Medical Coding and Compliance Solutions, LLC (MCCS), the software division of PMIC, announced a new software product to help medical providers comply with the National Correct Coding Initiative (NCCI) requirements. The program includes over 250,000 edits designed to prevent “unbundling” in the selection of medical procedure codes.

Medical services and procedures are reported to Medicare and other third party payers with CPT or HCPCS codes that describe the services performed. Correct coding requires reporting a group of procedures with the appropriate comprehensive code. “Unbundling” occurs when multiple procedure codes are billed for a group of procedures that are covered by a single comprehensive code.

Two types of practices lead to unbundling. The first is unintentional and results from a misunderstanding of coding. The second is intentional and is used by providers to manipulate coding in order to maximize payment. The first causes claim denials and reduced payment to providers. The second is a form of insurance fraud and costs taxpayers money due to exaggerated claim payments.

NCCI Platinum, a PC based software program, includes all of the official CPT and HCPCS code sets linked to over 250,000 NCCI edits. The software is updated quarterly as new NCCI edits are released by CMS. PMIC is featuring NCCI Platinum in its new catalog of coding and compliance products and the American Medical Association (AMA) is including the product in its new catalog of 2005 coding products.

PMIC has been the nation’s leading independent publisher of medical coding and compliance books and software since 1986. The company is known for innovation, quality and excellent service. The company’s best-selling Coder’s Choice line of CPT, ICD-9-CM and HCPCS coding products are used by over 100,000 health care professionals.

About MCCS

MCCS, a division of PMIC, is a developer of electronic coding solutions for the health care industry. The company’s best-selling Flash Code product was rated the #1 electronic coding software by Medical Software Reviews.

CREATIVE COMPUTER APPLICATIONS, INC., (CCA) (AMEX- CAP) a provider of Clinical Information Systems for hospitals, reference laboratories and multi-specialty clinic based laboratories, pharmacies and radiology departments announced today has entered into a licensing agreement with CareMedic Systems, Inc. to provide LMRP data and compliance validation software for multi-specialty clinic, commercial laboratory and imaging center, hospital and billing office environments.

CareMedic Systems, Inc., headquartered in Des Moines, Iowa, is the leader in Medicare Reimbursement Automation. CareMedic provides a compliance program supported by software that allows a hospital to validate if Medicare outpatient tests are medically necessary, at all points of entry to a health system CareMedic’s LMRP data has also been integrated into the CyberLAB II(R) and CyberRAD(R) order process. Before all tests are sent to Medicare, CareMedic’s hospital billing office Safety Net reviews all claims prior to submission to again validate Medicare medical necessity. If the hospital has the on-line option in the billing office, CareMedic will validate Mammograms and Pap Smear dates of service against the Medicare Common Working File (CWF) prior to submission.

“This is a wonderful opportunity for both CCA and our clients”, said Jack Murray, CCA Vice President of Sales and Business Development. “While Medical Necessity Validation was an important step in the process of controlling costs through the reduction of inappropriate testing, MNV just didn’t go far enough. With LMRP our clients can complete the functionality to really manage the process from start to finish.”

This relationship will provide CCA’s CyberLAB II(R) and CyberRAD(R) clients with the most advanced, integrated and cost effective LMRP compliance program available. There is not another LIS or RIS vendor today who can deliver a more complete solution,” said Michael Vasquez, President of CareMedic.

CCA designs, develops, implements, and services clinical information systems for the healthcare industry. The company offers solutions for laboratory, pharmacy, radiology, and other clinical areas. In addition, CCA offers an array of operational, reporting and Internet connectivity solutions.

A Bellevue, Wash.-based diagnostic imaging provider has bought InStar Systems International, a Colorado Springs developer of software for radiology departments and imaging centers.

The deal closed Thursday. Terms weren’t disclosed.

