Free medical billing software providers are out there waiting to secure your business. Many software companies, if you qualify, will allow you to download their free demo software in hopes you will eventually add on more expensive options. Still other medical billing software providers will offer to mail out free demo CDs and training tapes. Another important feature that is often available at no cost to you is the care of all software upgrades, backups, data storage, and server maintenance eliminating expensive IT support and pricey upgrades.

One great additional benefit to obtaining free medical billing software is that many companies will help you to evaluate your needs in effort to ensure your future business. Investigating such possibilities is a worthy venture as there is so much competition and there are many new medical billing software services arising every day both locally, in the form of small start-up companies, and the on Internet.

Free services for medical billing abound. Since most companies who offer free medical billing software do not customize their complimentary products you may find that you have to piece together various services through the use of different companies and providers. Don’t be discouraged all you need to get there are a group of decent software packages that track claims management, patient billing, insurance, and scheduling.

And don’t forget to check and make certain that the software you choose is HIPAA ready and includes all finalized aspects of HIPAA to guarantee full compliance with HIPAA standards as they relate to the electronic storage and transfer of protected health information. Further consider carefully how the free medical billing software you acquire and/or assemble will eventually create a seamless workspace in which everything from electronic medical records to healthcare forms is integrated. Luckily you will probably be able to configure all the free medical billing software you get without assistance, quickly and easily so check it out, it might be a great solution for your medical practice.

Below are paid listings of specialty software packages for the insurance companies, risk managers and brokers. This guide is not intended to be a complete directory but is an overview of some of the packages available. Suppliers themselves have provided this data. To obtain more information on any of the programs listed, please select the appropriate URL. For more information, please contact Fred Kurst: fkurst@lrp.com; (T) 703.393.8304, (F) 703.393.9027.

Most businesses don’t like billing. It’s tedious administrative work that costs them time and money. In fact, some businesses hate billing so much they’ll pay you to do it for them. That’s a potentially profitable, low-overhead business opportunity.

You can run a billing service from home full-time or part-time, with little specialized knowledge beyond the ability to use a computer. Adding a billing service is a great way for an accounting or secretarial service to expand its offerings. Of course, as with any business, the ability to market your service is the key to success.

There are two main types of billing services: those that serve health-care providers and those that serve small businesses (see “Billing-Software Companies”). Start-up costs for a general business billing service are significantly lower than those for medical billing services. If you already own a computer and printer, you can get started for less than $500 ($300 for software, $150 to $200 for stationery supplies). Start-up costs for medical billing services range from $4,000 to $10,000. In either case, a high-speed, wide-carriage dot-matrix printer is recommended for producing duplicate copies, along with a fast computer (preferably a 386).

GENERAL BUSINESS BILLING
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“Our research shows that small businesses in the service sector, such as landscapers and janitorial companies, lack the staff needed to generate invoices promptly and to adequately track payments and receivables,” says Scott McIntire, president of the American Association of Billing Professionals and owner of BlueJay Systems, which sells small-business billing software.

Lori Ende, who lives in Minnesota, chose to add a billing service to her home-based secretarial business when several of her existing clients asked for such assistance. She looked at several types of software before settling on the Basic Billing program ($289) developed by BlueJay Systems. (If you’re comfortable with database or accounting software, you can design your own billing system.) “Then I contacted the businesses that had previously expressed an interest, as well as others I thought were good prospects,” says Ende. “Eleven of the 50 businesses I spoke to agreed to try the service free for one month, and all signed on as clients.”

Ende received so many referrals from her original accounts that she was forced to turn away several prospective clients. The 45 to 50 hours she devotes to her billing service each month produces a gross income of about $2,400.

MEDICAL BILLING SERVICES

Medical billing primarily involves transmitting claims from doctors and dentists to insurance companies. Demand for medical-billing services, already strong, is expected to grow as pressure mounts to streamline the American health-care system. “Medicare in particular wants to see more efficiency,” says Art Streim, supervisor of support and training at AR Professionals. “Transmitting claims electronically can reduce processing time to as little as 7 to 14 days, whereas by mail it can take two months or more.”

Currently less than 10 percent of the more than six billion insurance claims filed annually are electronically processed. “Despite the pressure on health practitioners to file claims electronically, fewer than half of practitioners have computers,” says William J. Sarracini, president of National Healthcare Support Corporation in Mission, Kansas, “This gives the billing-service operator a considerable advantage in marketing his or her services.” Another key selling point is that a billing service can reduce a doctor’s overhead and improve cash flow by speeding claims.

