A-Life Medical, Inc., the leading provider of Natural Language Processing (NLP) for the healthcare industry, will exhibit Fusion3 at this year’s Radiological Society of North America (RSNA) 2006 conference, November 26-30 in Chicago, IL. Fusion3 integrates documentation management, patented NLP coding, billing, collections, denial management, and auditing into a Windows®-based platform providing the most advanced technology available today.

A-Life Medical’s Fusion3 was designed to effectively streamline the code to collection process. RSNA attendees will see how A-Life Medical’s advanced practice management system, Fusion3, codes radiology reports and submits charge data on the same date of service. The denial management module automatically tracks denials, sends appeal letters, and generates secondary filings without user involvement.

Fusion3 integrates a complete electronic document management system that provides users with instant access to ABNs, transcriptions, insurance cards, EOBs, CMS-1500 forms, or any scanned document. The Fusion3 document management system improves the flow of information and reduces paperwork and inventory costs. Fusion3 also provides coding and billing audit functionality. Fusion3 identifies a statistically representative sample of claims data and pulls electronic records from a centralized database. Detailed audit reports are automatically created to assist in the auditing process.

“We are very excited to showcase Fusion3 at RSNA 2006. Fusion3 offers radiologists a new and effective solution to create clean claims prior to being submitted using our patented NLP computerized coding technology. Fusion3 combines documentation management, NLP computerized coding, denial management and auditing. Fusion3 is a solution that is unparalleled by any product in the market today,” stated Cindi Karl, A-Life Medical’s Product Manager.

North Adams Regional Hospital administrators wanted to automate the hospital’s medication delivery process to enhance clinical operations and reduce the potential for medication errors, especially at the point of care. The hospital provides primary care services, specialty physician services, and diagnostic and treatment services to citizens in northern Berkshire County, Mass., and southern Vermont. Each year, North Adams performs more than 2,200 surgeries, and its emergency department treats more than 20,000 patients.

To help meet its medication delivery goals, the hospital chose Deerfield, Ill-based Baxter Healthcare’s Patient Care System, an integrated medication management system that uses bar code scanning technology and personal digital assistants (PDAs).

Before automation, North Adams’ nurses relied on a traditional hospital unit-dose system with a 24-hour cart exchange. Automated dispensing from electronic medication carts on the nursing unit now provides the nurse with immediate access to new medications as soon as the order is entered in the pharmacy system. This improves patient care by eliminating the delivery time involved in 24-hour cart dispensing. In addition, pharmacy staff can view the exact time when a medication is administered compared to the scheduled time.

Reporting from this system will provide North Adams with very discrete data regarding medication administration times and any problems that might arise. Pharmacy technicians can now restock the electronic medication carts based on inventory data in the pharmacy since they no longer fill 24-hour medication carts. Pharmacist time is saved, since checking medication carts is no longer necessary.

North Adams installed the pharmacy system in April 2003 and began deployment of medication carts and bedside bar-coded medication verification the following December. The hospital is working unit by unit, and the next golive is scheduled for this spring. The manual system is still in place on units that have not yet implemented the Baxter system. Pharmacy Manager Mark Kester expects that nurses on all hospital units will use the new program by late summer or early fall.

Bedside Bar Codes

Upon admission, every patient receives a bar-coded bracelet. New medication orders are electronically entered into the system, and nurses and pharmacists can immediately view the information. The pharmacist then checks all orders electronically for drug interactions, allergies, duplicate therapy and dosage errors. Next, the pharmacist prepares unit-dose prescriptions, which are packaged, bar-coded and sent to the nursing floor. There, the doses are stored in a wireless mobile medication cart.

Before she begins her rounds, the nurse reviews a to-do list from a handheld PDA or the nurse workstation. She accesses the medication for each patient from the medication cart and pulls up the patient’s electronic medication administration record on a handheld scanner or touchscreen computer on the mobile cart. Only medications requiring administration at that time are shown, and the nurse is directed to the correct drawer, bin and medication within the mobile cart.

She then scans the bar-coded medication to confirm the right medication and dose, and the patient’s bar-coded bracelet to ensure that the right patient is receiving the right dose of the right medication at the right time via the right administration route. The medication is administered, the patient profile is automatically updated and then it is tracked to the patient’s electronic medical record. Information is also tracked by the pharmacy and updated in the hospital’s inventory and patient billing records.

