medical billing transcription supplier information

Abstract: Here, two nurse executives suggest how to identify nurse-specific outcomes indicators for the cardiac setting.

Q

At our hospital we've taken on a major compliance initiative to ensure appropriate charges and accurate, consistent billing procedures. I've been asked to work on the project team to provide input on RNs' involvement in the compliance activities and to prepare an action plan for nursing's contribution to the effort. What compliance issues do nurses need to watch for?

Denise Ringer, RN, MS, Consultant, Latham, N.Y, responds: The General Accounting Office, the financial auditing arm of Congress, estimates that Medicare and Medicaid fraud cost $27 billion last year. As a result, several initiatives were enacted to help recoup these purported losses.

Hospitals across the country were accused of committing fraud when in fact they had done nothing more than make billing errors. Under the False Claims Act, hospitals incur a minimum mandatory penalty of $5,000 for each lab test that's double-billed, billed but not done, or billed and not ordered. Damages can be astronomical, often forcing hospitals to agree to costly settlements. Hospitalwide compliance programs are essential.

Nurses, like other members of the hospital staff, must know how to avoid these serious offenses and how to report any unresolved concerns. These commonsense measures are important regardless of who pays the hospital bill. Nurses need to work with physicians to ensure that they order and document appropriate tests and procedures. Nurses should clarify with the physician any duplicate orders or orders that ap pear unnecessary. Nurses should also pay special attention to verbal orders and canceled orders in terms of followup.

Another problematic area: hospitals billing patient transfers as discharges. I'm aware of one hospital where the computer automatically defaulted to "routine discharge. Staff not paying careful attention often selected this option when a patient was actually transferred to another facility.

Compliance programs also should include education on pre- and post-practice measures and the chain of command nurses should follow to report suspected areas of abuse.

Anne Woods, RN, MSN, CCRN, CRNP, Critical Care Nurse and Adult Nurse Practitioner, Exton, Pa., answers: Today, clinical nurses at the bedside have a unique opportunity to impact billing practicesmuch more than our counterparts in previous years. As the primary caregivers, nurses serve as gatekeepers for all care and diagnostic tests done on our patients.

Nurses need to check physician orders carefully for accuracy and duplication. It's not uncommon for the attending physician, resident, intern, or medical student to duplicate orders written by another physician simply because she didn't check the chart carefully. Also, when a physician writes an order to confirm a suspected diagnosis, she should clearly state the reason for the test in the progress notes. Third-party payers won't reimburse for diagnostic tests not substantiated in the medical record. The nurse can act as a patient advocate by checking the progress notes for these inclusions.

For laboratory diagnostic blood tests, the most frequently ordered tests for any patient, nurses must know the implications of correctly obtaining specimens. Drawing the wrong tubes of blood or the incorrect amount of blood for a test incurs additional cost. When the laboratory rejects a specimen due to hemolysis or insufficient quantity, the patient and the institution absorb the added cost.

Using the correct test for the differential diagnosis impacts billing compliance as well. Several years ago, patients being ruled out for myocardial infarction routinely underwent a multitude of laboratory tests to verify the diagnosis. Physicians commonly ordered creatine phosphokinase (CPK), CPK with MB indexes, and lactate dehydrogenase with isoenzymes. Today, using a troponin 1 level is much more efficient, accurate, and cost-effective for the institution and the patient. It's the nurse's responsibility to collaborate with the physician to ensure that the patient receives the correct tests.

In the past few years, we've learned of the impact of circadian rhythms on diagnostic tests. Drawing blood at routine times of day can give the clinician an inaccurate picture of the patient status. The physician must then reorder the tests to verify the result. Not only is this procedure uncomfortable for the patient, it incurs unnecessary cost.

By paying close attention to diagnostic tests that are affected by circadian rhythms, the nurse can decrease the frequency of repeating lab studies.

The primary nurse should document all procedures in the medical record. The old saying, "If it wasn't documented, it wasn't done," has never been more true, especially in regard to patient billing practices.

# posted by Medical Information : 3:33 AM  0 Comments

In business since 1997, Odyssey provides electronic-based billing solutions to private medical insurers and private healthcare practices as well as to healthcare operations such as medical equipment providers, rehabilitation centers and small hospitals.

The Letter of Intent contemplates that MDwerks will acquire customer contracts, software, vendor lists and access to a customer service, coding and software contract team, among other assets of Odyssey.

The completion of the transaction is subject to the negotiation and execution of a definitive purchase and sale agreement, as well as due diligence by both parties.

Howard Katz, CEO of MDwerks Inc., said, "Odyssey Healthcare Consultants Inc. has virtual billing capabilities that we believe can help us expand the services and solutions MDwerks offers its clients. Odyssey's infrastructure is scalable, flexible and adaptable, and therefore highly compatible with MDwerks solutions. In addition, Odyssey will enable us to expand our client base and enter new markets. The Odyssey team is experienced in creating medical billing solutions, functionality and services that have the quality MDwerks clients expect, and we look forward to completing this transaction as soon as possible."

