Now who says medical billing is simple. If it were simple and not a ton of money to be made, we wouldn’t have all these various companies using business intelligence software to help the hospitals and doctors the analysis services and algorithms to get down to the last penny (grin). We are also seeing a lot of mergers and acquisitions in this area as one finds the technology one company can add to the current business intelligence they have. These are not investments for the sake of “owning “ and investing any longer, they are working algorithms/partners.
These folks are becoming the “middle people” who represent both the providers and the payers, depending on who’s the client and paying for the services. Last August Cigna who did business exclusively with Emdeon dropped the contract, but will still use the, but made room for others. When you go to settle a denial on a healthcare claim, these are some of the 3rd parties involved in this process.
CIGNA to Drop Emdeon EDI Exclusivity for Insurance Claims Clearinghouse Services - Makes Room for Ingenix
Here’s a part of the Emdeon package is that is marketed, “Denial Manager”. You might want to read up and check this out as in this instance this appears to be the part done when the hospital is the paying client.
On the other side of the coin, a small Medicare Senior HMO company, Bravo who uses Emdeon, made a billion dollars in profit last year, so there’s a ton of money in the processing side of claims that are complicated and part of the reasons our care is so expensive.
We all talk about reducing costs in the clinical side and I certainly think some of the big profits on the billing side could use some scrutiny too. BD
NASHVILLE, Tenn., June 21 /PRNewswire-FirstCall/ -- Emdeon Inc. (NYSE: EM), a leading provider of healthcare revenue and payment cycle management solutions, today announced the acquisition of Chapin Revenue Cycle Management, LLC ("Chapin"). Based in Tampa, Florida, Chapin is a leading technology-enabled provider of hospital-based revenue cycle services including accounts receivable management, medical denials, appeals and collection improvement initiatives.
Chapin utilizes a proprietary contract management system built specifically for rapid and precise calculations of reimbursement amounts from all types of healthcare payers and contract arrangements. By leveraging this technology and Chapin's extensive experience in outsourced hospital revenue cycle management services, Emdeon will offer an added service layer designed to enhance the financial performance of institutional healthcare providers across its broad network.
"Healthcare providers continue to face financial challenges associated with rising accounts receivable balances, inaccurate claim submissions and declining cash collections from unpaid or underpaid claims," said George Lazenby, chief executive officer for Emdeon. "Our acquisition of Chapin will help Emdeon address these industry-wide problems and strengthen our already solid foundation in revenue cycle management solutions across the entire patient encounter."