A Message from CEO Gerry McCarthy
Season’s greetings! As the year wraps up, it’s a time of reflection at eSolutions, but also a time when we’re busily planning for our company’s future. As we take stock of this last year, it’s pretty incredible what we accomplished at eSolutions.
This 20th year in eSolutions’ history was one of continued growth and evolution, helping to further solidify our place as an industry leader. I’m proud that we collectively accomplished more for our clients, partners and employees than ever before, and I’d like to take this opportunity to share with you just a few of those accomplishments.
Investments for Today & Tomorrow
We put strategic, massive investments into our products, technology and people that not only strengthen our existing products, but also lay the foundation to deliver even more innovative, powerful solutions in the coming years. Our capabilities are growing while our potential is wide open to further positively impact the industry in ways we can only begin to imagine.
As providers are faced with more regulatory changes than ever before, eSolutions has invested in new products, made enhancements and provided extensive client education so providers have what they need – both within our applications and through educational content.
We’ve spent time and resources ensuring our skilled nursing customers were equipped to handle CMS’ new Patient-Driven Payment Model (PDPM), and that our home health clients are ready for CMS’ Patient-Driven Groupings Model, coming January 2020. Our team is also ahead of the game preparing for other CMS regulations like Medicare Beneficiary Identifier (MBI) usage requirements, the switch from checking eligibility in the Common Working File (CWF) to using the HIPAA Eligibility Transaction System (HETS), Review Choice Demonstration, and much more.
When regulations impact you, our team is ready to help minimize any disruption to your business, and your account representative is available to help you navigate changes impacting your bottom line.
Expanding our Footprint
eSolutions proudly acquired two health IT companies with proven technology and established industry relationships that bolster our offerings in the clearinghouse and revenue integrity markets.
Last summer, we acquired Practice Insight, a clearinghouse and RCM software vendor that provides fast, secure and robust integrated EDI solutions through its EDInsights® platform.
More than 68,000 providers rely on EDInsights® to edit and track claims in real-time, verify patient eligibility, process patient statements, provide patients with advance notice of procedure costs, and much more.
Through this acquisition, we’ve elevated our industry-leading clearinghouse solutions and introduced new product offerings to respective markets. We’ve also proudly welcomed the many established partner and re-seller relationships to eSolutions.
In October, we acquired Medidal, a premier provider of revenue integrity solutions that include Transfer DRG, Payer Search and Pharmacy Reimbursement products. These solutions are designed to identify and recover missed reimbursement opportunities on behalf of healthcare providers. Over the past 10 years, this suite of best-in-class products have identified and recovered more than $1 billion for its provider customers.
Thanks to our Medicare connection and data capabilities, we’ve already begun identifying millions of dollars in Transfer DRG underpayments for our hospital and health system clients. If you’re interested in learning more about these products, please reach out to us.
Through a company-wide effort, our team launched a refreshed modern eSolutions brand that empowers our clients and employees. This includes a reimagined logo and tagline, new product names, updated look and feel of our products, and a new user-friendly website.
Celebrating 20 Years
This year we hit a major milestone – 20 years in business. We celebrated throughout the year with activities and events that expressed our gratitude to our clients, partners and employees for helping us achieve this wonderful accomplishment.
Looking ahead, 2020 is shaping up to be a spectacular year in its own right as we continue down the path of unprecedented investment and growth. We’ll keep adding to and updating our existing proven core technology while searching for strategic ways to bring you new products that help you strengthen your revenue health.
Thank you for trusting eSolutions with your revenue cycle management needs. We sincerely appreciate your major part in our success, and we look forward to serving you and helping your business grow in 2020. I hope you have a safe and happy holiday season!
Take Steps to Access iQIES by December 23
The Centers for Medicare & Medicaid Services (CMS) has given its Quality Improvement and Evaluation System (QIES) a makeover. The system is used by providers and vendors to submit OASIS assessment data.
The enhancements are meant to make the system more reliable, scalable, secure, accessible and Cloud-based. They will occur in phases by provider type, starting with home health agencies (HHAs) in January 2020. The changes include an updated name: the Internet Quality Improvement and Evaluation System (iQIES). Beginning January 1, HHAs must submit their OASIS files to iQIES or risk claim rejections and payment disruptions.
Please note, if you don’t obtain access to iQIES by December 23, it will negatively affect your HHA’s ability to submit assessment data needed for claims matching purposes after January 1, 2020. Claims that can’t be matched to assessments will be returned to you, which will cause problems for your Medicare payments.
Providers Must Use MBI for Medicare Transactions Starting January 1
Reminder: Medicare patients have new Medicare Beneficiary Identifiers (MBI) that replace the old HICN number. Beginning January 1, 2020, all Medicare transactions must include the new beneficiary MBI number. Medicare transactions with the legacy HICN will reject at the front-end beginning January 1 – this includes claims and Real Time eligibility.
During the current transition period ending December 31, 2019, Medicare is processing either HICN or MBI. However, CMS is urging providers to send the MBI now and achieve 100% submission rate before the national deadline to ensure business processes will not be impacted. Here are some ways to prepare for the change:
- Providers should ask Medicare patients for their new card at the point of service.
- Providers can also login to their Medicare Administrator’s portal and use the MBI Lookup Tool.
- Medicare is returning the MBI on the Electronic Remittance Advice, even if the claim is submitted with the HICN. Beginning January 1, the ERA will be MBI only.