“InStar is focused primarily on servicing the small hospital and freestanding imaging center marketplace. No one else is doing that,” said John Wellbank, who was appointed chief executive officer of InStar, which builds software for scheduling, monitoring, tracking and billing patients.

InStar was acquired by National Medical Development Inc., which owns several imaging centers. National also owns a company that bankrolls acquisitions and a company that provides billing services to medical clients.

“So the advantage of having InStar in the portfolio is … now we have arms in owning imaging centers, managing imaging centers, managing the billing for imaging centers and supplying the software that imaging centers require,” Wellbank said.

Patient diagnostic imaging centers typically provide MRI, CT, ultrasound and X-ray services.

InStar has 10 employees, half of whom are software engineers. The others are in sales and service.

The company expects to double or triple its work force in the next three years.

Its offices are on the third floor of the Alamo Building in downtown Colorado Springs. InStar is looking for a larger location in the city, Wellbank said.

The small hospital, standalone imaging center business is the fastest-growing part of the imaging marketplace, he said, noting there are 5,000 imaging centers and 1,500 small hospitals in the country.

The United States spends more on healthcare than any other country, but lags behind many European countries in deploying healthcare information technology (HIT) systems that improve the quality of care and enhance efficiency. In fact, we are at least 10 years behind many European countries in adopting HIT. Other countries have widely accepted the idea that HIT can lower overall health spending and improve outcomes, a much broader view of their return on investment (ROI) than is accepted within the U.S.

The United States can benefit greatly from other countries’ successes and failures in their ongoing efforts to implement HIT systems with government oversight and support. As early as 1993, Germany started developing a national HIT network. Canada Health Infoway plans to have electronic health records (EHR) for hall the population by the end of 2009. The UK has established the National Programme for IT, the most comprehensive HIT system under development. It includes an integrated care record service, an electronic appointment system and an electronic prescription transmission service that will be accessible to all major healthcare providers by 2014.

Follow the Leaders

In sharp contrast, the United States does not have a mandated system for storing, sharing and exchanging HIT. Instead, it has a tangled and fragmented web of information that is housed in separate silos. Even within a hospital, information cannot be easily shared or accessed between departmental systems. With no common language or infrastructure, inefficiency reigns. As seen in European HIT initiatives, promoting the use of common terminologies nationwide reduces medical errors, lowers costs and improves outcomes.

Historically, U.S. healthcare organizations have under-invested in technology; IT resources often were relegated to billing, not to addressing broader clinical benefits. Also historically, allocation of gross revenues for healthcare IT was only 50 percent of what other information-intensive industries invested. It’s encouraging that we are beginning to see healthy investments in clinically oriented technology that is more portable, accessible and reliable.

The U.S. government needs to follow European governments’ examples in demonstrating strong leadership to drive national healthcare technology initiatives that will foster greater efficiency and higher quality patient care. In particularly, the government must set the criteria for standards and performance, then fund the necessary infrastructure to eliminate entrenched information silos and allow information to flow. By implementing a linked system of information, the United States can benefit from overall savings, better clinical outcomes, and a healthier population. This is particularly important as people age and must rely on multiple healthcare providers to treat a variety of chronic conditions and diseases.

Even with a single-payer system, Australia, Canada, Germany, Norway and the UK all began their HIT with fragmented and incremental processes that lacked interoperability. They realized the need for a national standard and mandates to move forward. Governments also are using public funds as incentives to get more providers onboard with applying HIT. Now, President Bush is trying to encourage the industry to move in the right direction, while European countries already have received their marching orders.

We need to prepare our systems for future levels of interoperability and communication. The U.S. Department of Health and Human Services (HHS) has already taken important first steps by creating the American Health Information Community to develop common standards and interoperability while ensuring privacy and confidentiality. At the request of HHS, Health Level Seven interoperability standards are being adopted for clinical and administrative data on various computers to communicate while preserving meaning. HHS also has signed a licensed agreement to provide the SNOMED CT (Systemized Nomenclature of Medicine Clinical Terms) across the country.