Certain statements in this news release may contain forward-looking information within the meaning of Rule 175 under the Securities Act of 1933 and Rule 3b-6 under the Securities Exchange Act of 1934, and are subject to the safe harbor created by those rules. All statements, other than statements of fact, included in this release, including, without limitation, statements regarding potential future plans and objectives of the companies, are forward-looking statements that involve risks and uncertainties. There can be no assurance that such statements will prove to be accurate and actual results and future events could differ materially from those anticipated in such statements. Factors that could cause actual results to differ materially from those in the forward-looking statements include, among other things, the following: general economic and business conditions; competition; unexpected changes in technologies and technological advances; ability to commercialize and manufacture products; results of experimental studies; research and development activities; changes in, or failure to comply with, governmental regulations; and the ability to obtain adequate financing in the future. This information is qualified in its entirety by cautionary statements and risk factors disclosure contained in certain of MDwerks' Securities and Exchange Commission filings available at http://www.sec.gov.

Pursuant to a December 1, 2005 agreement, Consulting For Strategic Growth I, Ltd. ("CFSG") provides MDwerks Inc. with consulting, business advisory, investor relations, public relations and corporate development services, for which CFSG receives a fixed monthly fee for the duration of the agreement. Independent of CFSG's receipt of cash compensation from MDwerks, CFSG may choose to purchase the common stock of MDwerks and thereafter sell those shares at any time it deems appropriate to do so.

# posted by Medical Information : 3:29 AM  0 Comments

Understanding the Current Procedural Terminology system helps enhance compliance and reduce delays in reimbursement.

Health care acronyms are starting to sound like those of politics and government, and the comparison is apt. Among the flurry of abbreviations (Table I) that deserves special attention from laboratories receiving reimbursement from Medicare and Medicaid is CPT, or Current Procedural Terminology.

Now in its fourth edition, the CPT list of over 7,000 five-digit codes--devised by the American Medical Association at the request of the Health Care Financing Administration (HCFA)--provides a useful method for identifying and billing medical services. Laboratory services are identified by the 80000 series.

CPT had its first effects on the clinical laboratory in 1984. As the Federal Prospective Payment System (PPS) was being implemented for inpatient reimbursement, the CPT coding system was being set in motion for outpatient payment.

Under Medicare and Medicaid regulations, the coding system must be used to identify procedures performed for outpatient reimbursement. If not, Medicare is not obligated to pay.

* Hics-Pics. Because some medical procedures had not been given CPT codes, HCFA added additional codes where needed. These Level II codes form HCFA'S Common Procedural Coding System (HCPCS), commonly known as "Hic-Pics." Some states and carriers have created local Level III HCPCS codes to identify services that do not have CPT or HCPCS designations. All such codes consist of five characters and are used by Medicare and/or Medicaid.

[Paragraph]Level I. CPT code. National. Example: CPT 85376, fibrinogen, thrombin with plasma dilution.

[Paragraph]Level II. Alphanumeric code beginning with letters A through V. National. Example: P9012, cryoprecipitate, each unit.

[Paragraph]Level III. Alphanumeric code beginning with letters W through Z. Local. Example: Y8305 (Colorado), platelet neutralization.

HCFA is phrasing out Level III codes as part of its standardization process for reimbursement. To simplify the transition, most carriers and intermediaries that use Level III codes are cross-referencing them to CPT codes.

Prospective payment regulations call for inpatient services to be reimbursed according to allowable fees in diagnosis related groups (DRGs). An anticipated decrease in revenue from Government payers led laboratorians to hope that private payers would fill the void. Some health care professionals worried so much about inpatient reimbursement that they failed to learn enough about CPT coding for outpatient services.

Now we acknowledge the importance of our outpatient market and how CPT coding affects that income. For example, a pro-thrombin time test for an outpatient whose fees are paid through Medicare must be identified as CPT 85610. Regardless of the laboratory's usual fee, reimbursement is a standard amount for all laboratories in a defined geographicl area. In Utah, for example, #85610 brings $5.37.

Laboratory reimbursement for each CPT-coded procedure is listed on a schedule. The amount varies from one Medicare area to another. Payments under Medicaid tend to be slightly lower. In Texas, for example, the Medicaid fee schedule allows 90% of the amounts reimbursed by Medicare.

Regardless of provider status--hospital, independent laboratory, or POL--Medicare and Medicaid reimbursement remain the same. Most laboratories are paid at the 60th percentile of the median of all national fee schedules. An institution will be reimbursed at the 62nd percentile only if it is classified as a rural hospital, has an emergency department, and offers 24-hour laboratory service seven days a week.

In general, all providers are reimbursed identically according to the lowest of the following fees: charge for test, local fee schedule, or national fee schedule. This is true whether or not the provider participates in the Medicare program. The provider must accept assignment for services and cannot bill the patient for any excess.

In 1990, Medicare alalowed a 4.7% increase in scheduled laboratory reimbursements and then capped payment at 93% of the new amounts. For 1991, amounts on the schedule were increased by 2%. The amount allowed, however, will be capped at the 88% level. The 2% increase also applies to 1992 and 1993, for which no cap has yet been announced.

# posted by Medical Information : 3:24 AM  0 Comments

The following scene is a familiar one at healthcare provider

organizations across the country. Staff physicians assemble in a lecture

hall or conference room for what has been described as a "mandatory"

meeting. An administrator calls for attention and begins to speak.

