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Here's where you can find out about what CHS is up to, what's coming in the future and events. Keep up to date with CHS happenings and find out what's on our calendar.

SIIA TRADE SHOW

Complete Health Systems has been long time supporters of the Self-Insurance Institute of America, Inc., or SIIA. In October, we attended their 33rd Annual National Educational Conference and Expo, which was held in Chicago, Illinois. As in year's past, we had the opportunity to meet with fellow professionals within the healthcare industry.  Thank you to everyone who stopped by and visited our booth.  

Every year, CHS conducts a raffle for gift cards or other valuable prizes at the SIIA Educational Conference. Last year, we gave our winners an opportunity to give back to worthy cause by donating their prize to a charitable organization. The U.S. continues to face a sluggish economy, and CHS felt giving back in hard times is important.

Similar to last year, we announced that we would give the winners of the drawing the prize of a $50 American Express gift card and they would have the opportunity to donate the funds to a charity. If they chose any of the following three charities, CHS made a commitment to match the donation for a total of $100.

  • The Wounded Warrior Project

War is a terrible option, but sometimes necessary. The least those of us, non-military folks, can do is honor the dead and help the wounded. Those who serve in the military put themselves in harm's way on our behalf. We, at CHS, are proud to support this charity.

  • The Salvation Army

As the economy fights to recover, contributions to charities decrease and the need for help increases. CHS helps support this fine organization, so that they can help those in need.

  • The Children's Miracle Network

This organization is a favorite of a member of the CHS team. This network works to increase awareness of healthcare for both sick and health children, in addition to raising funds in order to improve healthcare facilities.

winner1 winner2
Winner: Jamie Brown
Charity: Food For The Poor
Winner: Debbie Hickey
Charity: Children's Miracle Network
winner3 winner4
Winner: Debi Kelbert
Charity: Wounded Warrior
Winner: Kristy Swailes
Charity: Wounded Warrior

GUEST ARTICLE

CHS, will, in this and a few future issues of this newsletter, be addressing the subject of provider payments. Paying a claim accurately and on time is the major activity of TPAs and payers.A big part of the culmination of this activity is the actual payment to the provider (in most cases).

 In order to kick off this topic, I have invited no less than one who could, arguably, be declared the “father of virtual card payments” in our industry. I first met David Gillman when he visited with me in Chicago in 2010. What follows is an article that he contributed to this newsletter, at my request.

Our intent is to bring such articles to inform our readership. There may be an undercurrent of salesmanship but the value of education and information is preserved.

Chacko Kurian
President, Complete Health Systems, LC

SELECTING AN MPV
By David Gillman
Nexpay Inc.

The object of this article is to offer information to third-party administrators and other payers of health claims that would help them select an acceptable multidimensional payment vendor (MPV), or at least one that will not increase their risk of doing business. A Multidimensional Payment Vendor is one that provides for the payments of checks, EFT's, virtual payments, and straight through payments. There is only one point of responsibility – one vendor that is responsible for all the payment transactions.

First a little background to establish some credentials when addressing an audience that is mainly made up of Third Party Administrators (TPAs) and payers of health claims. I started out as a third-party administrator in 1980, handling the Walmart stores employee health plan, and I've been either a third-party administrator or licensing claims adjudication and billing software to third-party administrators since 1980. I know what it's like to market administrative services to plans, and I know what it's like to make a mistake and lose a plan. So my goal for this article is to lay down the structure of what I believe to be minimum requirements for a service organization that provides multidimensional payments.

My team created the first virtual payment in the healthcare marketplace in November 2006, when we integrated the loading of a virtual card into our provider remittance and faxed it to the provider. Therefore, I'm not an unbiased contributor as my team and I have been in this business longer than any of the range of other vendors offering virtual payments. It is also my, understandably biased view, that Nexpay is the gold standard in terms of our technology and our knowledge, as well as the provider reach enabled by our provider database which lies at the heart of the value of our system.

Volume of Transactions: Of course you've heard the old cliché, “the three most important things about buying real estate are location, location, location”. In our experience the three most important things to consider in this multidimensional payment strategy is volume, volume, volume. The importance and impact that volume has regarding this payment process cannot be over emphasized. Technology that may work very well at 5000 transactions per day may and probably will be overwhelmed at 25,000 transactions per day. It takes highly automated systems integrated to perform tasks that do not require human intervention to manage large volumes of payments. Our systems have managed large volumes of payments, but we built our systems over a period of seven years through trial and error, testing and rewriting.