Seamless Integration

Clinicians were hesitant to integrate a medication management system with North Adams’ legacy healthcare information system architecture. North Adams’ has relied on its MEDITECH HIS for 12 years, so the new pharmacy system had to integrate with the existing network. “When we replaced the pharmacy system, we had to make sure the new system would integrate with our current billing application, the application for transferring and admitting patients, and the laboratory information system,” Kester says. Patient Care System interfaced seamlessly with ADT (admissions, discharge, transfer) and the billing applications, and the hospital currently is testing the laboratory interface.

Change management has also played a key role. Baxter provided client service representatives to aid the North Adams team in building the database, training the staff and helping to work through the change management process that’s needed to successfully implement the system. Baxter also worked with North Adams’ IT organization to ensure that all interfaces were seamless.

North Adams experienced few training issues with its pharmacy system, but training nurses was “a more intense situation. A bar code system presents a very different practice environment for nurses that required a lot of practice change and workflow examinations,” Kester says. “In pharmacy, we have to be much more cognizant of the nurses, because what we do affects them in real time. If we don’t have the order entered by the time they want to give it, they’re looking for the order.” The biggest challenge, he adds, was helping the nurses become more familiar with the handheld computers they use to verify medication at the bedside.

When you think about the incredible volume of billing and reimbursement transactions that move between medical groups and payers, it boggles the mind. Football-stadium-sized claims centers handle millions of bills with hundreds of millions of line items and codes, and cut checks–not all of which are accurate.

Without a practical means to verify accuracy, most medical practices accept what they are sent and write off what they cannot understand or recover. But this is highly troubling as the probability of errors is great because many of these transactions are processed manually on both ends, or electronically with systems that do not use the same rules of logic for claims payment.

Consider one story from a medical practice where a major payer with claims offices in five cities each reimbursed a different amount for the same CPT code even though the contract with that provider is for only one amount. The medical practice accepted each of the five payments over and over again, even though only one was correct.

Lacking the automation to flag these discrepancies, medical practices don’t really know what amount should be reimbursed for a given CPT code so they simply accept any amount that seems reasonable. Add in that most practices have multiple contracts with multiple payers and the math becomes dumbfounding. Practices are simply out of control. Something has to be done.

“Needle in a haystack”

Physician practices today capture the services they provide to patients (or members) in the form of CPT–and other standard or non-standard codes–and bill them out according to a single fee schedule. This fee schedule has nothing to do with what has been negotiated in terms of expected reimbursement from any of the practice’s contracted payers.

As a result, the payer receives an amount that is not correct, according to the negotiated contract, and applies automated or manual rules logic to it to “adjudicate” the claim. This adjudication process:

1. Determines what, if any, portion of the service is covered

2. Changes the amount of the provider’s charge to the contracted rate

3. Deducts any co-payments, deductibles or co-insurance that should have been paid directly by the patient

4. Sends an explanation of payment back to the medical practice along with a check for substantially less than the provider’s original charge

The practice receives the check, applies the payment, and adjusts the balance according to the provider’s explanation of payment. But it’s a very difficult and cumbersome manual process for the practice to actually go back and check to see if the payment amount has been issued according to the negotiated contract.

Without most current systems, medical practices would literally have to have someone look at every claim that comes in and compare it to the negotiated contract to make sure the payment is correct. Manually verifying the accuracy of hundreds, if not thousands, of bills seems so impossibly expensive, time consuming and disruptive that it would cancel out any possible benefits.

This “needle in a haystack” is a very serious problem that many practices face and technology vendors are finally responding.

Today, automation is no longer more pain than gain. Systems are coming into their own and are collecting more money with fewer personnel. The questions to ask are:

* “What functionality is most critical?”

* “Which system and process of implementation will deliver the most value to your practice?”

On the front end

Automation of the end-to-end revenue cycle lowers costs and increases accuracy of billing, payment posting and collections. Integrating front desk automation with back office automation provides the greatest value because patient-owed amounts can be calculated, collected and posted at the time of the office visit, reducing back office handling and the number of bills mailed.