"As you all know," he or she begins, "the Federal government has become

increasingly vigorous in its efforts to crack down on Medicare fraud and

abuse. Even the FBI is involved. Healthcare organizations stand to lose huge

sums in disallowed billings and be liable for even more severe penalties."

The administrator then begins explaining the extreme steps the organization

needs to begin taking to protect itself. "Working with a team of outside

consultants, we have developed a plan that will allow us to maximize

allowable billings while protecting ourselves from problems when we are

audited. Medicare has strict rules for patient care documentation. Each

physician in this room must live up to those rules."

The lights dim and a slide presentation begins. "Let's start with a simple

example. Each patient's history and physical must document a complete review

of systems. If this is incomplete, Medicare will consider the work-up

consistent with a lower level of care than that for which we billed. And the

government labels that fraud." The examples go on and include discharge

summaries, procedure and operative notes, and even daily progress notes. The

severity of illness, amount of patient contact, and documentation required

for each acuity level of billing are presented. At facilities where

residents participate in patient care, the complicated requirements for

attending physician supervision and documentation are discussed.

The meeting lasts two hours. At the end, the administrator sounds a firm

warning: "We cannot risk incurring charges of fraud and having billings

disallowed. So, from now on, we will have a strict system of supervision of

physician compliance. When a physician has a history and physical that is

deficient in required documentation, he or she will receive a warning

letter. Those with three deficiency reports will have their admitting

privileges suspended until they attend a three-hour coding seminar presented

by our consulting firm."

And so goes the physicians' introduction to Medicare billing compliance

programs. I have been part of these kinds of meetings at two different

hospitals. Colleagues report similar experiences at institutions across the

country. The details may be different, but the message of the presentation -

from the physician perspective - can be summarized in one sentence: "Our

organization has a billing compliance problem, and to solve it you doctors

must jump through these additional hoops."

This outcome has obvious drawbacks. Physicians leave the meeting feeling

unfairly singled out and demoralized. With such attitudes, their work often

becomes less efficient. New organizational and management techniques are

greeted with cynicism. Thus, a new system of billing compliance measures -

no matter how necessary or potentially effective - is in trouble from the

start.

What is the solution?

Based on the experiences of several healthcare consultants who have

developed compliance programs and numerous physicians who have had to alter

their practice patterns because of them (as well as my personal experience

on both ends of this issue as a resident physician and a consultant), there

appear to be several physician-related elements critical to successfully

implementing a billing compliance program. These elements include effective

communication, early physician involvement, ease of program implementation,

and opportunities for feedback.

Plan Communication with Physicians Carefully

Some physicians have described their introductions to compliance issues as

an "ambush." They say they felt degraded and patronized by administrators

and consultants. As one surgeon practicing at a community hospital in

Southern California put it, "As if I don't have enough problems with managed

care second-guessing me and limiting my fees, now, all of a sudden, I have

to be lectured on how to do paperwork and penalized if I don't live up to

some vague requirements." Before the compliance program even began, this

physician was alienated.

The first step to cultivating physician buy-in for these programs is not to

simply mandate physician participation, but to educate them on the issues.

Before any meetings, provide physicians with background information and an

agenda. Furnish them with the recent history of Medicare audits to let them

know what the stakes are. Give them time to digest the implications of this

information before they sit for a slide show. If physicians understand the

results of poor billing compliance, they will be more willing to listen and

to take the steps necessary to ensure that compliance occurs. Continue this

process of education as compliance programs go into effect.

# posted by Medical Information : 3:18 AM  0 Comments

As the price of Santa Monica-based health-care giant National Medical Enterprises stock tumbles on the Big Board -- due to allegations of massive billing fraud -- investors are perhaps re-learning a lesson the hard way: Look at top managers and directors of public companies, and the attitudes those selections express.

On July 30, eight major insurance companies filed federal Racketeering Influenced and Corrupt Organizations (RICO) Act charges against NME, alleging the big hospital and psychiatric facilities chain bilked them out of a "substantial portion" of $490 million worth of patient billings.

The insurers charge that NME diagnosed psychiatric patients in such a way as to milk them for insurance payments -- and thus some patients were kept institutionalized when they should have gone home. The accusing insurers, which include such industry giants as Travelers Cos., Massachusetts Mutual and Mutual of Omaha, allege the overcharging reflects a "corporate culture" at NME gone bad.

The $3.98 billion-in-revenues NME denies all the charges, but the company has paid huge fines -- as much as $9 million -- to settle similar charges brought by various states, including Texas. NME did not admit guilt in that settlement, but was ordered by permanent state injunction to change admission procedures.

NME stock is sick; it traded last week in the $14-a-share range, down 37 percent from a $23-a-share 52-week high.

But perhaps NME's bottoming stock price started at the top of NME -- there is plenty to question about the board's make-up, the philosophy that guides selection of board members and the signal both send to NME rank-and-file.

Case in point: A 15-year NME board member is William Banowsky, who in 1986 tipped family and friends on inside information he garnered while a board member at Los Angeles-based retailer Thrifty Corp., then a public company.

