medical billing transcription supplier information

LAB/HEX is a complete LIS for independent, commercial, clinics, hospitals and research labs. All routine lab tasks are managed, including order entry, result entry, barcodes, microbiology, cytology, user-definable reports, autofaxing, remote printing and analyzer interfaces, to name a few. Integrated billing, HIS and practice management interfaces are available. Additional options include ad hoc reporting, document scanning, advanced pathology with voice recognition, electronic billing, medical necessity, and reference lab interfaces. All products are robust, stable and flexible, and can easily and readily be adapted to any application and laboratory. Large labs will find maximum growth capabilities -- simply by adding more workstations, analyzers, printer and users. Storage and speed can be increased as needed.

LAB/HEX

HEX Laboratory Systems

Circle 174 or visit www.rsleads.com/301ml-174

Data 24x7, no downtime

Polytech for Windows is a complete LIS designed by laboratorians for laboratorians. Ninety percent of technician work is performed in one screen, so there are no wasted movements. Utilization of the Medlink redundant database topology means no downtime. All data are available all of the time. The laboratory workflow is automated, while streamlining test processing and regulatory compliance. The system is simple, easy, affordable and flexible. ICD-9 coding and advance beneficiary notice (ABN) generation is standard, as are host-query capabilities and ad hoc reporting, along with rules logic. The product interfaces to all major analyzers and medical information systems.

Polytech

Comp Pro Med Inc.

Circle 178 or visit www.rsleads.com/301ml-178

Serving small to high-volume labs

Triple G Systems Group Inc. is a global provider of software for the clinical laboratory, ranging from a single facility to integrated networks spanning multiple facilities and wide geographic areas. The company develops and implements software -- ULTRA, for high-volume distributed lab operations, and NT-based TriWin, serving small to medium-size laboratories -- that automates and integrates laboratory processes in the hospital, clinic and private reference laboratory settings.

ULTRA is a comprehensive LIS for the management and automation of all areas, including identification, tacking and routing of specimens, managing workflow and aggregating test results across sites and platforms. All its modules are fully integrated, allowing users complete access throughout the system.

ULTRA

Triple G Systems

Circle 181 or visit www.rsleads.com/301ml-181

Marketing to physicians

With ClinLab's LIS, lab managers not only have the opportunity to increase the technologist's efficiency, but automate other office functions, as well. A customer overview of the system delineates a variety of benefits. Lost charges can be eliminated and revenue increased. Less time is spent searching through file cabinets and logs. Writing and rewriting patient demographics on sample logs, requisitions, result slips and send-out logs are eradicated. Transcription errors no longer exist. All patient information can be accessed in seconds; and physician and nursing staff can view verified patient results anywhere, anytime. Billing summaries and ICD-9/CPT checks aid with correct billing of tests. LIS reports help ensure correct reimbursement for all lab tests is received on the first submission. Recoding is diminished or completely ended. Workload analysis reports help evaluate efficiency, while utilization analysis helps highlight profitable services. Flexible reporting and faxing capabilities help market lab services to outside physicians.

Ongoing industrywide challenges in the management of healthcare information are acute; some providers, insurers, and practice managers find them overwhelming. In fact, operational difficulties in processing and man aging medical records and billing information have only intensified in the current environment of managed healthcare reimbursement, complex claims processing, and compliance with the Health Insurance Portability and Accountability Act of 1996.

Common Challenges for Providers and Physicians

Today, staff at many healthcare organizations, including medical practices and medical management firms, still manually extract data from complicated explanation of benefits forms. This is an increasingly time-consuming task in the current managed care environment. Rekeying this information into IT systems often introduces clerical errors, especially when staff is working with numerous nonstandard forms from several insurance payers.

The sheer volume of EOB documentation and the need to archive and store documents for several years make document organization, storage, and retrieval expensive and labor intensive. Employees dread having to rum mage in dusty dungeons where paperwork is stored, occupying space that could be used better for other purposes. This document storage and retrieval problem also wastes worker and management hours.

Complicating matters is the fact that HIPAA requires that medical records remain confidential and secure. Unfortunately, as IT managers of visionary healthcare organizations everywhere have discovered, this requirement may collide with their desire to automate operations and coordinate patient information through transparent, practicewide information accessibility.

MaternOhio Takes Action

In the computerized business world, where connectivity is key, software solutions offer interfaces that effectively integrate functions, bringing new operational efficiencies to medical practices and other healthcare organizations. In fact, such automated solutions are increasingly critical in effective healthcare financial management.

The size, mission, and capabilities of Columbus, Ohio based MaternOhio Management Services made it ideal to pilot an innovation involving shared document imaging. The company was founded by ob/gyn physicians to facilitate a cooperative business model along specialty lines. Formed to streamline costs and share administrative support functions, it operates as a physicians' cooperative and allows members to select services according to their specific operational needs. It now serves 200 physicians, 140 of whom are ob/gyns. MaternOhio provides members with business support services such as contract negotiations with suppliers and vendors. In addition, because ob/gyn practitioners are particularly vulnerable to malpractice litigation, MaternOhio developed group risk sharing initiatives with insurers and carriers, and established its own malpractice insurance company.