Front-desk payment posting and benefits verification

At a minimum, front-desk personnel who receive patient co-payments, co-insurance and other payments need to be able to post those amounts correctly and to reconcile cash to payments posted at the end of each day.

They should not be allowed to make any adjustments to the account. To achieve this, it is important to pay attention to the security capabilities within the system. Some systems require practices to give levels of security (i.e., level 1 thru 9, for instance) rather than screen- or field-specific security. The latter provides better flexibility and allows front-desk personnel to assist in the collection of co-pays.

The front desk will seem more knowledgeable and be able to assist greatly in collecting money due from patients if the system allows benefits verification and estimation prior to and during the patient’s visit.

Without this functionality, practices will either write off these amounts unnecessarily or have to send a bill to each patient to collect. Handling patient responsibility amounts at the front desk during the visit is less costly and results in higher collections than handling it on the back end.

Nuesoft Technologies has introduced a program that offers medical billing schools free use of its NueMD(TM) medical practice management software system. The Billing Education Software Training (BEST) program gives instructors a hands-on training tool for students studying collections, billing, submissions, electronic data interface (EDI) posting, and other billing-related functions.

“Our physician client base has expressed the need to have access to qualified staff candidates who are up to speed on the newest billing technologies,” said Nuesoft Technologies President and CEO Massoud Alibakhsh. “And, billing professionals need to be aware of tools that will help them effectively handle insurance reimbursement and third-party billing. Nuesoft created the BEST program to address both of those needs.”

NueMD’s practice management solution is delivered over the Internet using a high speed connection. Because of this delivery method, NueMD is platform independent, and can be used by multiple users in multiple locations. This format is conducive to an educational facility that might have several locations, use varying operating systems, or require students to work on billing projects outside of the classroom environment.

Great Oaks Institute of Technology and Career Development in Cincinnati is one of the first participants in the BEST program.

“We are excited to be using NueMD for our training facilities,” said Certified Professional Coder Cheryl Carrier, who is an adult education instructor at Great Oaks. “It is very important for students to use a billing software program in a classroom setting so that they can get the practical experience that they will need to prepare them for their careers. And NueMD’s ease of use makes it a perfect fit for our needs.”

For additional information about Nuesoft’s BEST program, please contact (800) 401-7422.

About NueMD

Developed using the JAVA platform from Sun Microsystems (NASDAQ: SUNW), NueMD is a completely platform independent medical practice management system that uses the latest Internet technology to run seamlessly on PCs using Microsoft (NASDAQ: MSFT) Windows operating systems, Apple’s (NASDAQ: AAPL) OS X, or the Linux OS from Red Hat (NASDAQ: RHAT). Because NueMD runs as a Java application — not through a computer’s Web browser — the NueMD application and all related patient data are hidden behind an additional layer of protection, guaranteeing clients’ security and HIPAA-compliance. For more information, visit ( http://www.nuesoft.com ) or call (800) 401-7422.

Consumer-directed health care has made it inescapable. Healthcare providers must be able to let non-ED patients know, before they receive healthcare services, their expected out-of-pocket costs for those services. Four providers offer insights into how to approach this challenge.

Question: What is more difficult than providing price transparency?

Answer: Providing meaningful price transparency.

The latest report of the HFMA-led PATIENT FRIENDLY BILLING[R] project, Consumerism in Health Care, notes that to be meaningful, pricing information must be relevant to the patient who needs it. Think about a patient who is anxious about an upcoming procedure, and worried about what it will cost and how to pay for it. The patient wants to know what the cost of the services will be out of his or her own pocket.

To give a patient an advance estimate of his or her expected financial obligations, a provider must be able to overlay the patient’s insurance benefits with his or her specific medical condition and expected treatment. Patients then could use such estimates from various providers in combination with information about each provider’s quality of care to make a meaningful interpretation of the value of care that each provider can deliver. That’s true price transparency.

Many providers have or are developing the ability to provide patients with advance estimates upon request. Typically, this is a manual process, requiring a highly skilled and knowledgeable individual. The next step for these providers is to be able to routinely and proactively provide each patient with an estimate of his or her out-of-pocket financial obligations–and then use this information as a basis for discussions with the patient about matters such as up-front payment, payment terms, and financial counseling.