Banowsky, as a Thrifty director, learned inside details of the then-pending acquisition of Thrifty by Los Angeles-based utility holding company Pacific Enterprises.

Banowsky quickly passed the news to his close ones -- a blatantly illegal act.

The Securities and Exchange Commission caught wind of Banowsky's tipstering, got $750,000 from him and described his actions as fraud. He signed a consent decree, neither admitting or denying guilt.

Banowsky left the Thrifty board. But NME left him on its board.

What signal does this send to NME employees and senior managers?

"The prevailing view is that you probably don't ask people to stay on boards after they experience those kinds of circumstances because of the potential messages it sends to employees, regulators and shareholders," said Peter Smith King, associate professor at Loyola Marymount University who teaches business ethics.

Added Stan Trilling, head of The Trilling Group in the downtown Los Angeles offices of PaineWebber, "Shareholders and institutions should have asked NME why he (Banowsky) was left on the board. If they didn't get a clear answer, they should have exited the stock."

Another case in point: Two of NME's "outside" directors are A.J. Martinson and Howard Nachtman, doctors who have been retired for 12 and 17 years, respectively. Both are former NME employees.

Yet, as outside directors, they are supposed to represent the interests of shareholders, and keep a sharp eye on Chairman Richard K. Eamer and other management board members.

Of NME's other nine outside directors, two more, James Livingston and Peter de Wetter, are former NME executive vice presidents who worked for Eamer.

Another outside board member, Richard Stever, is former NME senior vice president.

Also on the NME board is Raymond Hay, who became chairman and chief executive of LTV Corp. in 1983, three years before it declared Chapter 11 bankruptcy. Hay now runs his own company.

Another board member, Senior Executive Vice President John Bedrosian, who despite being No. 2 at NME, in the mid-1980s found enough time to become chairman of Valley State Bank. That bank went into federal receivership in 1987.

The outside directors, who also monitor executive pay, have been rewarding to Chairman Eamer.

Although NME stock price has languished for the better part of 10 years -- the stock traded as high $15 a share (adjusted for splits) in 1984, about where it is now -- last year Eamer collected salary and benefits of $17.5 million. About $15.5 million of that was bonuses based on NME's stock performance.

"The overwhelming majority of the (1991) compensation was based on stock options . . . and options are subject to the vagaries of the market," said David Olson, NME spokesman. "Some of those options went back 10 years."

NME is the brainchild of Eamer, who founded the company in 1966, along with Bedrosian and Leonard Cohen, president and chief operating officer.

Eamer's interest in medicine was not scientific or therapeutic; indeed, prior to starting NME he was a lawyer. In 1969, the founding trio took NME public and raised $23 million.

Over the 1960s and 1970s, NME built and acquired numerous hospitals and other health-care facilities, becoming a giant. Fed by a torrent of federal dollars -- the Medicare program for the aged paid health care bills that in previous generations went unpaid -- NME revenues reached $1 billion by 1981.

# posted by Medical Information : 3:16 AM  0 Comments

Did you ever feel trapped in the paperwork created by your doctor, medical laboratory, hospital or other health care provider and your insurance company? Have you been overwhelmed by insurance claim forms for the simple medical expenses of an annual physical checkup? Think of the blizzard of forms that must be handled by family members of those who have serious and ongoing illnesses or major surgeries. That's a group that includes 58 million Americans between the ages of 18 and 64.

Now Quicken, the personal financial software company, has created a simple new product for your computer that will help you track medical bills and insurance claims, giving you control over at least one aspect of your health issues. It's so simple to use that there's no instruction booklet! Just load the disc, or download the software from www.Quicken Medical.com and you're ready to go.

Quicken Medical Expense Manager tells what bills to pay, when to pay them, the correct amount to pay, and even tracks your expenses for potential tax deductions. It will keep you organized so you can contact the insurance company and talk from a position of knowledge and power. It even has sample dispute resolution letters that are automatically filled out with the information from your series of bills.

The program helps you track tax-deductible expenses, including mileage charges for your regular trips to the clinic or hospital. It's a systematic way to keep track of what bills are pending and what has been paid. Ultimately it creates a personal medical history that you can keep for years.

In short, this product holds your hand and guides you through the maze of insurance forms and doctor bills. Until the American health care system gets everything automated and online, this is the closest you'll get. Here's how it works:

Getting organized

Start by entering names of family members. There's a place for you and your children, or elderly parents -- and even a record- keeping category for family pets!

Then, for every medical related expense there's a category: doctor visit, dental visit, hospital services, laboratory services, even recurring medical expenses such as prescriptions or diabetic supplies. You can create your own categories if you have a wide range of medical bills.

Every time you receive either a bill, or one of those complicated insurance forms called an "Explanation of Benefits" (an oxymoron if there ever was one), the program guides you through the paperwork to track the important information and enter it into the program. For example, there are categories for provider, reason, service, co-pay and expected insurance coverage for each bill you receive.

Then you can track the progress of the payment in the box labeled "status." Perhaps this bill is pending with your insurance company. When the final bill arrives and the insurer has made a complete or partial payment, you can refer back to this original record. Then write your check for the balance due, if any, and mark the category "paid."