Staffing Levels: All new systems, of course, have errors; case in point healthcare.gov. In our experience, a 1% error rate at 5000 transactions per day is 50 problematic payments that have to be touched and corrected. Applying that same error rate to 25,000 transactions per day is 250 payments, 5,500 per month. The multiplier for FTEs to correct problems is a business killer for an MPV. The one you choose should be adequately staffed to deal with problems. To give you a yardstick to measure a MPV’s staffing requirements, it is important to know the staffing level of customer service representatives and their daily volume of payments.  In the early days we found that for every 11 payments we received one phone call. Many of those calls were from providers who were receiving a virtual payment for the first time.

There's no doubt that the marketplace has moved beyond whether or not a provider will accept a virtual payment. Some TPA/Payer prospects, and some virtual payment vendors, believe the virtual payment is a useful tool to drive acceptance of EFT. I don’t necessarily disagree with that statement. However, I believe there will always be a place for virtual payments in the healthcare industry because of the simplicity of payment collection and reconciliation that it offers to that 15 to 20% of the provider base that is not highly, technically equipped. It appears that no matter which side of the argument a TPA/Payer prospect adheres to for the near-term, TPA/payer's are adopting virtual payments as a payment methodology at an increasing rate. With this active marketplace comes the opportunity for an MPV to capture a greater share than the competition. But with greater share comes greater volume; which may be a challenge to any vendor with new technology entering the marketplace. TPA/Payers need to consider volume and scalability of the MPV, especially as these challenges relate to the TPA/Payer’s risk, loss of new business, and loss of existing business.

Scalability: Handling incremental volume requires scalability. We think to reach true scalability; the MPV must have an integrated banking subsystem (IBS), integrated customer service software (CSR), integrated command-and-control scheduler (CCS), an integrated error state tracking system (EST) and document replication software (DRS).  

  • The IBS communicates with, and processes all banking functions from initial payment loads to reissues of same or different payment types. IBS communicates with CCS.
  • CSR gathers all input from providers and payers and communicates with CCS.
  • EST tracks each and every payment through more than 50 edits determining the status of each payment, including payment aging (if this is not automated properly it will result in loss of discounts and violation of prompt pay rules, and subsequent loss of payer/TPA business, even possible litigation) and reports any error state to CCS.
  • CCS initiates all banking functions; including ACH depositing from plans, EFT transactions to providers, positive pay data file transmission, intra-account funding activity, reconciliation, and notification of bank deposits and account balances.
  • CCS, in communication with CSR, EST, and IBS; performs all functions of control and management of funding; payment data normalizing and loading; payment document creation and delivery; account balancing, and reconciliation. It is the “brain” of the system.

The above summarized processes, coupled with multiple FAX servers create the perfect technology infrastructure for healthcare multidimensional payments.

Revenue Generation: One last item; the CCS is the brains, but the provider database is the heart of an MPV system. Over the last seven years we have built a provider database of more than 440,000 providers who have expressed their preferred method of payment and delivery system. Of those 440,000 providers, more than 70% accept virtual payments. If your purpose in working with an MPV is to lower costs AND create revenue make sure you ask the MPV how many providers in their database accept virtual payments or straight through payments. Example, having 900,000 providers in a database that accept EFT, is not going to create revenue through virtual payments.

Simple Workflow: An MPV system is a complex collection of technologies and data working in concert to perform payment creation and delivery. If you choose the right MPV, and I hope this article has provided you a basis for comparison, you should not have to modify your claims system, or your workflows to accomplish adding multidimensional payments to your claims system. The MPV should have a methodology to accept a payment file from your claims system, perform the payment and delivery function, and return a single reconciliation file in a format that your claims system will accept.

David Gillman can be reached at dwgillman@nexpayinc.com

RBS (REGULATORY BUDGET SENTINEL)

OBSTACLES CONTINUE TO EFFECT HEALTH INSURANCE MARKETPLACE
By: Nicola Crean, CHS Marketing Coordinator

On October 1, the new health insurance exchange system was unveiled to the public. Although some challenges were expected to arise during the enrollment period, experts did not anticipate the troubles that would occur within the next month.

Sluggish, and at times faulty, the government’s health insurance website was among the biggest obstacle for users to overcome. Pair that with the public’s uncertainty of the insurance exchanges in general, and many Americans’ frustration with Obamacare, as a whole, continued to rise.

“There’s been nothing normal about this law from the start,” said Larry Levitt, Kaiser Family Foundation’s insurance expert. “There’s been no period of smooth sailing.”

Effects on Insurance Exchange Enrollment

The technology issues have resulted in sluggish enrollment compared to what was originally expected. As of November 2, the HealthCare.gov site reports that 26,794 people have enrolled in coverage options offered through the website. Although the enrollment number is lower then what was predicted, there are still 993,635 individuals who are waiting for the final decision.

