Healthcare providers - Testimonials and Use Cases

• Provider offices can see reduced staff wait time and volume of documents faxed to them because the information is found in the the eHIP Clinical Viewer.
• Medical record coordinators save time by using etHIP, which reduces the number of information requests they make to other health care providers.
• Tumor registries are able to gather longitudinal information on cancer survivors using eHIP to find records from the patient’s care team.
• Assistance with Insurance Verification – Many patents have a Medicare Replacement plan rather than Medicare, even though they still hold a Medicare card.  Medicare allows 180 days for filing a claim while many of the replacement plans do not have this time allowance.  If Medicare denies a claim due to the patient being covered under a Medicare replacement plan and the office has to refile the claim with another insurance company, denial of payment due to lack of timely filing is possible. The eHIP Clinical Viewer contains insurance information collected from the patient by providers across the community, providing assistance in determining current insurance coverage.
• Assistance with Pre-Authorization – Many procedures (such as joint replacement) require multiple diagnostic or preventative tests and treatments such as physical therapy, medication therapy, and more. etHIN provides a means to gather this information to make the pre-authorization process easier versus relying on the physician’s office to provide the documentation.
• Prevention of Duplication of Services – For many CPT codes, there are usage requirements (such as only one procedure per six months or only three procedures available per indication).  If the patient has Medicare or another insurance that does not require pre-certification, the office can use etHIN to find out if the patient had additional studies during the timeframe which would result in non-payment for both technical and professional services.
  • If one MRI of a lower extremity (ankle, knee) is done per month that is a duplication within the allotted CMS time frame, the annual reimbursement lost would be $2,868.00. The reimbursement for that type of MRI is $239.00.
• Verification of Insurance to prevent denials due to lack of timely filing – Access to etHIN allows you to review the patient’s insurance (i.e., Medicare vs. a Medicare replacement plan) to ensure claims are filed in a timely manner. If this prevents one visit (99203) from being denied each month, you can prevent an annual loss of $1,365.00.
• Access to Patient Information – Additional access to patient information can determine the level of E&M (evaluation and management) service needed to be performed. The ability to perform and charge for 99203 instead of a 99202 would result in an additional $39.78 per patient.

• Billing services are able to look up patient insurance information in order to submit clean, timely claims for insurance reimbursement.
• Hospital Revenue Integrity Department is able to gather documents and other information required for reimbursement purposes.
• Provider offices are able to determine the dates of previous studies performed on patients to prevent duplication of tests or providing services that are not reimbursable (i.e., MRIs within the six-month period are not payable by Medicare).
• As many of the ICD-10 codes incorporate multiple conditions (such as pregnancy and epilepsy or diabetes and neuropathy), eHIP will provide the coder with the necessary information to determine the patient’s appropriate diagnostic code.
• Coding Assistance Examples
  • etHIN provides the user with the ability to see previous ICD-9 and 10 coding, which will assist in coding co-morbidities or determining if a patient has a chronic or acute condition.
  • Anesthesia coding – etHIN provides the patient’s history and current illness to determine the physical modifier (P1-P6).
  • E&M Coding – etHIN can help a physician support the level of E&M coding due to the history, previous studies and physician notes that are found within eHIP.
  • Critical Care Coding – CMS has recommended HIEs such as etHIN as a way to meet the requirement for the new Critical Care Management codes. HIEs can provide the physician with the information necessary to facilitate management of the patient’s care.
  • Post-Procedural Coding – For any modalities performed after surgery (such as physical therapy), etHIN can provide the facility with the operative note to ensure that ICD-10 coding is consistent, helping to ensure payment.
• Coding Reimbursement Examples
  • Prevention of duplication of services, resulting in non-payment to your facility – If one MRI of a lower extremity (ankle, knee) is duplicated each month within the allotted CMS time frame, the annual reimbursement lost will be $2,872.00.  The reimbursement for that type of MRI is $239.00.
  • Verification of Insurance to prevent denials due to lack of timely filing. etHIN provides the ability to view the patient’s insurance (i.e., Medicare vs. a Medicare replacement plan) to ensure claims are filed in a timely manner.  If this prevents one visit (99203) from being denied each month, this prevents an estimated annual loss of $1,365.00.
  • Access to Patient Information – Additional access to patient information can determine the level of E&M (evaluation and management) service needed to be performed.  The ability to perform and charge for 99203 instead of 99202 would result in an additional $39.69 per patient.