No longer will you wonder if you already paid the bill, or whether the insurance company has contributed the proper amount. If you disagree with the final bill -- the one you're being asked to pay -- just click and the program will help you write a letter of dispute to the insurer.

Getting control

Knowing what you're supposed to pay -- and when -- is only part of the paperwork problem. It always seems that the insurance company or medical provider has the upper hand when you call for an explanation -- because they have everything organized by date on their computers. Now, you're on an equal basis. Your computer records will give you a sense of power and control over the process.

In the category for each bill, there's a spot to note the date and name of the person with whom you discussed this bill, and there's even a box for billing and medical notes associated with this service.

You can use the "sort" feature to study the bills by date, by family member, by physician -- in any way you can imagine. And it's all done instantly, without shuffling through file folders of paper and getting frustrated.

Yes, you should still organize the paperwork -- dropping it into file folders that you'll want to save. But now, all the important billing information is not only at your fingertips, but organized so that you don't wind up paying the same bill twice-- or getting a letter from a collection agency!

In fact, if you've been handling medical bills by just waiting until that "final notice before collection" becomes your signal that you'd probably better write a check, you'll figure the $49.99 price of this software is well worth it. And that's The Savage Truth.

Terry Savage is a registered investment adviser, and appears weekly on WMAQ-Channel 5's newscasts. Distributed by Creators Syndicate.

# posted by Medical Information : 3:14 AM  0 Comments

UnitedHealth Group, the third-largest HMO in the country, says it has been able to improve the quality of care its member physicians provide by using billing data to track patient care. According to The Wall Street Journal (August 19, 1999:B4), UnitedHealth supports its claim with a recent evaluation of performance of more than 42,000 doctors in 17 states, all participants in one of the HMO's plans. The evaluation shows that those physicians are doing a better job of providing medical care than when the HMO first assessed the situation in 1997.

In this 1997 assessment, UnitedHealth reviewed data for its plans in 4 cities and found inconsistencies in the level of care given to patients. The HMO sent confidential reports of such patients to physicians, who determined if a mistake was made, if the patient did not follow their recommendations, or if the standard treatment was not prescribed for some reason.

For example, if UnitedHealth claims data indicate that a heart attack patient has not been billed for a prescription to beta-blockers--a standard deterrent to recurring heart attacks--the HMO can let the physician know.

The latest UnitedHealth evaluation has indicated marked improvements in a wide range of commonly accepted clinical measures: Among 63,846 diabetic patients in 23 medical plans, doctors gave 76% of the patients a glycated hemoglobin blood test within the past year, up from 71% in 1998. In one case, the HMO informed a physician that 20 female patients had not had mammogram tests for possible breast cancer. The physician followed up, and most of the patients have since gone in for testing.

# posted by Medical Information : 3:12 AM  0 Comments

Medical A/R Solutions provides increased

data management, automated processing and expanded reporting

capabilities for medical billing software

Transworld Systems Inc., a leader in providing profit recovery solutions to the medical industry, today announced the launch of Medical A/R Solutions, an integrated accounts receivable management software solution from GreenFlag Profit Recovery(SM).

The product enhances data management and automates processing capabilities found in medical billing software to simplify the complicated patient account aging process, and identifies and electronically transfers past due accounts to Transworld Systems Inc. for recovery. With Medical A/R Solutions in place, medical practices can enhance their effectiveness recovering slow-paying patient accounts, accelerate reimbursements from insurance companies, and reduce A/R aging.

Interface Reduces Costs, Expands Medical Billing Software Capabilities

The Medical A/R Solutions data management component saves time and FTE costs by automating the accounts receivable review process.

-- Each user is able to establish unique system parameters to identify accounts requiring attention.

-- Residing on a dedicated PC networked to the billing system database, Medical A/R Solutions copies key data files from the main billing system nightly, analyzes the data, and presents the past due self-pay and insurance accounts in an easy-to-use format.

-- Once accounts have been submitted to Transworld Systems, payments, adjustments, and transfers of responsibility are automatically reported.

-- The user has the option to review the past due accounts individually or send all to Transworld Systems automatically.

Medical A/R Solutions: Unique in its field

Medical A/R Solutions combines a unique combination of features unparalleled in its field:

-- Automates analysis and transmission of accounts to dedicated

profit recovery partner, Transworld Systems Inc.

-- Tracks payments, adjustments and transfers of responsibility

-- Expands medical billing software analysis and reporting

capabilities

Successful Pilot Program Catalyst for Expansion

The Medical A/R Solutions successful pilot program has been in place for 12 months. Since its inception in October 2001, 26 clients have been signed, and $2.5MM has been recovered or resolved at an average recovery/resolution rate of 58%.

"Transworld Systems... Medical A/R Solution has saved our billing staff considerable time by automating ... a manual process of printing and faxing patient financial records to Transworld, our patient collections partner... the system has been successful at producing superior results improving our bottom line via increasing revenue and decreasing overhead."