Recent mandates require that government purchases should help speed the adoption of HIT. President Bush’s health information technology plan is an important part of his overall healthcare agency to make America’s healthcare safer, more accessible and more affordable. The President has ordered the development of an EHR for every citizen by 2014 and created the Office of the National Coordinator to drive the effort and create a nationwide health information network.

Unfortunately, as of the end of September, legislation (HR 4157 and S 1418) promoting the implementation of HIT is stalled. Hopefully, the House and Senate can reconcile their differences and pass a bill that will accelerate the use of HIT to improve efficiency, enhance patient care, reduce medical errors and provide greater security. We need to get things moving.

Estimating Total Cost

How much is it going to cost? Patient safety and IT expert Rainu Kaushal, M.D., M.P.H., an instructor at Harvard Medical School and a staff physician at Brigham and Women’s Hospital, Children’s Hospital and Massachusetts General Hospital, predicts that the largest costs in establishing a national HIT network in the United States within five years will be $103 billion in capital costs and $53 billion in interoperability costs. U.S. hospitals are expected to incur the highest functionality costs ($51 billion), followed by skilled nursing facilities ($31 billion), and office practices ($18 billion). However, projections should be viewed with some skepticism. Other countries initially underestimated the cost for HIT implementation; we should learn from their miscalculations.

Today’s computerized practice management (PM) and claims coding systems revolutionized healthcare. Though much of the claims process is electronic, the coding and input of patient data is still a highly manual process. For those occupying such positions, repetitive-motion injuries can be the result. When a Calif.-based community health clinic purchased an automated charge capture and coding solution to help protect staffers from repetitive-motion injuries, it was stunned by a substantial and unforeseen benefit.

Livingston Medical Group is a non-profit community clinic in Livingston, Calif., that provides comprehensive ambulatory, educational and preventive health services using a fee-for-service reimbursement method. Livingston has the equivalent of nine full-time providers, including physicians, physician assistants and nurse practitioners. Prior to January 2006, we used the equivalent of two and a hall full-time employees to manually key in charges for the services provided by our clinical staff.

Problem

The sheer amount of data that passed through the hands of our billing staff on a daily basis was staggering, and as a result, we became concerned about staff members possibly sustaining repetitive-motion injuries. For that reason, we considered purchasing automated charge capture software.

We assumed our providers were probably undercoding some charges, and we knew this type of software could help eliminate missed charges, ensure coding accuracy and reduce our audit exposure. But this was not the primary motivation behind our decision to purchase the software. Our intent was much more basic. We simply wanted to eliminate the process of manually keying charges and help our staff avoid injuries.

Solution

Once we decided to purchase a charge capture and code-editing system, the search for the specific product was brief and easy. We did not evaluate a long list of vendors or schedule multiple demonstrations. We knew we wanted to purchase the CodeScan Scanning Edition through Columbia, S.C.-based Companion Technologies–a company with whom we were already familiar.

Companion Technologies has a reseller agreement with the product’s developer (White Plume Technologies of Birmingham, Ala.) to offer CodeScan as an integrated charge capture and coding module for its PM system. Our primary requirement was that it integrates seamlessly with our PM system and its accounts receivable module.

We knew Companion Technologies’ PM system implemented well with other software, having successfully integrated it with other systems in the past, including software that checked patients’ insurance eligibility. Further, a nearby community health center in our 13-clinic consortium, Golden Valley Health Centers, had integrated CodeScan with its Companion Technologies PM system, and highly recommended it.

Installation, Implementation and Training

Companion Technologies installed their CodeScan interface on our server, and the systems worked together flawlessly. With CodeScan, we replaced our traditional encounter forms with Scantron “scannable” encounter forms. The new forms were developed specifically for our practice and offer our providers more diagnosis codes, procedure codes and modifiers from which to choose. We also receive quarterly updates to the CodeScan product to ensure coding accuracy and compliance with the latest regulations.