• Care coordinators are able to use etHIN to see a consolidated community-wide view of patient medical records to determine gaps in care.
• Care coordination departments receive daily report providing information on their patients who had a hospital visit during the previous 24-hour period, enabling timely scheduling of follow up appointments.
• Medical record coordinators are able to find needed information in etHIN and reduce the number of information requests made to other providers in the local health care community.

• Hospice/Home Health entity is able to find patient demographic information, medications, and admits/discharges in the eHIP Clinical Viewer, which aid in providing in-home care. They also use eHIP to find insurance information for billing services.
• Home Health entity receives alerts from etHIN, notifying it of patient hospital events to assist with patient scheduling and in-home follow up.
• Long-term care entity is able to review cross-community medical data in eHIP at the time a referral is received rather than when the patient arrives at the facility.
• Long-term care facility is able to receive patient care documents directly from the hospital using Direct secure messaging rather than waiting to receive faxes, which can delay patient intake
• Long-term care facilities use eHIP to able to gather a more detailed, complete medical history on patients suffering from dementia and other diseases.

• Public Health entities receive daily reports from etHIN to assist with Birth Defects and other public health tracking efforts.
• Public Health entities utilize the eHIP Clinical Viewer to gather communicable disease information and other information needed for public health tracking.
• Syndromic Surveillance information is electronically submitted to the TN Department of Health by etHIN, reducing the manual data entry burden on the data source.
• Immunization data is electronically submitted to TennIIS by etHIN, reducing the manual data entry burden on the data source.

• Direct secure messaging is used by medical providers to send referrals to specialists with clinical documentation attached to the message, reducing time spent faxing.
• Referral coordinators use the etHIN Clinical Viewer to view community-wide medical records of new referrals received by the practice prior to first appointment.
• Long term care facility is able to receive patient care documents from hospital using Direct Secure Messaging rather than waiting to receive faxes, which can delay patient intake.

• Physician practices are able to quickly obtain lab reports and images performed at facilities and participating laboratories using eHIP Clinical Viewer. Before eHIP, the patient often had to be rescheduled because they could not get the results prior to the patient’s visit.
• In-patient addiction facilities are able to locate medical information of patients  suffering from withdrawals using eHIP, allowing appropriate medical care to be provided.
• Emergency Department personnel is able to view consolidated community-wide medical information from etHIN inside their own EHR system by utilizing etHIN’s Single Sign-On (SSO). SSO eliminates the need for logging into the eHIP Clinical Viewer separately, saving precious time in emergencies. Crucial data from etHIN is available inside the hospital EHR when patients are unable to respond or do not recall medication, allergy or other details.
• A rehab facility without an EHR system is able to send discharge summaries to etHIN via Direct Secure Messaging in order to share data with other etHIN participants.
• Rural physician offices are able to view patient reports from a specialist who treated the patient, supporting the referring physician in providing appropriate follow-up care.
• Behavioral health specialists are able to determine their patient’s medical conditions and medications prescribed by other care team members of the patient using the eHIP Clinical Viewer.  
• Pharmacies can see a patient’s medications in eHIP and check for drug interactions and adverse effects after the patient is discharged from a hospital or other provider setting.  
• Physician offices are able to review and study diagnostic test results performed at a hospital or another provider setting by using etHIN’s Clinical Viewer prior to the patient’s office visit.   This prevents rescheduling a patient’s office visit because the physician did not obtain the results in a timely fashion. 
• Hospital pre-admission testing (PAT) departments can identify and review the screening results performed inside their own EHR system because the hospital utilizes Single Sign-On (SSO) integration with etHIN. Having this information from etHIN helps eliminate test duplication, efficient surgical and in-patient service visits, and improve patient satisfaction.
• Rural physician offices are able to see patient records from multiple hospitals and providers using the eHIP Clinical Viewer. This especially assists when treating patients who are unsure about other providers or facilities they visited and treatments/tests potentially performed by other providers.

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