States that are operating their own exchanges appear to have more success. There are a total of 14 states that elected to run and manage their own insurance marketplaces. Their websites are separate from the federal site, so they have not experienced the same issues. CTV News reports that these states have had 1.5 million Americans apply for coverage.

“It’s not all doom and good,” Kaiser Family Foundation President Drew Altman said in a Washington Post article. “What this says is that the problems are system problems, not problems with demand or interest.”

Importance of the Youth Enrollment

In order to offset costs, the success of the new plans essentially requires healthy, younger individuals to enroll in the plan. Having a mixture of health individuals along with sick or older enrollees would diversify the plans’ pool of covered Americans.

“There’s general agreement that we need younger and healthier people to offset the costs of sicker people coming into the system,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plan, in a CNN article. “That’s what will add more stability.”

Experts fear that healthier individuals will chose to either pay for lower coverage options or avoid enrolling in any insurance plan. Providing insurance primarily for those who tend to have more chronic illnesses will lead to insurance being forced to raise costs. Having a variation of young, health individuals, in addition to sick or older people, will help to control insurance expenses.

Website can be Bypassed

The federal government is in the process of activating other avenues that people can use to enroll in the exchange’s insurance plans. When the website began to falter, other methods were put in place to avoid slowing the enrollment process.

“With the fixes that we’ve put in place as of this morning, we do believe that the majority of those high-priority fixes for direct enrollment to work have been addressed,” said Julie Batalle, director of the Centers for Medicare and Medicaid Communication Office. “We continue to work with issuers and work through some additional issues.”

In its early stages, President Obama’s insurance marketplace has been scrutinized and continues to overcome several obstacles that occurred almost instantly. As more people become familiar with the exchanges and how it operates, experts agree that there should be rising enrollment numbers.

Enrollment will continue through March 2014, and at that time, the government will be able to provide more demographic and enrollment information. Until then, Americans will continue to face health care decisions when it comes to determining what plan is both affordable and fits their individual needs.

HOLIDAY SEASON TRIGGERS UNHEALTHY HABITS

By: Nicola Crean, CHS Marketing Coordinator

Holiday season is officially here!

This season often includes many festive celebrations with coworkers, family and friends. These social gatherings feature food ranging from home-baked treats to endless buffet lines. Traditionally, the period from Halloween to New Years is considered to be one of the most indulgent times in America.

Many individuals who maintain healthy lifestyles and diets throughout the year struggle to avoid treating themselves to high-calorie meals and sugary treats. Whether it is due to accessibility of treats in the office or the numerous holiday functions that are attended, Americans feel the pressure every holiday season to avoid the season of eating.

“At any time of year, unhealthy temptations in the form of great-tasting, high-calorie foods are readily available,” said Dr. James Hardeman, author of Appears Young than Stated Age – A Doctor’s Secret on the Art of Staying Young. “It is important to realize the health pitfalls of the season and formulate a commonsense plan to deal with them.”

The Center of Disease Control reports that Americans gain an average of one pound during the holiday season. Although this may not seem like much, this study suggests that this weight is hard to lose and can end up contributing to long-term side effects from weight gain.

Workplace Options conducted a poll of employees to determine how they plan to remain on track this holiday season. About 70 percent of respondents report that they will avoid second helpings of food, in addition to indulging in holiday sweets. The same survey found that 21 percent of the individuals had no intention of being conscious of their behavior or eating habits until the New Year.

“Results from our poll show that a majority of the workforce know what is good for their bodies and are aware of the importance of a healthy lifestyle,” said Alan King, president of Workplace Options in a press release from the company. “Taking action is the next step to achieve healthy results, even if it does mean waiting for the New Year to put resolutions in place. It is a good place to start.”

While it may be easier to control what food is available at home, it is difficult to avoid unhealthy snacks and treats in the office, especially at this time of year. Experts recommend bringing in more nutritious snacks that can be shared with others. While it may not be as tempting as the home-made baked good, others will appreciate have this alternative.

An article published on FoxBusiness.com outlined specific ways to be sure to avoid overindulging this holiday season. Here are a few key points to remember this holiday season.

  • Be moderate with food and alcohol consumption.
  • Stick to normal exercise routine.
  • Always eat from a plate, never a bowl or tray of food.
  • Eating a small meal rich in fiber and protein prior to a party helps avoid overeating.
  • Avoid getting second or third servings of food.

 “The worst thing you can do is to throw up your hands and give in,” said Malia Frey, a weight loss expert in About.com, in the FoxBusiness.com article “This will only make the situation worse and make you feel bad about yourself. Accept the weight gain and move forward.”

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