For more information, visit the CMS website.
eSolutions Acquires Medidal, Strengthening its RCM Portfolio
In October, eSolutions acquired Medidal, a premier provider of Transfer DRG, Payer Search, and Pharmacy Reimbursement solutions.
Medidal’s revenue integrity solutions are designed to identify and recover missed reimbursement opportunities on behalf of healthcare providers. Over the past 10 years, Medidal has developed a suite of best-in-class products that have identified and recovered more than $1 billion for its provider customers. These tools are used nationwide by many of the country’s leading healthcare providers.
Transfer DRG is proprietary technology that allows us to conduct underpayment audits for your organization to ensure you are reimbursed for those claims. Clients using Transfer DRG recover $3,500 per claim on average of underpayments.
Instead of writing off claims and forfeiting revenue, providers can deploy Recover to locate active, billable insurance for self-pay claims. Our batch verification process makes it easy to automatically check multiple patients across virtually all payers. In fact, health centers using Recover can expect to convert 3% of self-pay patients to insured.
With Pharmacy Payer Search hospitals can locate pharmacy coverage for claims that have gone unpaid. Our tool searches for Medicare Part D and Medicaid eligibility and once accounts are identified, we submit the claims for you. We’ll help you set up an automated, secure, HIPAA-compliant file transfer to transmit your claim files. We route the files accordingly for processing and adjudication within 48-hours.
“These new capabilities are highly complementary to our solutions,” said Gerry McCarthy, CEO of eSolutions. “Medidal’s proven technology, coupled with our existing services, will offer immediate benefit to our clients by delivering accurate and earned reimbursement back into the hands of providers.”
Countdown to PDGM
PDGM is coming in just a few short weeks! eSolutions is here to help as we get closer to the deadline.
In anticipation of PDGM, eSolutions is launching new PDGM-specific reports for our home health providers in Medicare Analytics and Claims Editor. These solutions, coupled with the ability to view the entire patient encounter rather than just a single claim, will help HHAs navigate the changing reimbursement environment, get paid quicker and reduce denials. Report areas will focus on:
- Episode Tracking
- RAPS at Risk
- HIPPS Code Changes
Also, don’t miss our recent webinar, “PDGM: Ready, Set, Go!” featuring Melinda Gaboury, COS-C, chief executive officer of Healthcare Provider Solutions Inc., in Nashville, Tennessee. This webinar covers all the intricate details of billing RAPs and Final Claims under PDGM beginning January 1, 2020, as well as the necessities of eligibility verification and orders management. Access the webinar today and watch it with your entire billing staff.
PDPM Has Arrived
PDPM launched in October, and eSolutions is happy to have helped our clients prepare.
We know there will surely be some bumps in the road as providers get used to the requirements of this new payment model. Don’t forget that we still have a wealth of resources on our website to help answer your questions, including “Ask the Expert: PDPM Q&A with Maureen McCarthy.” Find more resources here.
New Tool for Ambulatory Clients
eSolutions has launched Revenue Insights powered by TITAN, just for our ambulatory clients. Providers can use this vital new tool to quickly get a pulse on their revenue cycle, including their top revenue codes, denial rates, reimbursement bottlenecks and efficiency of their operations.
Its features include:
- Simple setup
- Impactful, high-level data visualization
- Easy-to-understand dashboard of key performance indicators
- Early warning system for revenue cycle performance
- Ability to upgrade to full TITAN capabilities with more drill-down functionality
Introducing the New ClaimRemedi Claim Holds Feature
eSolutions recently released a new Claim Holds feature to all users. Do you like the versatility of editing claims in the ClaimRemedi portal? Then you’ll love this new feature!
The Claim Holds feature allows you to set specific criteria for clean claims to be stopped in the ClaimRemedi portal after scrubbing. You can make edits/updates to claims on hold using the Editable Forms feature, and then submit them to the payer.
For more information or questions, please contact our Client Services Team at 866.633.4726.
TITAN Webinar Now Available
Do you want to find out how comparative analytics and business insights can improve your bottom line? Check out this new TITAN webinar, “Driving Performance Improvement with Comparative Analytics,” now available from eSolutions. TITAN analyzes ERA data for more than half of U.S. providers – see what it can do for your data! Learn more about the power of TITAN today.
Other Notable eSolutions News
- Keeping Clients Happy: Meet Stephen Call
- eSolutions Welcomes James Evan as New CFO
- Joe Bell joins WEDI Board of Directors
See You in 2020!
eSolutions will be busy traveling during Q1! If you’ll be attending any of the following shows, be sure to visit us at the eSolutions’ booth:
- January 12-15
HFMA Western Region Symposium – Las Vegas
- January 16-17
HFMA Massachusetts-Rhode Island Chapter – Foxborough, MA
- January 19-21
MUSE Executive Institute – Newport Beach, CA
- January 22-24
Mega Conference – Wisconsin Dells, WI
- February 7
HealthPac – Savannah, GA
- March 4-5
Medtrade Spring – Las Vegas
- March 11
eCW Day Show-KC – Kansas City, MO
- March 12
HFMA Metropolitan NY Chapter – New York
- March 9-13
HIMSS20 – Orlando, FL
- March 16-19
NACHC Policy & Issues Forum – Washington, D.C.
- March 20
AIMSVAR – Pittsburgh