eSolutions- The Medicare Experts


Revenue is what keeps businesses alive. But why is good revenue health especially important for health care? Effective RCM not only helps practitioners maintain financial viability but also allows them to offer the best possible care. However, with rising regulations and payer policies, clinicians spend valuable time chasing account receivables and struggling with denials. It’s estimated that doctors leave billions of dollars on the table every year in the United States alone due to poor RCM practices. While several RCM solution providers emerging in the market fill this void, what healthcare organizations need is an expert.

For two decades, eSolutions has helped providers in markets ranging from hospitals, home health, hospice, health centers, and skilled nursing/long-term care to streamline cumbersome Medicare billing and claims processing. Today, the company has helped over 500,000 providers achieve stronger revenue health and empowered them to focus on what really matters—their patients’ health and well-being. With eSolutions, providers can experience a high ROI in critical RCM areas such as eligibility, claims submission and management, denials and audits, remittance and payment reconciliation, and revenue integrity. In 2019 alone, the company processed more than 340 million claims and 600 million eligibility transactions. “Our products are designed to remove inefficiencies and manual roadblocks to free up not only money but also a significant amount of administrative hours,” begins Gerry McCarthy, CEO of eSolutions.

With a strong understanding of industry challenges and provider needs, recently, the company joined hands with Waystar, a major healthcare payments software provider. Waystar will acquire eSolutions, and the two leaders are set to take Medicare connectivity to brand new heights. Historically, providers had to leverage two different systems, one to handle commercial claims and another to handle Medicare. The acquisition will lead to the first-of-its-kind, single, end-to-end healthcare payments platform to manage both private and government payments.

Our solution is a unique ‘no-touch’ experience thanks to our Medicare connection and expertise. On average, we’re able to recover $3,500 per underpaid claim, which adds up quickly.

Gerry McCarthy, CEO of eSolutions
The Industry Standard for Revenue Health

eSolutions has always been a game-changer in the RCM space. The company has spent years perfecting its products’ spread across the RCM continuum. Their products are designed to easily integrate into other HIT platforms to reduce time to revenue and bring unparalleled transparency into patient and claim data. Additionally, eSolutions offers workflow management tools, paired with actionable data analysis and insights. “Workflow automation and delivering insights to providers at just the right time is the reason we have thousands of clients using our best-in-class products,” says McCarthy.

With sudden changes in regulations and cost of medication in the face of a pandemic, now more than ever, healthcare organizations need to abandon manual, error-prone processes in managing revenue cycles and adopt technologies like artificial intelligence (AI). eSolutions is adept at delivering analytics and decisioning that are invaluable throughout the entire revenue cycle,  offering  Medicare claim insights and remittance advice data from more than half a million providers. Providers can see how they measure against their own KPIs and also how they’re doing compared to colleagues in their region and across the entire country.

Providers that opt for eSolutions are at a distinct advantage when it comes to delivering the right information for action because of the company’s relationship with Medicare, Medicaid, and commercial payers.  “We’re known as the industry’s Medicare experts for a good reason. We are one of a handful of approved CMS Network Service Vendors (NSV) and Health Information Handlers (HIH),” informs McCarthy.

These designations provide eSolutions’ customers direct access to Medicare’s claim adjudication system and Common Working File (CWF), helping them get paid quickly and accurately. As a result, the company delivers more Medicare claim data than anyone else in the market at the time when providers need it to manage suspense claims, rejections, denials and audits. The company also provides all-payer capabilities in the physician and LTPAC markets that assist with the processing and payment for Medicare Advantage claims.

Keeping in mind that Medicare has strict standards and a denial rate up to three times higher than commercial payer claims, eSolutions is laser-focused when it comes to staying up to date on regulatory changes and compliance. Apart from adjusting quickly to new payment models, eSolutions offers comprehensive analytics and insights to help providers proactively prevent denials and detect underpayments. “eSolutions is in a unique position thanks to our CMS Network Service Vendor and Health Information Handler status coupled with proprietary technology that allows us to access data in Medicare’s FISS/DDE,” states McCarthy.

Holistic Approach to RCM

eSolutions was a boon for providers during COVID-19 in more ways than one. The company regularly updates its products to account for critical coding and regulatory updates. To help providers keep up with the sudden overwhelming changes, eSolutions provides clients with necessary education, webinars, and guides, and facilitates expert Q&As with industry leaders. To address the issue of increased costs due to supply needs and the expense of treating COVID-19 patients, eSolutions offers tools to find and recoup every dollar that is rightfully owed to providers. This helps keep financial pressures at bay as providers can identify payment issues in the process or on claims before they are billed and proactively make changes to improve reimbursement chances and time to payment.

eSolutions is also at the forefront of revenue integrity products that find and plug revenue leaks. According to the AHA, hospitals are estimated to lose more than $300 billion collectively due to COVID-19 this year. In such trying times, finding and recovering every last dollar can truly impact survival. eSolutions’ Transfer DRG solution is a proprietary technology that conducts underpayment audits on a hospital’s behalf and helps recover full payment for Transfer DRG claims going back four years. “Our solution is a unique ‘no-touch’ experience thanks to our Medicare connection and expertise. On average, we’re able to recover $3,500 per underpaid claim, which adds up quickly,” mentions McCarthy.

Earned Revenue Gets Paid

It comes as a little surprise that using eSolutions’ Medicare solutions alone, providers generally realize an improvement in payment time of two weeks. “Our Medicare solutions deliver more data quicker than any other solutions on the market,” mentions McCarthy. The immediate benefits harnessed by Community Health Network, a central Indiana-based health system, is the perfect example of eSolutions’ efficiency. With more than 200 sites of care, Community Health Network has used eSolutions’ Medicare Enterprise suite of products to improve A/R days dramatically, decrease Return to Provider (RTP) claims, lessen coding and registration errors, and enjoy faster, accurate Medicare reimbursement. The numbers are impressive: The client witnessed a 49% reduction in claims paid after 60 days, a 70% reduction in outstanding RTPs, and a 67% reduction in RTP percentage. eSolutions made it possible for Community Health Network to get a handle on its cash flow and was able to deliver additional transparency into its Medicare revenue cycle that the reimbursement team couldn’t obtain from relying on their EHR system alone.

McCarthy credits a large part of eSolutions’ success to its employees who are passionate about solving providers’ toughest challenges, and care for them the way they care for their patients. On an ending note, the CEO states, “We’re extremely proud of a 95% client retention rate. Clients come for our technology but stay with us for years and years thanks to the outstanding service we provide them.”

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