Following are descriptions of approaches, lessons learned, and tools that four providers are using to achieve price transparency by giving individual patients advance estimates of their expected financial obligations.

A Fast Start: Geisinger Health System

As 2002 got under way, patient satisfaction scores for Geisinger Health System in central Pennsylvania were below peer norms. Revenues could have been better. Payers were requiring more and more documentation to justify patient services. Where others might have seen cause for discouragement, Geisinger saw opportunity.

“We recognized that we could improve the patient experience while enhancing revenues by reengineering the patient access process,” explains Gregory Snow, Ceisinger’s vice president for the revenue cycle. “We saw that we could eliminate the gaps that existed in the financial clearance process, with specific focus on precertification and referrals, patient benefit levels, and communication of the patient obligation amount.”

When it comes to estimating patients’ out-of-pocket costs in advance of services, Geisinger has gone about as far as any hospital or hospital system in the country today. Geisinger’s preservice program “MyVisit,” with a dedicated staff of 100, currently serves all inpatients at the health system’s three hospitals, about 80 percent of scheduled outpatients, and 30 percent of patients making office visits to the system’s 700 physicians. In the first nine months of FY06, Geisinger financially cleared about $420 million in net revenues, resulting in nearly $6.7 million in losses avoided or net revenues increased.

Geisinger achieved these results by performing in advance, before patients receive services, functions that historically came at the point of service or later in the revenue cycle, including:

* Registration

* Insurance eligibility checking

* Verification of patient insurance benefit levels

* Precertification

* Medical necessity checking

* Referral authorizations

* Identification and communication of each patient’s out-of-pocket obligation (copayment and deductibles)

* Financial counseling, including payment plans and alternate payment arrangements

* “Special handling” accounts (package pricing)

Uncharted Waters: Texas Health Resources

Many hospitals provide patients with out-of-pocket estimates before a few selected services, such as cosmetic surgery, or when specifically asked to do so. But only a few organizations are fully committed to calculating and collecting the patient’s estimated financial obligation in advance of services across the board. Typically starting small and feeling their way into what are essentially uncharted waters, these organizations are telling examples of the state of the art.

And there is art as well as science involved, according to Jack Roper, senior vice president of finance at Texas Health Resources, which is headquartered in Arlington and has 13 hospitals in the Dallas-Fort Worth area. “Patients don’t all fit into a single formula. We’re making estimates that are reasonable based on the information we have in hand, but we also have to be flexible should information change, and it frequently does.”

The EMR horse is out of the stable and galloping full speed ahead, and it could race right over the industry if we don’t take a hard look at the current EMR software model presently being offered to providers. With the departure of Dr. David Brailer as National Coordinator for Health Information Technology in May, our industry finds itself at a critical juncture. The current software-based EMR solution being touted does not address the massive process breakdown that exists in healthcare and will ultimately prevent any widespread adoption of clinical solutions by physicians.

While providers are starting to feel pressure to adopt some kind of EMR solution as new performance-based reimbursement programs emerge, still they struggle with increasing concerns about the impact EMR implementation will have on their financial viability. A few very large physician groups have emerged as the super-successful poster children for software-based EMRs, often with the benefit of intensive hand-holding from EMR vendors hoping to use them as success stories. Others have experienced the frustration of very long implementation cycles, high up-front costs and elusive tangible benefits.

As the bulk of the market watches these dramas play out, waiting for standards and best-practice approaches to emerge, the time is now or never to examine the current packaged software approach to EMR, make sure we understand why the market is heading down the current path, and dare to ask if there might not be other, less toilsome routes to achieving the benefits of data-driven clinical workflows and accessible, accurate electronic health information.

A frequently successful strategy for understanding market conditions is to follow the money. As we look at the government initiatives and funding to establish regional health information organizations (RHIOs) and to drive adoption of national standards for EMRs, where is the money? Who is pushing for RHIOs and standards? Who is framing the debates and who will benefit?

Clearly, every major EMR software vendor stands to benefit in a world where everyone must have an EMR, and they are deeply invested in shaping the standards and perpetuating their approach to sustain business models, which are founded on selling packaged software at large or significant profit margins.

