Jefferson University Physicians

Client Spotlight: Jefferson University Physicians, Philadelphia, PA

 

Decade-long EMS partnership continues to boost efficiency and outcomes

 “There’s never anything EMS can’t do,” says Ursula Gosnay, Operations Manager for Jefferson University Physicians, part of Jefferson University Health. The multi-specialty physician practice handles over 800,000 patient visits each year in Pennsylvania, New Jersey and Delaware.

 Jefferson has been a client of EMS for about a decade. Gosnay and her team continue to rely on the EMS Healthcare Informatics team for a variety of EDI software, service and custom programming needs. She says the relationship has been integral to day-to-day success for the 630-doctor group, spread between 105 practice sites.

“We began using the EDI Claim Reconciler when our clearinghouse made a formatting change that disrupted the reconciliation process for our 837 and 277 files. We then moved into using the EDI Power Reader, and we were one of the first users of the EDI Power Toolbox. Our billing office continues to rely on the EDI Power Reader each day.”

Since its implementation, Jefferson has had EMS provide several customizations to the EDI Claim Reconciler. One project involved making an add-on for claim edits involving NPI (National Provider Identifier) numbers.

“The Claim Reconciler is almost flawless and has some great features,” she says. “The new reconciliation process has saved us money in lost claims. We’ve been better able to identify claim edits and research our unmatched 277 and 837 files.”

Nick Gilkin is the Supervisor of Lockbox and Reconciliation at Jefferson. He adds that he and his staff are also using the EDI Power Tools Suite in new ways with their Epic system to increase efficiency and dollars generated.

“We can filter Epic files using the Power Reader,” explains Nicholas Gilkin “If we have an issue with a rejection code, I can go in and look at the rejection codes and see how big or small the issue is. I can then cross reference it, pull the outdated codes and replace them before uploading to Epic. It helps ensure we receive payments before the end of a given month, with no lost time or revenue.”

Jefferson Health recently called on EMS to create a way to separate global reimbursements into respective business line remittance files for posting.

“Large organizations like Jefferson often have individual EHR implementations for each business unit (e.g. hospital and physician groups) , even though they are all under one organizational umbrella with one tax-ID,” says Dave Pontrello, VP of EMS. “Payers will then treat these different business units as one single provider and remit payments in one 835 file with a global reimbursement. It makes internal accounting and claims management difficult.”

EMS’s solution creates a new separate 835 remittance file from the original global file that corresponds to the physician group’s part of the whole.

The new separated 835s are then able to be easily uploaded and posted in the group’s separate EPIC installation, in essence mimicking an internal payment from unit-to-unit. All while accurately reflecting the proper claim agings and dispositions and all without manual data entry and/or complicated reconciliations. 

“It allows the organization and its business units to benefit from scale, as well as remittance details and accuracy desired by each unit,” he adds.