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| How many users can we have on eobResolve? Is there a per-seat license fee? |
| My practice management system already includes a contract management solution. Why would I use your product? |
| How does eobResolve "automatically identify fee schedule underpayments"? Do I still have to maintain the fee schedules? |
| Could the product work with outside billing service agencies and what would be the costs? |
| Does eobResolve provide a good ROI even on high volume, low dollar claims like chest x-rays? |
| How does NHXS know our negotiated fee schedules? |
| Being part of a large hospital system, we already have a system in place to address these issues, isn't this a better solution for small private practices? |
| My PMS has allowed amount fields available that we use to identify underpayments. What added value would eobResolve provide? |
| Pricing based on per provider is really expensive for large groups with a lot of physicians that do not practice full time—will you consider an FTE methodology? |
How many users can we have on eobResolve? Is there a per-seat license fee?
The eobResolve license fee allows for an unlimited number of users. There is no per-seat license fee.
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My practice management system already includes a contract management solution. Why would I use your product?
While most practice management systems (PMS) can load a payor specific fee schedule and compare that to the payor's allowed amount, few if any can also apply clinical edits or pricing rules that involve multiple lines. The average claim consists of 1.7 lines, and 25% of multiple line claims have at least one line allowed at an amount other than the contracted fee schedule amount. This causes the typical PMS to generate a high number of false positive variances. Our system allows a practice to price the claim exactly like the payor would, including an explanation of why each line was priced that way. This eliminates countless hours on the phone with a payor trying to understand each payment.
Even for groups with few commercial contracts, eobResolve is a cost effective way to audit government payors like Medicaid, Medicare and Tricare. Additionally, even for non-contracted plans, eobResolve can identify coding opportunities and even assist with denial management research to better differentiate between a clinical edit and a noncovered service. Finally, many eobResolve users take advantage of the 835 view print solution for secondary claims.
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How does eobResolve "automatically identify fee schedule underpayments"? Do I still have to maintain the fee schedules?
One of the most critical steps in a successful audit is to match the payment to the right contract. This is especially true today with so many payors offering multiple products with different fee schedules. eobResolve takes full advantage of fields in the electronic remittance file in order to greatly improve the accuracy of this matching. This is especially true for the 10%–15% of paid claims from payors that lease networks. NHXS provides industry expertise to physician advocacy organizations regarding ‘silent PPO’ business practices and has written extensively on the subject.
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Could the product work with outside billing service agencies and what would be the costs?
Yes, eobResolve is used by some of the nation’s largest medical billing companies. This is because eobResolve provides a high enough ROI that the billing company does not need to pass the cost onto their clients. This is because NHXS charges a flat fee for unlimited payors and claims.
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Does eobResolve provide a good ROI even on high volume, low dollar claims like chest x-rays?
eobResolve was designed specifically to lower the appeal threshold for physician services. Because eobResolve automatically identifies disputes and generates appeals letters, it now is cost effective to appeal even small dollar underpayments.
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How does NHXS know our negotiated fee schedules?
Government mandated fee schedules (i.e. Medicare, Medicaid, workers compensation, Tricare) are in the public domain and as such are built and maintained by NHXS on behalf of all clients. For commercial health plans, NHXS requires some form of documentation describing the fee schedule in question. Ideally, this would be a copy of the plan agreement describing the reimbursement method, along with an electronic version of the fee schedule if available. We will also accept other forms of documentation and assist our clients in obtaining these materials from the payor.
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Being part of a large hospital system, we already have a system in place to address these issues, isn't this a better solution for small private practices?
While it is true that larger health systems typically have more robust technology and technical expertise to perform payment audits, we believe that eobResolve can more efficiently automate the current work flow for a large organization - especially given its cost. Most systems today still require a fair amount of analyst time to reduce false positives; because of the cost, these audits are performed no more frequently than monthly or quarterly. By contrast, eobResolve completes the denial analysis daily allowing the reimbursement team to focus efforts on recovery, making them more productive. In general, we find that the contract modules offered by top end PMS’s can apply fee schedule and simple pricing and clinical edit rules. However, these have to be customized by the user and rarely can handle complex single or multiple claim edits. eobResolve currently tracks more than a million pricing rules and edits for each payor.
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My PMS has allowed amount fields available that we use to identify underpayments. What added value would eobResolve provide?
While most practice management systems (PMS) can load a payor specific fee schedule and compare that to payment at the line level, few if any can apply clinical edits or pricing rules that involve multiple lines. Our system allows a practice to price the claim exactly as the payor would, including an explanation of why each line was priced that way. This eliminates countless hours on the phone with a payor trying to understand each payment. To reduce rework associated with false positive payments, an audit system must be able to mimic the logic used by payors to price a claim. Best of all, the customization of payor specific rules is done for you by NHXS.
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Pricing based on per provider is really expensive for large groups with a lot of physicians that do not practice full time—will you consider an FTE methodology?
We are willing to price our services based on an equivalent FTE methodology. In fact, we currently have large clients today who’s fees are based on an FTE methodology.
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