The potential income from a medical billing service is determined by the number of claims filed. Some operators charge per claim, and other charge a percentage of the amount billed or flat monthly fees. “Most people charge $1.50 to $2 per claim,” says Merry Schiff, owner of Health Software Systems, although some services charge as much as $3 per claim. “Once you get going, it’s possible to make $10,000 a month.” That’s the case for Linda Jones, who runs Our Billing Service in Sebastopol, California, and has processed as many as 11,000 claims in one month (at $1.80 per claim).

Medical billing is more complex than general small-business billing. The method for filing insurance claims can vary from state to state. Thus, the training and ongoing support that a billing-software company offers is just as important as the software itself. When choosing a software package, ask for references of doctors who have worked with a given system; doctors are more likely than operators to give you an honest appraisal.

“Both types of billing services offer outstanding opportunity and income potential,” says McIntire. “But remember that you are the one who has to market the service. Your success depends on how much effort you put into it.”

As the academic year gets under way, the nation’s medical, dental and nursing schools are seeing fewer minorities in the classroom. The numbers are so low that a commission, led by former U.S. Secretary of Health and Human Services Dr. Louis W. Sullivan, is examining how to boost minorities in the medical field.

“We are hearing from deans and other university officials who are saying they have none or only one new Black or Hispanic student in their classrooms for the first time in decades,” Sullivan says.

While African Americans, Hispanics or Latinos, and American Indians represent more than 25 percent of the U.S. population, they represent less than 14 percent of physicians, 9 percent of nurses, and only 5 percent of practicing dentists.

The Sullivan Commission on Diversity in the Healthcare Workforce held its first heating on the matter this summer in Atlanta, collecting testimonies from educators, local legislators, business leaders, students and community advocates. Just last month, the 15-member commission held hearings in Denver and is planning to hold hearings in other major cities before the end of the year (see Black Issues, May 22).
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“Although the problem of underrepresentation of minorities in the health professions is well documented, both state and federal tax dollars continue to support medical schools and residency training programs whose production of physicians falls far short of the goal,” Dr. George Rust told the commission at the Atlanta hearing. “In 1997 the Medical College of Georgia had only one African American student matriculate in its freshman class,” said Rust, professor of family medicine and deputy director, National Center for Primary Care at Morehouse School of Medicine.

“The real questions should no longer focus on ‘does it matter’–but rather how to address the long-standing need for greater depth and diversity in our health care work force. The ‘how’ must consider a wide range of multi-faceted interventions that bring together parents, young people, educators and educational institutions, providers and professional associations, federal, state and local agencies, and society in general,” said Valerie Hepburn, director of the division of health planning for the Georgia department of community health, also testifying before the commission at its Atlanta hearing.

Recent action by the U.S. Supreme Court in support of affirmative action in college admissions does not offer a solution for the lack of minorities in health-related fields, according to Sullivan.

“We know this ruling will not automatically lead to changes in how schools, especially health professional schools’ recruit, admit and retain underrepresented minority students,” Sullivan says. “It will take innovative approaches by schools to fulfill the dream or putting a health professions career within reach for more of our nation’s qualified minority students.”

Findings from the hearings will inform the commission’s final report, scheduled for release in Spring 2004, on bringing about systemic change at U.S. health professionals schools, and ultimately, to eliminate disparities in health status and unequal access to health services. The commission is administered by the Duke University School of Medicine and funded by the Kellogg Foundation.

Relative value units (RVUs) quantify the different values of the different services that you provide. For example, the removal of an acoustic neuroma is assigned a higher number of RVUs than is the removal of cerumen. RVUs are published in the Federal Register each November. They are calculated on the basis of the amount of work required (which accounts for 46% of the total RVU), the expense to the practice (50%), and the cost of malpractice insurance (4%).

RVUs vary in different parts of the United States because they are adjusted in accordance with the Geographic Practice Cost Index (GPCI). If the cost of living in your geographic area is exactly the same as the national average, your GPCI is 1.0. Areas where the cost of living is higher and lower than average are assigned correspondingly higher and lower GPCIs. For example, the nationwide average number of RVUs that Medicare assigns to a tonsillectomy and adenoidectomy procedure (CPT 42820) is 7.54 in 2003 (was 8.21 in 2002). In Indianapolis, however, the cost of living is calculated lower than the national average, and this difference is reflected in our lower-than-average GPCIs for work (0.981), expense (0.922), and malpractice (0.481). Therefore, when the GPCIs for Indianapolis are factored into the equation, a tonsillectomy and adenoidectomy procedure here is assigned 7.06 RVUs in 2003 (was 7.69 in 2002). Note that the 4.4% reduction in the 2003 Medicare conversion factor ($34.59 vs $36.20 in 2002) plus t he 0.63 reduction in RVUs for CPT 42820 results in a 2003 payment (effective 3/1/03) of $244.51 vs $278.38. That is a 12.16% reduction.