David F. Kirk, Administrator
Intermountain Orthopedics
Boise, Idaho

"Surgery Inc. was introduced to Transworld Systems in July 2001. Since that time, Transworld has collected over $600,000 for our office in delinquent insurance claims...collection cost was a mere 1%! We were the beta test site for their Medical A/R Solutions interface with The Medical Manager (R) system...the results are astounding and the process is totally automated. It is like having three extra full-time employees on staff! I would recommend Transworld and the Medical A/R Solution interface to any practice that wants to cut costs and improve their accounts receivable."

The current Medical A/R Solutions interface is available for The Medical Manager (R) software billing component only. Future plans to include other medical industry standard billing packages are slated for execution in 2003/2004.

# posted by Medical Information : 3:11 AM  0 Comments

Per-Se Technologies (Nasdaq: PSTI), a leading provider of integrated business management outsourcing services, application software and Internet-enabled connectivity for the healthcare industry, today announced that its Physician Services division has signed a contract with Annapolis, Maryland-based Anne Arundel Medical Center (AAMC).

Per-Se's Physician Services division will provide coding, billing and accounts receivable services for 16 radiologists employed by AAMC affiliates, Anne Arundel Diagnostics, Inc. and Shipley's Imaging, LLC, located throughout Anne Arundel and St. George's counties.

"Radiology has long been one of Per-Se's core specialties," said Frank Murphy, president of Per-Se's Physician Services division. "We are confident that our team of radiology experts, proven processes and technologies will improve Anne Arundel's radiology revenues."

"We chose Per-Se because of its front-end expertise, specifically charge capture and coding, and the fact that all of its coders are trained and certified," said David Klingler, director of radiology for AAMC. "With its technological advantages and reporting capabilities, Per-Se will ensure that our doctors receive appropriate payment for each procedure they perform."

Per-Se's Physician Services division is the only national provider of outsourced business management services for hospital-affiliated physician practices. A team of professionals with specialty-specific expertise guides physicians through the business complexities of healthcare, the challenges of compliance and the intricacies of revenue cycle management. Customized services include billing, collections, coding, payer relations, client reporting, fee analysis, compliance and documentation training.

Additional innovative products and services include business intelligence reporting, financial and business management consultation and PerYourHealth.com(sm), a patient Web portal providing online access to billing information.

# posted by Medical Information : 3:07 AM  0 Comments

Physician Micro Systems, Inc. (PMSI), a leader in the development of electronic medical records and practice management systems, today announced the release of its highly anticipated Practice Partner Medical Billing Version 8.0. Medical Billing 8.0 is a Windows-based release of the practice management system, featuring a new user-friendly interface and the addition of many new and enhanced features.

Medical Billing 8.0 unveils a new graphical user interface (GUI) that is fast, flexible and easy to navigate. Many screens are customizable, allowing practices the ability to configure the system to meet their specific needs. This versatility and configurability allows Medical Billing 8.0 to satisfy the requirements of all types and sizes of medical offices.

Medical Billing 8.0 adds a variety of powerful new features including:

-- Seamless Integration: Medical Billing 8.0 provides an unprecedented level of integration with Practice Partner Patient Records and Appointment Scheduler, allowing easy access to any of the applications with just one click. The closely integrated Practice Partner systems also reduce redundant data entry by providing robust sharing of information across the applications. This seamless integration of the Practice Partner software makes installation and setup easier while providing all of the tools necessary to transform any practice into a truly paperless office.

-- Powerful Demographics: Enhanced and customizable demographics fields allow users to effectively manage the complexities of today's families and insurance plans. New demographics capabilities allow practices to store additional information including email addresses, patient photos, insurance cards, unlimited alternative patient IDs, multiple phone numbers, name and address history, phone notes, and patient photos. The system can also automatically dial phone numbers and create emails from within the demographics screens.

-- Improved Account and Patient Lookup: Medical Billing 8.0 makes it easy to find patients and accounts within the system. There are over 20 different ways to lookup patients including account ID, guarantor name or ID, insurance ID, nicknames, former names, alternative patient IDs, sounds-like patient name, and much more.

-- Customizable Ledger: The new fully customizable ledger screens feature a spreadsheet style that allows significantly faster posting than other character-based and graphic-based systems by utilizing 10-key data entry and a functional enter key.

-- Electronic Encounter Form: Using Patient Records or Medical Billing, the fully configurable, on-screen electronic encounter form can be completed by the provider or automatically populated from data entered in the progress note. The billing clerk can then easily review the charges and post them with a single mouse-click, saving time and reducing posting errors.

-- Case Management: New case management functionality allows practices to accurately track referrals, authorizations and cases.

-- HIPAA-Compliant Electronic Claims Submission (ECS): Medical Billing 8.0 uses the new HIPAA-compliant ASC x12 format for electronic claims submission.

-- Powerful Reporting Capabilities: Medical Billing 8.0 provides a full suite of reporting tools, adding new reports such as expected payment analysis, analysis of diagnosis and provider recap reports. A powerful graphic-based report writer is also available and practices can now use Crystal Reports or Microsoft Excel for creating custom reports.

"Practice Partner Medical Billing Version 8.0 represents a tremendous step forward. With the release of a Windows-based practice management solution, we are providing an easy-to-use application that is not only tremendously flexible and powerful but is also fully integrated with Practice Partner Appointment Scheduler and Patient Records to offer practices a complete software solution," said Dr. Andrew Ury, President of PMSI.