EMR software vendors need to take responsibility for delivering tangible and sustainable results for their software, which presents significant and inherent challenges. These are challenges the industry should be talking about today, but we are not because once again, solutions that deliver true ROI for both the provider and patient are not easily delivered using packaged software.

Given this status-quo ante, a question which has, not surprisingly, been absent from the current industry debate is: Will packaged software solve the EMR problem? The answer is no.

If Not Software, Then What?

Software alone is not suited to manage the enormous variability, paperwork and intensive human effort required to make an EMR system work effectively. The business of healthcare is broken; software, combined with intelligent processes and a service-oriented architecture, is the solution.

We need to build an EMR model where the vendor is not paid for software; that would be free. They are paid for getting the grunt work done, and the more accurately, cheaply and efficiently they get it done, the more profit they make. This idea amounts to a radical new take on the pay-for-performance (P4P) craze we see emerging in healthcare.

This would be a model where doctors pay the EMR industry for results, not software and hardware. Instead of asking physicians to be at risk for outcomes and process all by themselves, the EMR industry would share risk with them, and be rewarded by them for limiting that risk with correct and timely data and repeatable best-practice process that they build into the clinical workflow.

The EMR industry has been working hard to develop software that will meet the unique needs of the thousands of small physician groups in the U.S. that most agree is the critical market segment for making the NHIN (national health information network) a reality. Small practices don’t have the financial bandwidth required for the traditional EMR software and hardware needed for implementation while also dealing with the continuous challenges of the billing and collections aspect of practice management.

Software vendors have gone to great lengths to develop exhaustive pick lists to click from, and wizards to guide the provider through the process of populating an EMR. Dozens of EMR vendors have wrought marvelously elegant approaches to streamline tasks and make data entry as natural a part of the patient-doctor experience as possible. In their efforts, they have missed the core driver of adoption; medical groups need EMR solutions that allow them to improve quality while also becoming profitable. Essential is a healthcare infrastructure that provides an automated service backbone that will ensure that doctors are fiscally fit, that insurers and government pay doctors, and there is motivation to adopt technology.

Electronic medical records (EMRs) offer many advantages. However, there are also risks involved with adopting a full commercial EMR. These include high cost, the disruption of clinic routines, and poor or no vendor support. We created and implemented a partial, or miniature EMR (mini EMR) based on Microsoft Access 97 (Microsoft Corporation; Redmond, Wash). This program serves as an electronic front sheet for the patient chart that records International Classification of Diseases–9th revision codes and chronic medications and allergies, and provides reminders for prevention, procedures. The mini EMR has been inexpensive, adaptable, easy to maintain, and very well accepted, and it has caused little interruption of our clinical activities. We believe the program can serve as a bridge to a future commercial EMR once that market has matured.

For several years our residency program had been considering the purchase of an electronic medical-record (EMR). We had seen demonstrations of the products and were aware that a few practices in our area were using full EMRs. We knew of their many advantages, as delineated in several recent articles. (1-3)

Our faculty had 3 major concerns about the purchase of an EMR. The first was price. The cost of implementation cited in the literature varies widely; one source estimates $15,000 per full-time physician. (1) There is disagreement as to whether the operating expenses of paperless EMR systems are less than traditional paper systems. (4) The savings in dictation and filing are often offset by fees for service agreements and technical support. Thus, it seemed unlikely that an EMR would significantly decrease our operating costs in the immediate future.

Our second concern was the potential for physician dissatisfaction and disruption of clinical flow. At least 10 residency programs had purchased commercial EMRs and discontinued using them. (5-7) Our clinic was running smoothly, so we believed that the advantages of a full EMR would not compensate for the inconveniences and frustrations that seem to accompany a commercial product. Our third concern was the apparent lack of a dominant EMR vendor. A recent survey of the industry revealed tremendous turnover, (8) and a survey of family medicine residencies reported that no vendor had more than 25% of the market. (5) Consequently, we feared investing in a product when its vendor might go out of business.