Your software should be able to calculate and keep track of all the RVUs you generate (figure). To make such calculations, divide your revenue by the total RVUs to arrive at the revenue/RVU figure. Then total all your costs (except for physician-related expenses) and divide that figure by total RVUs to arrive at the cost/RVU figure. Once you know these figures, you can take steps to ensure that (1) your contracts are paying you more than your cost/RVU and (2) your revenue/RVU is greater than your cost/RVU.
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Finally, be sure that at least one of the parameters you use to determine your fee schedules is based on the 2003 Medicare conversion factor for RVUs.

It’s already that time of year again–by now you’re wrapping up your training runs for the Boston Marathon and getting mentally prepared to tackle the race course. And once again, the American Medical Athletic Association (AMAA) will be there to support your efforts and provide you with an educational and fun weekend.

The following details outline the AMAA-sponsored events for the Boston Marathon weekend and address questions frequently asked by runners and/or meeting attendees.

The AMAA’s 33rd Annual Sports Medicine Symposium at Boston: The Runner’s Body

The symposium is scheduled for April 17 and 18 and will be held at The Colonnade Hotel (Huntington Ballroom), 120 Huntington Avenue, Boston. Registration will be available online until April 12–go to www.amaasportsmed.org. Following that date, call 800-776-2732 to register. Onsite registration begins at 7:00 a.m. on April 17; however, be prepared to pay an additional onsite registration fee.

ACPM Continuing Medical Education

The 33rd Annual Sports Medicine Symposium at Boston has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American College of Preventive Medicine and the American Medical Athletic Association. ACPM designates the lecture portion of the educational activity for a maximum of 10.6 Category 1 credits. This activity has been approved for American Medical Association Physician’s Recognition Award credit. This activity has been reviewed and is acceptable for up to 10.75 prescribed credits by the American Academy of Family Physicians. 1.1 CEUs will be awarded for athletic trainers through the NATA.

Saturday

AMAA Cocktail Hour

Join us for an AMAA-hosted cocktail hour in the conference foyer immediately following the symposium on Saturday. It’s a perfect way to unwind after a day of lectures and meet fellow AMAA members.

Pasta, Pasta, Pasta!

All AMAA members and their family and friends are invited to attend a private dinner at Maggiano’s Little Italy on Saturday, April 17 at 7 p.m. To make a dinner reservation, please contact Nancy Talbot at 800-776-2732 or send an e-mail to ntalbot@americanrunning.org. Tickets are $30 per person.

Monday

Bus to the Starting Line

Everyone registered for the Race Package or Meeting Package A has a seat reserved on the AMAA bus to Hopkinton. The buses will depart from the front of The Colonnade Hotel on Monday morning, April 19 (departure time TBD, but it will be approximately 8 a.m.). Two buses will remain at Hopkinton until the start of the race; these are used for AMAA members waiting to run and baggage (which will be returned to The Colonnade Hotel after the start of the race).

Post-Marathon Celebration

Following the race, AMAA members and their “cheerleaders” are invited to toast their achievements at a post-marathon celebration at Brasserie Jo (located adjacent to the hotel). The gathering, which will last from approximately 3-6 p.m., will include food, beverages and recorded footage of the 2004 Boston Marathon. Gear left on the bus in Hopkinton can be retrieved during this time and AMAA runners will be given the opportunity to shower.

SATURDAY, APRIL 17 (On-site registration and continental breakfast begin
at 7:00 a.m.)

Welcome (8:00 a.m.)
8:10-8:50   Cardiovascular Medications & Exercise  James Ziccardi, D.O.
8:50-9:30   Statins for Everybody?                 Frank Yanowitz, M.D.
9:30-10:10  Statin Myopathy                        Paul Thompson, M.D.
BREAK
10:25-11:05  Menopause & Marathons                  Susan Love, M.D.
11:05-11:45  Sudden Death with an Apparently        Sumeet Chugh, M.D.,
Healthy Heart                          FACC
11:45-1:00   LUNCH (on your own)
1:00-3:00   Hyponatremia:                          Steve Clement, M.D.,
A Panel Discussion                     Lewis Maharam, M.D.,
Art Siegel, M.D.,
Joseph Verbalis,
M.D.
BREAK
3:15-3:55   Overtraining                           Tom Howard, M.D.
3:55-4:35   What’s New in Treating Heel Pain?      Amol Saxena, D.P.M.
4:35-5:15   Chronic Exertional Compartment
Syndrome of the Lower Leg              Fred Brennan, D.O.
Saturday Meeting adjourns at 5:15 p.m.
Cocktails (5:15-6:45 p.m.)  Bus Ride to Maggiano’s (6:45)
Dinner at Maggiano’s (7:00-9:30)

SUNDAY, APRIL 18 (On-site registration and continental breakfast begin
at 8:00 a.m.)