We anticipated this would result in more accurate coding and a slight reduction in missed charges, bur again, this was not our primary concern.

We were successful in accomplishing staff buy-in by keeping everyone informed throughout the process and inviting every staff member to provide input. Design of the Scantron encounter forms, for example, was a collaborative effort.

After we installed the CodeScan software on our billing office PCs and added the CodeScan interface to our PM system, a White Plume representative provided CodeScan training to all of our providers and billing staff during the installation process. I attended the training sessions, and we all participated in follow-up meetings to ensure that everyone knew exactly how to use the system before we went live.

Hardware and Components

Hardware requirements for implementing the CodeScan solution were limited to a Scantron scanner and a Kyocera FS-9520DN printer. The scanner was included in the quote from Companion Technologies, and we leased the printer.

The printer is fairly large, as it utilizes various trays required by the different types of encounter forms, as well as nine different output trays representing our various check-in windows. Prior to an encounter, a form is printed and handed over to the provider. Several fields are already populated at that point, including the patient’s name, encounter type, insurance information and other data. The provider completes the form by checking off boxes during, or immediately following, the encounter.

CodeScan also is available in a Tablet Edition, which allows providers to record charges electronically on a tablet or desktop PC, instead of paper forms. However, we chose the Scanning Edition.

ATS Medical Services, in Rockford, Ill., signed a contract with Digitech Computer Inc. for billing services on ambulance transports, including dispatch software and billing and collections services.

To succeed in healthcare, new technology must prove itself not only to users, but also to those who pay for it.

“A new technology cannot displace an established technology–with its installed base of plants, equipment, training, personnel, and satisfied customers–unless the innovation is about ten times more cost-effective than its predecessor.”

–Peter Drucker

One new technology that shows potential for cost effectiveness in healthcare billing is natural language processing (NLP).

NLP software extracts facts, such as ICD-9 codes, from narrative text that is typically created by transcriptionists working from physician dictation. The results of several formative studies suggest that NLP can improve medical record coding productivity and consistency without sacrificing quality. In fact, commercial NLP products for radiology and emergency medicine are now being sold. But whether the technology works as promised is only part of what is required for commercial success in a mainstream market.

Other factors that will play a role in the rate of adoption and the staying power of NLP include:
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* How does NLP affect workflow?

* What mode of clinical data capture (unstructured text or structured/coded) will emerge as most desired by clinicians?

* Are other supporting technologies required for mainstream adoption?

* Can NLP fit into existing healthcare information technology legacy environments without requiring significant human re-engineering and/or costs?

* Is there a natural buyer?

* Will NLP increase revenue or reduce cost? By how much?

* Does NLP address healthcare executives’ high priorities?

Three vendors–A-Life Medical, CodeRyte and Paradigm–have made significant investments in NLP software designed to automate various aspects of medical record coding from narrative text. A-Life began in 1996 with an ICD-9 and CPT-4 coding product for emergency medicine and in 2000 expanded its scope to radiology. CodeRyte started in mid-1999, aggressively built an autocoding ICD-9 and CPT-4 product for radiology and has already expanded into cardiology. Paradigm’s NLP software, built over a number of years, identifies ICD-9 diagnosis and procedure codes from dictated/transcribed inpatient charts.

NLP and workflow

Since NLP products for radiology and emergency medicine are now emerging in the early adopter market, NLP’s end-to-end impact on workflow and workload will soon be apparent. 3M sponsored studies of products from three NLP companies conducted in “laboratory” settings that have demonstrated 30 percent to 50 percent improvement in coder-productivity, reduction in workload reflected in the number of charts that can be coded without human intervention (40 percent to 65 percent), and improved inter-coder consistency with no reduction in coding accuracy. However, what these “laboratory” studies do not tell us is what the environmental, workflow and integration affects of NLP will be in a variety of healthcare settings, factors that will influence the rate of the adoption.