Our foremost goal was quality improvement (QI). This should include electronic reminders for due prevention items, the ability to display our completion rates for key prevention items without the time and expense of pulling charts, and the ability to check on critical combinations of diagnoses and medications (eg, congestive heart failure and [BETA]-blocker usage). Second, we wanted to improve the legibility and accessibility of key parts of a patient’s chart, particularly medications and chronic diagnoses. The ability to access the full chart electronically and to change our current dictation of daily SOAP Notes (SpeechStudio; Portland, Ore) were less important to us.

Development

Since we did not believe a commercial program would meet our goals, we decided to create our own partial or miniature electronic medical record (mini EMR). Several reports in the literature have described the value of mini EMRs. (9,10) One of the authors with previous programming experience (R.D.C.) began writing the first version in May 1999. We found a formulary database, Multum (Multum Information Services, Denver, Colo) from which we could import generic and trade medication names and categories. We also created a list of 700 primary care International Classification of Diseases-9th revision (ICD-9) codes common in our practice.

Current Use

Starting in May 2000, all of our 6.5 full-time equivalent physicians began using the mini EMR. Our patients’ demographic clam were initially imported from our billing program into the mini EMR from a delimited text file. This same method is used to update phone numbers monthly. We had traditionally placed a preprinted sheet of paper for notes and orders on the front of each patient’s chart at each visit. This sheet was replaced with a printout from the mini EMR that included current ICD-9 codes, medications, and reminders for age- and sex-appropriate due prevention items. Front sheets are batch-printed each morning, then placed in the patient’s chart where it remains until the next visit, to be replaced by the most current printed version. When dictating the visit, the physician also updates the mini EMR entry for that patient on the computer. (Figure). It takes approximately 30 seconds to call up a patient record and enter or change several diagnoses or medications or to add prevention item dates. This is not additional time, since most physicians would otherwise have to update the problem and medication lists in the paper chart. However, it does require that the physician be at a computer terminal. Physicians or nurses also update the mini EMR as data from Papanicolaou tests, laboratory values, and so forth, become available.

Replacing MegaWest Medical Management Suite, Companion PM is a fully integrated practice management system designed to help physician practices improve productivity, efficiency and levels of care. Its features include A/R billing and reporting, collections, a patient master, claims processing and appointment scheduling, and it encrypts source code and data streams to ensure HIPAA compliance. The system offers optional modules for orthopedic practices, health centers, anesthesiology, allergy management, advanced collections, patient care tracking, document and image management, and electronic remittance of claims. Companion PM’s scalability and modular design allow it to be tailored to a practice’s exact needs. As part of its flexible system architecture, it also uses tools that are SQL-, HL7-and ODBC-compliant. Its operating system and platform independence enable practices to use their existing hardware. Companion Technologies Corp., Columbia, S.C.

An eight-member California blood-center consortium asked for help designing and developing an information tracking and management system for blood banking. The result is the SafeTrace donor-management information system. This system has comprehensive donor-recruitment capabilities, and can manage fixed site and mobile donor collection. It maintains real-time, historical donor demographic and deferral data. Its Oracle database is compatible with standard third-party database tools, interfaces with automated testing equipment, and supports current and emerging regulatory guidelines. Look to SafeTrace for donor management, final transfusion/product, laboratory, inventory/distribution, and billing requirements.

As I travel around the country to attend HFMA chapter meetings, I often ask how many attendees have heard of HFMA’s PATIENT FRIENDLY BILLING project. I’m pleased to see a growing number of bands go up. My follow-up question-”Do you work for an organization that has embraced the Patient Friendly Billing philosophy?”–unfortunately gets a less affirmative response. Although many folks are familiar with HFMA’s efforts to focus the industry’s attention on this topic, apparently not everyone has jumped on the bandwagon to implement the: recommendations.

For those unfamiliar with this effort, Patient Friendly Billing is a collaborative endeavor of HFMA, the American Hospital Association, the Medical Croup Management Association, and select provider partners to promote clear, concise, and correct patient friendly financial correspondence. A team of talented volunteers has spent more than three years highlighting opportunities to improve the messages and information that we send to our patients via the patient billing process. This group began by sitting down with hospital and physician billing office staff to identify barriers to cresting patient-friendly communication. In addition, hospital software vendors were consulted to validate the find lugs and, more important, to be part of the solution. The team also formed focus groups of patients and family members to determine at what point during the process communication is preferred and, if so, what level of detail should be provided.