (AAFP) report.
In 2016 alone, 37 million out of 448 million requests – either for prior approval of services (24 million) or for payments of services already provided (424 million) – were denied, according to a 2018 study from the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services.
While there’s no quick fix to the problem, it is true that about 90 percent of claim denials are preventable, according to a 2014 Advisory Board study. You can’t prevent every claim denial, but you can reduce them by strengthening your hospital eligibility processes. The success or failure of the patient claim game begins and ends with your intake process.
Easily Find Medicaid Coverage with Cascading Search
You can take another step toward capturing more revenue using eSolutions’ Multi-Payer Eligibility’s new cascading search feature. Our unique search technology allows you to discover patients’ hard-to-find Medicaid coverage by checking multiple payers in one transaction.
In 37 states, even if you have limited patient information, eSolutions’ cascading search feature can search for unknown, billable Medicaid coverage on any Medicare beneficiary.
An eSolutions’ large home health and hospice client in Florida added the cascading search feature to Multi-Payer Eligibility late last year. Its billing team easily created a Medicare + Medicaid comprehensive cascade to automate Medicaid search for all Medicare beneficiaries.
The provider discovered additional Medicaid coverage for approximately 27 percent of its Medicaid population! This greatly improved the agency’s ability to collect on services they may otherwise have been forced to write off.
Contact us to see if cascading search can help you discover more Medicaid coverage! We want to show you how it works – click here to learn more and schedule a personalized demo.
Client Services Spotlight
Meet Andrea Munson: As Director of Implementation and Projects, Andrea is responsible for the Implementation, Enrollment, and Strategic Operations teams. She is always busy making sure her teams and managers are firing on all cylinders when it comes to helping eSolutions’ employees assist clients. She also makes sure that any system that can be automated is, to make eSolutions’ products work as seamlessly as possible for new and existing clients.
UHC Admission Notifications Made Easy
eSolutions has launched a new product to help skilled nursing facilities handle new prior authorization requirements from UnitedHealthcare. UHC now requires SNFs to obtain a prior authorization for admission notification within 24 hours. This means SNFs and their busy teams are spending extra time waiting on the phone, faxing or manually entering patient info online to obtain the authorization.
eSolutions’ new PriorAuth-Admission Notification platform does the work faster and more reliably! SNFs can save significant time and money – in fact, about $7 per transaction – when they use PriorAuth-Admission Notification. Considering 1 in 5 Medicare beneficiaries are served by UHC, the savings can add up quickly!
See how much this new tool will save you – Request your demo today!
New Product Videos
eSolutions is proud to announce our library of new product videos. These quick animated videos give you a snapshot of what our products do and the benefits they can bring to your organization:
- Medicare Enterprise Package
- Multi-Payer Eligibility Verification
- Quality & Compliance
- Clearinghouse Tools
Stay tuned! More videos are coming soon.
Upcoming Trade Shows
Heading to any trade shows in Q2? We’d love to see you! Be sure to visit the eSolutions’ booth and let us know what’s new with you and your organization.
- April 1-3
eClinicalWorks Enterprise and Urgent Care Summit, Ft. Lauderdale, FL
- April 3-5
PointClickCare SAMMI 2019, San Diego, CA
- April 7-10
Urgent Care Association Conference, West Palm Beach, FL
- April 10-12
eClinicalWorks Health Center Summit, Boston, MA
- April 23-26
NAHAM Annual Conference & Expo, Orlando, FL
- May 15
eClinicalWorks Day Show, Dallas, TX
- May 14-17
CPCA CFO & Billing Managers, La Jolla, CA
- May 14-18
ASCA, Nashville, TN
- May 27-31
eClinicalWorks Education Expo, Boston, MA
- June 12-14
HCHB Annual Users Conference, Dallas, TX
- June 19
eClinicalWorks Day Show, Kansas City, MO
- June 23-26
HFMA Annual Conference, Orlando, FL