About Physician Micro Systems, Inc. (PMSI)

Seattle-based PMSI is a leader in the development and marketing of innovative electronic medical records and practice management products for medical offices and large healthcare enterprises. Founded in 1983 by Andrew Ury, M.D. to provide comprehensive software solutions for office-based physicians, PMSI is one of the pioneers in electronic medical records software. With over 19 years of experience and more than 1,300 offices using Practice Partner software, PMSI has created software products that are finely honed to the real-world needs of physicians, nurses, and office professionals.

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XGear Technologies has released the newest version of its proprietary Practice Management and Billing Software, ClaimGear. Upgrades to the software were designed to further reduce the amount of time required by clients -- medical billing companies, clinics and doctors' offices -- to send and receive patient and financial information to insurance companies and third party administration organizations. In addition, several new features were added to enable tracking and editing of patients' information, claims data and scheduled/canceled appointments.

"We work closely with our clients to determine key industry needs, then adapt and enhance ClaimGear as needed to meet those needs," said Douglas A. Kegler, President and CEO. "We are particularly excited about this release, which we spent months developing and testing, because of the way it enriches the user experience.

"One of the optimum attributes of this upgrade is the 'point and click' usage, which allows a great deal of editorial capacity for the updating of patient's information, as well as a higher navigational speed -- no wasted time going from screen to screen," affirmed Kegler. "The integration of our unique system-wide notes feature means that clients can view and edit information in any screen. Each note entered into the system is stamped with the time, date and username for tracking purposes."

"I just wanted to thank you all so much for all of your hard work! It feels so good to finally be using a software vendor that listens to suggestions to make our day-to-day job a little easier!" said Merilee at NW Professional Billing Services. She went on to say, "I am so excited about the new changes I have seen, and look forward to working with a vendor that will always 'be there' for us billers and make our suggestions happen. Thanks again for everything, and keep up the great work. We certainly appreciate it!"

Another key enhancement to the system is its time-saving Payer address database, a unique feature that allows clients to easily load payer addresses and contact information with easy-to-use search functions. The hours of time previously used for this task will be greatly reduced, allowing for better time allocation.

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After some time in compliance with MTIA's customer-based guidelines and protocols, Acusis has also developed a set of internal principled billing parameters. AcuCount, the Company's solution to straightforward and automated line pricing, has a clearly defined methodology and auditable invoice detail, in line with those principles set forth by MTIA.

Acusis and MTIA are committed to preserving the creativity and diversity in the medical transcription industry. MTIA's Billing Principles are designed with companies like Acusis in mind -- companies who create their own processes but respect the billing fundamentals set forth by an industry-respected organization like MTIA. According to MTIA's Executive Director, Molly Malone, "Our organization is vigilant in promoting best practice billing situations in the medical transcription industry which are clear, fair and understandable to our clients -- the doctors, hospitals and clinics who have a lot at stake and need accurate and reliable service across the board."

"We are fully committed to giving our customers the best service possible," says Acusis President and CEO, David Iwinski, Jr., "whether that is in the way we provide consistent 98% accuracy in a 24-hour turnaround time or less or if it's making sure that our billing methodology is accurate and clearly understandable for all of our customers."

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For more than 12 years, Loida Garcia's physician billing and collections service company, Med Billing Services, was growing and thriving. From its base of two employees and four clients, the company had grown to more than 20 employees, collecting millions of dollars each year for over 30 physicians, physician groups, clinics and other healthcare providers in the Miami area. But, when Garcia looked ahead to the future, she saw the need for changes within her company.

"By all accounts, Med Billing Services was thriving," says Garcia, who has more than 25 years' experience in medical management. "We were doing well financially. Our clients were happy, our employees were happy. But the medical field had changed, as had technology. Doctors were becoming increasingly frustrated by complex business functions -- such as billing, collections, and dealing with insurance carriers and managed care providers -- which took time away from patient care. As a result, they were becoming more and more dependent on us to provide immediate answers to problems, and instant access to information."

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 sought to resolve many of these problems by creating new standards for the electronic storage, management and transmittal of healthcare data. HIPAA requires the use of standardized coding for medical conditions and procedures, as well as the use of standardized electronic transactions between healthcare providers and payers to create a nearly paperless nationwide system. HIPAA mandates that all healthcare providers and payers conform to its transaction standards by October 16, 2003.

In April 2001, Albert Santalo, Ben Sardinas, Francisco H. "Frank" Recio, and Santiago Pique founded Avisena, Inc., to address the implications of HIPAA on healthcare organizations. The four also saw a tremendous opportunity to offer healthcare providers a wide range of services, ranging from the automation of basic front-office functions such as appointment scheduling and payment processing, to support for back-office functions such as billing, collections, and insurance claim follow-up.

