Flu Season and CMS Vaccination Ruling Creating Spikes in Medicare and Medicaid Claims

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Thousands of Healthcare Providers Using IVANS Health Information Exchange Platform to Manage Surge in Claims Quickly and Securely

Clare DeNicola, president and CEO of IVANS, Inc., said, "Having the right technology at a provider’s fingertips will not only save significant time and money, it will help deliver preventative care in a more efficient manner to those who need it most."

IVANS, Inc. announced today that its national health information exchange (HIE) platform is helping healthcare providers manage the upcoming spike in claims expected over flu season. In addition to the regular influx of patients requesting flu shots, providers are preparing to handle additional patients due to a new vaccination requirement proposed by the Centers for Medicare and Medicaid Services (CMS). The CMS ruling, which is expected to go into effect during the 2011-2012 influenza season, requires certain providers to offer Medicare and Medicaid patients an annual influenza vaccination. To help healthcare professionals more easily manage the processing of the additional claims expected, IVANS is providing an easy way for customers to get additional access to its LIME HIE platform throughout the flu season.

Clare DeNicola, president and CEO of IVANS, Inc., said, “Providers tell us that they process an enormous amount of Medicare claims during September through December for the flu shot. With CMS anticipating the adoption of the influenza vaccination ruling to begin in early fall, IVANS has been working with thousands of providers to upgrade their technology solutions to support faster claims processing and information sharing so they can manage payments quickly and securely.”

Being able to verify patient eligibility electronically will also be critical when flu season begins, and healthcare providers can use IVANS LIME HIE platform to check Medicare eligibility online at the time of the patient visit. Medicare claims denied because of patient ineligibility are a leading source of uncompensated care. By checking a patient’s Medicare eligibility electronically prior to administering the flu shot, providers eliminate timely phone verification and reduce their Medicare claims denial rates by an average of 50 percent.
Rick Mieses, who is general manager of Medidyne Corp., a medical equipment supplier located in Fairfield, NJ, is familiar with the benefits of using HIE technology to conduct real-time Medicare eligibility verification said, “Using IVANS LIME to check Medicare eligibility is saving us hundreds of dollars we would have incurred from uncompensated care. And, because we are able to perform patient checks directly from our desktop computer, our staff can re-focus their efforts on patient care instead of administrative tasks.”

In a typical year, approximately 5 to 20 percent of the population gets the seasonal flu, resulting in an average of 23,600 flu-related deaths across the United States. For older people, influenza and pneumonia is the seventh leading cause of death and more than 50 percent of flu-related hospitalization occurs in people age 65 or older. While CMS estimates the influenza vaccination ruling will cost $330 million annually, decreased medical care costs will be $710 million and savings in patient time amounts to $170 million.

DeNicola said, “With flu season around the corner, having the right technology at a provider’s fingertips will not only save them significant time and money but, most importantly, it will help them deliver preventative care in a more efficient manner to those who need it most.”

IVANS Inc. provides the property and casualty insurance and healthcare industries with fully managed network, electronic data interchange (EDI) and agency-company interface solutions to help solve complex business issues. Headquartered in Stamford, Conn. and a CMS approved vendor, IVANS serves over 1,000 insurance and healthcare organizations, more than 30,000 independent agents and 500,000 healthcare providers through clearinghouses and direct company relationships. With over 25 years of experience successfully managing networks, the company also offers its clients relentless customer service, security solutions, reliable and accessible technical helpdesk support and expert enablement. IVANS, which was formed by 21 insurance companies, also has offices in Tampa, Fla. and Cincinnati, Ohio. For information, visit http://www.ivans.com.

Cecile M. Locurto


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