To this forward-thinking firm, a patient payment and medical records system based on shared document imaging made sense from both operational and financial standpoints. Sharing the image across workstations, with different staff' members authorized to access and work with the imaged and linked documents, made more sense than continuing the all-too-familiar wasteful paper chase. MaternOhio staff hoped to use optical character-reading capacity for aspects of a patient's record other than EOB forms, searching and matching for Social Security numbers and medical records so all components would be cross-referenced, with no information standing alone and all information secure as required under HIPAA.

ALEXANDRIA, Va. -- In a move that could speed the development of a uniform electronic billing standard for pharmacy services, the National Association of Chain Drug Stores has joined the X12 Pharmacy Advisory Panel.

NACDS announced its decision last month, becoming the sixth pharmacy organization to join the panel. The group already includes the American Pharmacists Association, the National Community Pharmacists Association, the American College of Clinical Pharmacy, the American Society of Consultant Pharmacists and the American Society of Health-System Pharmacists.

X12 is an organization accredited by the American National Standards Institute to develop uniform standards for electronic data exchange, including such health insurance claims as professional pharmacy claims. The panel was launched in 2002 to promote a single billing standard for professional pharmacy services, based on the same EDI claims format--known by the unwieldy title of ASC X12N 837--that physicians and all other health care professionals use. Advancing community pharmacy's importance as a provider of services to help manage patients' therapeutic outcomes.

* Integrating pharmacy into national organizations and widely used coding systems that have been developed to allow all other health care providers to document their professional services, and bill payers for those services.

* Supporting compensation for pharmacists' professional services.

NACDS' decision to join has been a while in coming. Mary Ann Wagner, vice president of pharmacy regulatory affairs for NACDS, indicated in an interview late last year that the organization might join the X12 group to boost its chances for developing a single, standardized electronic billing procedure, despite some reservations. Those reservations hinged on fears that X12 could classify certain disease state management services already performed by pharmacists as medical benefits, instead of pharmacy benefits, potentially denying pharmacists the right to bill payers for those services.

However, the expanded effort by the panel to promote pharmacists' therapeutic efforts--and payment for those efforts--was apparently enough to allay NACDS' concerns.

"NACDS has joined the X12 Pharmacy Advisory Panel to help expand chain pharmacies' electronic billing for professional services to all possible health care payers," said Roy Bussewitz, vice president of managed care and telecommunications at NACDS.

In addition, Wagner, Bussewitz and other NACDS staffers likely were reassured by the composition of the chain drug industry leaders who have agreed to serve as the organization's representatives on the X12 panel. All three have developed solid reputations as champions of an expanded role for community pharmacists and of payment for their patient care services. The group includes Anthony Provenzano, manager of clinical programs for Albertsons; Rebecca Chater, group manager of clinical services for, Kerr Drug; and Jean-Venable "Kelly" R. Goode, an associate professor at Virginia Commonwealth University's School of Pharmacy and a shared faculty member with Ukrop's Super Market Pharmacy.

In the complex and tedious world that is health care billing, those who pay the bulk of the bills--insurance carriers and health plans--have always had their hands full managing bill payment to physicians practices and hospitals of all sizes and types.

But with the latest trend--consumer-driven health care--taking center stage in recent years, managing bill payment is growing more, not less, complex--even as simplifying bill payment continues within the industry.

Consumer-directed plans typically mean more choices of health plans and providers, as well as more financial risk, for employees and health care consumers. Simply stated, health care users, typically employees and their dependents, must pay for medical services for a defined amount with dollars in a flexible spending account, a health savings account or a health reimbursement arrangement.

Health savings accounts, for example, can be used by workers to pay for routine medical expenses, which count toward the deductible of accompanying catastrophic health insurance. Ultimately, consumer-driven plans shift more of the responsibility for health-spending choices onto the patient

The challenge is that when you create a new way for providers to be paid, as you do with consumer-driven health care, you create more complexity. Some carriers/payors are turning to technology to ease the pain that comes with managing bills in a consumer-driven world.

PreferredOne, a regional health benefits management company serving 550,000 members in Minnesota, needed to meet that growing demand from employers for consumer-driven health products--and solve the technology challenges that go with it. A relatively new entrant in Minnesota's payor market traditionally dominated by several well-established organizations ranging in size from 700,000 to 1.5 million members, PreferredOne needed an edge.

In January 2003, PreferredOne introduced Consumer Advantage, a defined-contribution plan that combines a high-deductible medical plan with both a health reimbursement arrangement and flexible spending account. Quickly, Consumer Advantage became PreFerredOne's fastest growing health plan product, but the product posed an administrative challenge.

With one system housing medical claims data and a second system storing health reimbursement arrangement or health savings account records, each claim had to be processed at least twice, causing bill payment issues. Labor-intensive and error-prone, the process threatened to offset the product's inherent cost benefits. PreferredOne quickly developed a strategy to improve product administration, using software technology from TriZetto Group, a Newport Beach, Calif., technology provider for health plans and carriers.