Avisena centers on powerful, Web-based, proprietary software called Avisena Practice Manager, and combines it with highly effective support services. Through the use of Practice Manager and its many components, client-physicians are able to easily record and access real-time information regarding daily business activity; avoid entering information that would ultimately result in insurance claim denials; and self-generate reports on demand relating to patient billing, insurance claims, and payments. Offering convenience, safety and HIPAA compliance, all information is stored on a secure, centralized server. Avisena's unique Reimbursement Management System (RMS) enables the company to immediately address claim denials or incorrect or partial payments on a line-item basis, and to keep working until an acceptable response is achieved.

Rounding out Avisena's software and support services are its consulting services and document management services. Avisena professionals are available to consult on a wide range of business issues that will help client companies ensure smooth operations, increase revenues, enroll providers in managed care plans, and maintain HIPAA compliance. Further facilitating this compliance, and providing client companies with easy access to patient information, Avisena can scan existing paper documents, such as medical and financial records, and store them electronically.

Because Loida Garcia's company had focused on providing personalized customer service, much of its work was being performed on the telephone or in an off-line, paper-based manner. Billing claims were sent to insurance carriers by mail and electronically. Rejected claims were analyzed manually. Account status reports were printed out and sent to clients when requested. Med Billing Services and its clients lacked the electronic resources to meet the mandates set forth by HIPAA.

"Certainly, we were in need of an upgrade," says Garcia. "We needed to find an electronic solution that would enable us to more easily submit claims for clients, more quickly collect on those claims, and allow our clients to instantly assess the status of their collections activities. And with the quickly approaching HIPAA deadlines, we knew we had to do something right away.

"But," she adds, "it would have cost hundreds of thousands of dollars to license this technology."

About the same time that Garcia was searching for a solution to her company's problem, Avisena was looking for new opportunities to expand its business. Already providing software and support services to a large number of clients, Avisena had devised a strategy that would enable it to add more clients by acquiring successful medical billing and collections companies. Upon meeting Garcia, the principals became immediately interested in acquiring Med Billing Services, considering it a successful company that would enable Avisena to increase its portfolio of customers.

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Redefining the economics of third party medical billing services, Medical Transcription Billing, Corp. (MTBC) has introduced full-service medical billing for a flat fee of 4% of collections. MTBC is the first company to apply state-of-the-art software and Internet-based technology to medical claims and patient billings, enabling its customers to reap the benefits of improved practice management and increased cash flow at a reduced cost.

Small medical practices now have a compelling solution for outsourcing their in-house billing, which according to the American Medical Association (AMA) costs an average of 10% of the practice's total revenue. Using MTBC's billing services, a typical practice can save tens of thousands of dollars per year in labor, benefits and other employee-related costs, while retaining control over their billing process. Medical practices also receive payments faster as a result of electronic claim submission and filing, and will see a significant reduction in unpaid claims and account aging.

"Billing is at the heart of any medical practice, and prompt collections is the key to its success," said David Rosenblum, President of MTBC. "The medical billing industry is highly fragmented, with local and regional mom-and-pop firms who cannot afford the infrastructure investment necessary to reap the benefits of the latest technology. As a result, these vendors give their customers little or no control over the billing process or reporting. MTBC offers a nationwide service that maximizes the power of the Internet and technology to give medical providers better control over scheduling and billing, 24/7 access to all of their billing information, and comprehensive practice management reports, while reducing costs."

"MTBC's 4% billing service is highly affordable, even for a solo practitioner like me," said Dr. James Brown, M.D., Athens, GA. "Billing was a major source of aggravation in my office, as it cut into the time my staff and I could spend on patient care. Now MTBC handles everything for us and we can devote more of our time to caring for people instead of chasing down payments from insurance companies, government payers and patients."

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Passage of legislation requiring employers to offer health care coverage was not the only important industry bill either gaining passage or going down to defeat.

Sent to Gov. Gray Davis for signature was legislation reforming hospital billing practices, protecting patient-doctor relationships and tightening financial controls on medical groups. Losing were bills strengthening new nurse-to-patient regulations, speeding hospital construction and rolling back cuts in Medi-Cal reimbursements to doctors. Other highlights:

* Legislators turned back a bill sponsored by the California Nurses Association--and opposed by the hospital industry--that would subject hospitals to fines if they did not meet new nurse-to-patient ratios set to go into effect Jan. 1. Nurses said that means the new regulations will lack teeth, but hospital lobbyists contend that they should not be subject to fines given a nursing shortage.

* A bill largely prompted by the Tenet Healthcare Corp. scandal also failed. The legislation would have capped hospital charges for uninsured patients. A weaker measure, which the industry did not oppose, got through. It requires hospitals to clearly post their retail charges for services.

A bill failed that would have lifted a hiring freeze on state hospital building inspectors. Hospitals are under a state mandate to seismically retrofit facilities, but the industry contends that the hiring freeze is slowing construction.

* A pair of bills was passed that will allow some patients to retain their doctors for a limited time even after doctors and health plans end their contractual relationships. The protections, though, only apply to pregnant women, patients with chronic illness and other specified groups.

Medical groups, which have failed by the scores in recent years, also would be subject to tighter financial controls by the Department of Managed Health Care. Under the legislation, the department will issue ratings on the medical groups' financial strengths.

* A last-ditch effort by the California Medical Association to roll back a 5 percent cut in Medi-Cal reimbursement rates died in the waning days of the legislative session.

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