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Advisory Working Group eBilling with NDCHealth

Advisory Working Group eBilling with NDCHealth. Begin with the end in mind. - Stephen Covey. Wednesday, 3 August 2005. Agenda. Introductions NDCHealth and EDI Processing Installation Industry Comparison Importance of eBilling and the DoD Success with DoD Installations

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Advisory Working Group eBilling with NDCHealth

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  1. Advisory Working GroupeBilling with NDCHealth Begin with the end in mind. - Stephen Covey Wednesday, 3 August 2005 Attachment #8

  2. Agenda • Introductions • NDCHealth and EDI Processing • Installation Industry Comparison • Importance of eBilling and the DoD • Success with DoD Installations • Challenges with DoD Installations Revenue Cycle Management

  3. Introductions • [Name Redacted]: • Senior Director, Product Management • Former Manager of Technical Support • [Name Redacted]: • Manager, EDI Implementation and Programming • Former Trainer and Project Manager

  4. NDCHealth and EDI ProcessingHospital Applications and Services • Hospital Installations • Other Sectors • Retail Vision • Nursing Homes • Durable Medical Equipment • Renal Dialysis Centers • Annual Transactions • 150M Claims • 40M Remittance Transactions

  5. The NDCHealth Vision An Ongoing Commitment to Excellent Customer ROI • Patient Quality of Life • Customer ROI • Improved Outcome • Real-time ‘decisioning’ • Messaging • Compliance • Enhanced Insight/Enabling • Workflow enhancement/improvement • Deeper and more granular information • Unmasking transactional information • Information Foundation • Accuracy • Speed • Responsiveness • Claims • Editing • Fraud/Abuse • Adjudication • Systems • ePrescribing

  6. Total Hospital Solution: ePREMIS® Encounter Eligibility Medical Necessity Post-Service Pre-Service Claims Management- Medicare Direct Entry Remittance Management MedPrint Statements Xchange Claims Status Eligibility Medical NecessityPre-Certification/Referrals/Auth.’s Professional Services, Claims Management Optimization Services, Services & Support Continuum of Care/Revenue Cycle NDCHealth Intelligent Network Transaction Delivery NDC ePREMIS Claims Management Editing Medical Records Registration Claim Generation Charge Assembly Registration Admissions Encounter NDC ePREMIS Solutions Throughout the Continuum of Care

  7. Current Hospital/Health System Customers

  8. Installation Industry Comparison • Civilian Similarities to DoD Billing • Comparable Claim Content Requirements • Paper Claims @ 10% of Volume • Non-Government Claims • Streamlined Processes • Single System • Revenue Cycle Management • Integrated End to End Process

  9. How’d We Get Here • Late 1980’s Industry adoption of Electronic Claim Delivery • Migration of Claims from Paper to Electronic • Advantages of Electronic Billing • Faster Delivery • Standardization & Automation • Delivery Confirmation

  10. In DoD Terms - By Comparison Paper Billing is to Electronic Billing • As Hang-Gliders are to Fighter Jets • As Horses are to Armored Personnel Carriers • As Rowboats are to Aircraft Carriers - Anonymous

  11. Importance of eBilling and the DoD • Streamlining of Billing Processes • Consistency of Data Delivery and Retrieval • Audit Trails • Security • Reporting • Automation of Workflow • End-User Adaptability More Money, Earlier

  12. Proven Deployment Method • Installations • Over 500 ePREMIS Implementations Live • 150 Currently Being Implemented • 3 Years of ePREMIS Implementation Experience • Quality Driven Process • Continuous Self Assessment and Review of Client Feedback • Seasoned Implementation Team: • 80% from PREMIS Implementation Staff • 10% from PREMIS Customer Support • 10% from New Hires

  13. Success with DoD Installations • William Beaumont – Fort Bliss: • ePREMIS Full Installation • April 2005 – On-Site Training • Gunther Air Force Base: • Multiple Sites with Signature Performance • July 2005 – Remote Training • Sites Currently Live: • 13 Live on ePREMIS • 22 Live on XChange to be upgraded to ePREMIS

  14. Challenges with DoD Installations • Enrollments • Workstation Configuration • End-User Training • Process Change Same as Civilian

  15. Four Phases of ePREMIS Implementation

  16. ePREMIS Baseline Functionality • Web-delivered claims management system • Interactive user interface • Process Driven Workflow • Validates claims against payer requirements • Handles electronic and paper claims • On-demand and automated reporting • Assists hospitals in controlling their financial performance by automating routine tasks • Facilitate Follow Up

  17. Transaction Flow • TPOCS Generates Claim File(s) • Claim Submission • Event Driven Automation • Error Identification • Create Reports • Error Free Claims Released to Clearinghouse • Payer Response & Remittance Follows

  18. User Experience • Home Page with Message Delivery Center • Interactive Claims Screen • Address & Analyze Errors • Exception Based Intuitive Navigation within Claims • Graphical • On-Demand Reports • On-Line Interactive Help

  19. User Experience • Event Messaging • Menu Driven

  20. Interactive Claim Replica

  21. Four Requirements to Proceed with ePREMIS Go-Live • Enrollments Finished • Workstations Configured • Claim Files Tested • Preliminary Training Completed

  22. Questions and Answers

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