Using TriZetto's Facets Extended Enterprise application suite, all of PreferredOne's critical data--claims, HRAs, FSAs and more--are held in one central data repository. The claims are processed in one step, quickly and accurately, says John Hofflander, PreferredOne senior vice president and CIO. With both traditional and consumer-driven plan claims now on a single administrative system, PreferredOne has eliminated the expense and risks of integrating disparate software.

"The key to efficient bill management is having the data in one version and in one place," says Hofflander.

Hofflander explains that the new system also automatically updates information related to health reimbursement arrangement or flexible savings account balances, deductibles, and copayments.

"One of the biggest challenges of administering health reimbursement arrangements and flexible savings accounts is that schedules and criteria for rolling over unused balances vary tremendously by employer," he says. "The upgraded system handles this entire process automatically across all employer groups, eliminating hours of work for PreferredOne employees."

Consumer-directed plans may provide health plans and carriers with tremendous opportunities, but, as was the ease with PreferredOne, it also may involve some real IT challenges, mainly the strain of increasingly complex administration.

Kim LaFontana, director of Collector Services and Payor Relations at Athenahealth, a Waltham, Mass., technology provider that tries to smooth electronic billing and collections between doctors' offices and insurers and health plans, says that the consumer-driven health care movement is indeed making things more complex for both payors and providers. Mainly, the carriers need to know when the consumer or employee has met the deductible, which is the point when the insurance carrier or health care plan needs to make payments to doctors or hospitals.

As many patients know firsthand, surgery is a critical and often lifesaving part of the healthcare delivery system. It is also the financial lifeblood of a hospital--a revenue producer that can't afford to be undermanaged or inefficient. But often, within the confines of operating room suites, underutilization of information technology equates with waste.

Texas Children's Hospital in Houston is a 697-licensed-bed, internationally recognized pediatric hospital in the Texas Medical Center and the largest children's hospital in the U.S. As part of the specialized care that the organization provides, its surgical staff operate 24 hours a day in three different sites, treating patients ranging from newborns to adults. The challenge of managing costs and revenue for this demanding area is formidable, but it's a challenge met by Judy Swanson, R.N., director of perioperative services, who has managed operating rooms (ORs) like Texas Children's for more than 17 years.

Soon after joining Texas Children's Hospital in February 2001, Swanson discovered that an existing perioperative information system in the department needed upgrading. This basic system required a lot of manual data entry and contributed to inefficient workflow and inaccurate data. Because Swanson's team could not generate statistical reports from the system, they had to manually enter information into Excel spreadsheets, which was costly and resource-intensive.

Scheduling was computerized, but intraoperative nursing documentation and inventory control were handled on paper--often with illegible handwriting. Surgeon preference cards were stored in Microsoft Word, so there was no automated method in place to keep these updated and ensure all supplies used in the operating room were recorded.

These shortfalls contributed to an inefficient charging process that was continually at risk for errors and often riddled with them. Nurses documented surgical cases and calculated OR charges manually, in addition to caring for patients. If an implant was omitted from the documentation, this costly supply would be missed on charges, amounting to significant lost revenue for the department.

About 40 percent of patient records sent to billing contained missing or wrong information that needed to be reconciled. Errors might be as significant as the wrong patient name, medical record number or account number, or they might be a simple misspelling. Regardless of the reason, all errors were routinely sent back to the OR department for correction.

Inaccuracies wasted staff time, sent nurses scurrying around trying to correct information and caused reimbursement problems. The department might spend up to 11 days to process a bill for surgical charges, and anything beyond the five-day limit of some managed care companies could lead to a late charge. Perioperative services averaged in excess of $100,000 a month in late charges.

Swanson knew that the department needed a comprehensive business system to address multiple user needs, not just a system to manage preference cards or billing. Department users wanted accurate and complete documentation and a complete record of patient care. She decided to replace their existing surgical software with a comprehensive OR management system that would be good for the hospital's business as well as good for clinicians and clinical documentation.

The hospital began looking for software that would automate all phases of surgical care, from scheduling and supply management to preference cards, nursing documentation and billing. The system also needed to provide easy-to-use data management capabilities and a complete electronic record of the surgical event.

Workflow Meets Automation

The hospital team evaluated all appropriate software systems on the market, and in 2001 they selected CareSuite OR Manager, a perioperative solution from Wakefield, Mass.-based Picis, a company that specializes in automating high-acuity areas of healthcare. They chose this system because they felt it offered the clinical and administrative functions that the hospital needed, electronic record-keeping from preoperative care through surgery to recovery, and complete OR management. The system also interfaced with the hospital's IDX admissions system and offered many different ways to capture and report statistical data without the need for manual data entry.

Swanson's staff set out to fully implement the system, so the organization could use this technology to its fullest. The implementation team examined in detail the functionality of the system and then streamlined organizational processes to maximize the use of its capabilities.