NLP radiology clients of A-Life Medical and CodeRyte are beginning to realize significant workload reductions through NLP batch processing. NLP customers electronically ship their dictated/transcribed ASCII records to the remote service centers where their charts are coded overnight and returned ready to be shipped to third-party payors. Charts that can’t be “autocoded” by NLP software are flagged by the system for human review.

Clinical Data Capture

Among those who study the potential of NLP as an autocoding or coding-assist tool for billing, debate exists over the size of the market opportunity, in light of the variation in prerequisite use of dictation/ transcription.

In acute care markets, transcription services may actually be on the rise with transcribed documents representing a small but important percent of the total patient chart. Physician dictation and transcription services are heavily used in many hospitals for pathology, operative, history and physical exam reports as well as discharge summaries. Radiology and emergency medicine are also heavy transcription users.

But in other areas of medicine such as physician offices and clinic settings, handwritten notes are still the norm. In an October 1999 Harris poll, physicians were found to document in the following ways (frequencies):

* Handwritten notes (54.2 percent)

* Dictation/transcription (31.1 percent)

* Speech systems (4.4 percent)

* Computer keyboard (4.3 percent)

* Handheld devices, like PalmPilot (0.2 percent)

* Mixture of other (5.8 percent)

A major assumption made by those investing in NLP is that, in spite of the high cost of transcription services, “free text” or ASCII is not going away and may be on the rise.

Supporting Technologies

Automated transcription of continuous speech has yet to deliver on its promise, but may eventually be a big market driver for NLP by eliminating transcription costs. Without automated speech recognition, NLP vendors will be pinning their hopes on physician preference to talk versus type and that the demand for that preference will outweigh the cost of transcription services (about $10,000 per year per physician at many hospitals). For institutions already absorbing the cost of transcription, NLP software costs may seem relatively small compared to the benefit. Yet the sales process for NLP vendors to institutions accustomed to either handwritten or template-based clinical documentation will likely be more difficult.

The Medical Group Management Association (MGMA) traditionally provides an exhibit hall at makes others pale in comparison. This year, Oct. 3-6 in beautiful San Francisco, MGMA offers three days of exhibit hall exploration, with the chance to see an impressive array of information technology, to attendees at its annual conference. Suppliers of practice management systems, electronic medical records, scheduling, transcription and voice recognition services, wireless technology, credentialing info tech, financial and claims management systems and document management technologies will be on hand to demonstrate their products and help attendees consider what’s right for their organizations.

To help maximize your MGMA exhibit experience, Health Management Technology offers a showcase of some products you can personally test-drive at the conference. While you are there, stop by HMT Booth 1309 and say hello.

Companion Technologies Booth 523
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Companion Technologies develops practice management, electronic medical records and electronic data interchange software.

Companion PM is a fully integrated practice management system that works on Windows, Unix and Linux platforms. Its modular design can be scaled to meet specialty-specific requirements while accommodating changes in practice size and organization. Companion EMR is a Windows-based electronic medical records system that works on PCs, handhelds, laptops and tablets. It provides local and remote access to clinical data and automates prescriptions, labs, encounters, medical histories, patient education, and more.

Companion Technologies also offers group practice and claims management EDI systems that automate billing processes and help reduce errors, maximize reimbursement and improve cash flow. Visit Booth 523 to see which system best fits your data management needs.

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Dictaphone Booth 717

Dictaphone Corp. provides solutions that use speech recognition and natural language processing technology–to streamline the clinical documentation process and reduce transcription costs.

EXSpeech offers transcription-assisted speech recognition integrated with Dictaphone’s dictation system. Enterprise Workstation 2.0 is optimized for complete provider control of documentation with voice-driven self-editing of recognized documents. It also incorporates technology that automatically extracts key medical data from text reports for quick look-up and reuse to speed documentation further. The GoMD suite provides PDA-based dictation and charge capture. The ichart solution offers these products on a centrally hosted ASP basis.

