Medicare Open Enrollment Challenges Solved With Advanced Technology


MINNEAPOLIS, Nov. 11, 2013 (GLOBE NEWSWIRE) -- Every year during Medicare's open enrollment, seniors have many coverage options, from Medicare's basic coverage to Medicare Advantage Plans. But Medicare coverage changes may go undetected by providers, leading to delayed or lost revenue.

The ABILITY | EASETM system from ABILITY Network improves providers' revenue cycle management by helping billing and admissions staff easily track eligibility changes. A key feature of ABILITY | EASE is Move Catcher, a report that alerts staff when a beneficiary switches enrollment.

Hebrew Home and Hospital, a small hospital and skilled nursing facility in Connecticut, had frequent eligibility issues related to Medicare as a secondary payer and HMO Advantage Plan changes. The moves were going undetected, resulting in delayed reimbursements and the occasional loss of revenue. Then they implemented ABILITY | EASE to solve this problem.

"Before ABILITY | EASE, we spent a lot of time verifying insurance coverage, and we were still experiencing denials," said Business Manager Theresa Simms. "Our head Medicare biller would research denied or rejected claims and the reasons why, and it was proving costly. We could get stung with even one denial a month being incorrectly billed, then finding out the patient wasn't eligible – we couldn't afford that."

ABILITY | EASE Move Catcher sends alerts if a beneficiary is enrolled in an HMO and changes back to Medicare; if a beneficiary is enrolled in an HMO and changes to another HMO; or if a beneficiary is enrolled in Medicare and moves to an HMO. With Move Catcher, a healthcare provider isn't stuck billing the wrong insurer and waiting longer than necessary for reimbursement because of changed coverage.

"We compared the cost of a new system like ABILITY | EASE against the loss of revenue as a result of incorrect eligibility. This was a no brainer – it paid for itself in two months," Simms noted.

Medicare open enrollment for 2014 runs through Dec. 7, 2013.

ABILITY Network will host a free webinar about Medicare eligibility tracking with
ABILITY | EASE on Thursday, Nov. 14, 2013, from 2 - 2:30 PM Central Time.

ABILITY® Network Inc is a healthcare technology company trusted for over a decade by thousands of hospitals, home health care agencies, hospices, skilled nursing facilities, DME providers and physicians throughout the US. ABILITY provides a broad suite of innovative workflow tools to help manage the administrative complexities of healthcare. Learn more at

CONTACT: Audrey Anderson Media Relations ABILITY Network Inc 612.277.1481

Source:ABILITY Network Inc