Welcome (9:00 a.m.)
9:10-9:50   ITB Friction Syndrome             Robert Fawcett, M.D.
9:50-10:30  The Adolescent Runner             Lyle Micheli, M.D.
10:30-11:10  Exercise and Recovery             Fran Mason, M.D.
from Cancer                       and Sean Swarner
BREAK
11:30-12:10  Psychological Aspects of Long
Distance Runners and How One Can
Enhance Performance               Andrew Lovy, D.O.
12:10-12:50  Sport Specific Strength Training  Bruce Wilk, P.T., OCS and
for Running Injuries              Megan Greco, D.P.T., ATC
Meeting adjourns at 1:00 p.m.

Hospitals are always looking for ways to improve operating margins. One reason for a drain in cash flow is due to payment denials because medical necessity is not met. Medical necessity denials are a significant challenge to hospitals not only because of lost revenue, but also because of the resources and time required to resolve denials. Organizations that have made strides in improving the management of medical necessity denials share one key characteristic: their priority is to prevent denials from occurring in the first place.

Hospitals have developed processes to avoid medical necessity denials in two general areas: at patient access (before providing the medical service) and in patient accounting (well after the patient has gone home, but before the bill is submitted for payment). These scenarios are typically referred to as preservice editing and postservice bill scrubbing, respectively.

Everyone heralds the implementation of IT in physician practices as a positive. It saves time, money and, in some cases, the patient’s well-being. But for most physicians, the introduction of automation also carries a risk. When practices operate as silos, separated from each other by architectures and applications, not being able to electronically share patient-specific information with medical colleagues treating the same patient can add workarounds, negating the time and money saved.

There’s a new model of care on the horizon. When several physicians who treat the same patient can share pertinent information about that patient over a common Web-based network, it’s a win-win. Not only does the patient receive timelier and more comprehensive medical care, but also the physicians involved can save time and money–and both are valuable assets for most small and medium-sized practices.

Anthony Alfieri, D.O., a cardiologist in Wilmington, Del., was so intrigued with the “community care model” that he started a company dedicated to building a network of practices that use a common electronic medical record (EMR) and practice management (PM) system–in this case, systems licensed from Kansas City, Mo.-based Cerner Corp.

Seemingly small changes can make a huge difference. While a community hospital may engage in an ongoing and successful effort to improve efficiency, all it takes is one disparate scheduling system to compromise and damage the outcome. Similarly, all it takes is one right move to put the efficiency effort back on track.

Problem

Lowell General Hospital in Lowell, MA is a 200-bed independent hospital serving residents of Greater Lowell, a suburb of Boston. Each year, our surgical services department performs more than 8,000 procedures in an 11-room, hospital-based surgical suite and a three-room ambulatory surgery center.

The surgery department used a disparate standalone scheduling system that did not integrate with the hospital’s main system. Our staff scheduled appointments with doctors’ offices over the phone and entered bookings into the system. In many cases, we received inaccurate information from the admitting doctor’s office, but because we weren’t connected to the hospital’s main system and because our system didn’t require any specific information or flag errors, surgical bookings were scheduled without detailed information about patients’ conditions or the procedures required.

In short, our staff learned to behave as if gathering patient information during the scheduling process was not a priority but getting the room booked was. On many occasions, they even created generic names for patients and added them to the system with no clinical or surgical details–all to expedite a faster transaction and to book operating space for the surgeon involved.

When they hear the phrase CPOE, most people think big–big cost, big end-user, big implementation. But it’s not necessarily so. Moses Lake Community Health Center (MLCHC) in Moses Lake, Wash., is proof.

MLCHC is a community healthcare facility with two clinic sites and a variety of owned support services such as laboratory, imaging, pharmacy and dental. Fifteen providers (physicians, PA-Cs and ARNPs) and about 170 support staff handle monthly medical encounters totaling about 5,000. Their patient population consists of those with Medicare, Medicaid, private and commercial insurance, plus self-pays and those unable to pay, and the organization is dedicated to giving every patient the same level of high-quality care.

MLCHC began using the Physician Micro Systems Inc. (PMSI) Practice Partner electronic medical record (EMR), Patient Records, in October 2002. Ten months later, the organization relocated all of its paper charts off-site, but it wasn’t done by a long shot.

According to EMR Specialist Carolyn L. Hutchinson, MLCHC’s second step in its planned automation strategy was to implement a computerized physician order entry component. Their primary motivation was, of course, to track orders, particularly lab orders. But their secondary motivation–and rigid requirement–represented a challenge. “We wanted an order entry (OE) system to electronically track referrals, whether they be for an ultrasound, a mammogram, a visit to an orthopedic surgeon or a mental health referral. We saw the ability to do that within the OE component.”