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iLIANT Booth 423

iLIANT provides comprehensive business support services aimed at leveraging technology in ways that simplify a physician practice. The company uses software that is in the forefront of technology for billing and collections to streamline processes and reduce the cycle of revenue management. Among these software products are scanning technology, claims review and editing systems, online eligibility verification, and powerful data repository systems for customized reporting.

iLIANT’s Revenue Cycle Management services provide advantages to physician practices in fundamental ways by reducing accounts receivable days outstanding and increasing collected revenues per patient visit, iLIANT provides software and business services to more than 2,200 physician clients across the U.S. Visit iLIANT at Booth 423 to learn more.

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Sy.Med Development Inc. Booth 1419

OneApp is a managed care/ credentialing software system developed and licensed by Sy.Med Development Inc. It simplifies and automates completion of any form or credentialing application, improves the management of provider data and electronically stores key documents. OneApp is designed for use in any provider-centered healthcare organization and is used by more than 385 clients in 43 states. It can he installed on an individual PC or in a networked environment. Features include:

* Microsoft SQL Server database;

* automated form and application completion process;

* reporting, tracking and alert functions;

* optional privileging, imaging and data export modules.

Visit Booth 1419 for a OneApp demonstration.

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LaserFiche Booth 933

LaserFiche Document Management software solves healthcare business issues across departments by joining paper, e-mail and electronic records in a single interface. Designed on a nonproprietary platform, LaserFiche ensures long-term archive accessibility and enables active document support for existing practice management and electronic medical record software environments.

LaserFiche can assist healthcare organizations to realize benefits in multiple departments. Fast access to records helps to speed the billing process, reduce compliance costs, and improve efficiency and accountability while tracking patient records. The company’s solutions provide intelligent full-text retrieval, Web distribution and workflow to deliver information across a secure scalable system that integrates with existing IT infrastructures. Visit LaserFiche at Booth 933 for more information.

Are you leaving money on the insurance reimbursement table? Find out how to get the most out of medical billing.

The expansion of optometric practice into medical eye care has been exciting. Aside from being challenging, fun and necessary for the growth of our profession, medical eye care can be quite profitable. Optometric continuing education is replete with wonderful courses explaining the clinical side of eye care. What sometimes is missing is the final step - how to get paid. I’ll use this article to help you with some of the fundamentals of medical billing and coding.

Noticing recurring themes

After presenting several medical coding seminars, a few things have become apparent.

* Doctors and their staffs are interested in learning proper medical billing and coding.

* Many doctors feel that they’re leaving a ton of money on the reimbursement table.

* Many doctors feel intimidated by the process of medical billing and coding and therefore tend to under-bill for their work.

The following sections of this article will address these issues in greater depth.

O.D.s want to know

If you have any influence on your state association’s continuing education agenda, then please consider yearly coverage of billing and coding topics.

A good role model for billing and coding information is the American Academy of Ophthalmology (AAO). Besides publishing a regular newsletter and sponsoring an Internet chat room devoted to billing issues, the AAO coordinates a yearly national lecture tour called CodeQuest, which is a full day packed with essential information on medical billing issues. Yes, they discuss what is new for the season, but they also review the basics every year because new staff and returning staff need to hear some things regularly. The AAO has responded to their members’ needs for regular billing and coding information.

Revealing a common fear

From what I’ve heard, many doctors around the country are afraid that they’re leaving money on the insurance reimbursement table. And after hearing samples of their fee schedules, I’m afraid they’re correct. For example, let’s say that you’re a Medicare provider and that your fee for 92004 (new comprehensive exam) is $65. The average maximum Medicare payment for 92004 is $123.60. Therefore, each time you bill Medicare for 92004, you’re leaving $58.60 on the insurance table.

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%.