Medical Insurance Billing Software

• Database recovery and restoration (rebuild from a serious crash)
• Document Delivery Service, including faxing, transcription, RIS, etc.
• Medcin database, ShipPlan (default insurance plan information)
• Terminal services setup and administration

• Supported EM Coding using a built in E&M Calculator.
• EHR Stimulus Money is waiting for you!
• Convenience of having all your patient medical records at your fingertips.
• DUR review to notify you of any drug interactions that may occur.
• Paperless Electronic Patient Charting.
• Backing of the Medcin Database.
• E-Prescribing
• Integrated product with Medical Insurance Billing Software.

• Quickly create/view any prescription
• Improved patient care - decreased errors and pharmacy calls
• DUR checks  
• Formularies for insurance plans
• Electronic requests from the pharmacy for refills

• Young adults will be able stay on their parents' insurance until their 26th birthday
• Insurers will not be able to rescind policies to avoid paying medical bills when a person becomes ill
• New plans must provide coverage for preventive services without co-pays. All plans must comply by 2018
• A 10 percent tax will be imposed on amounts paid for indoor tanning services on or after July 1

• Compliance increased from 72% to 94%;
• revenue increased 12% overall; and,
• on average, each physician saw 8% less patients during the first year of implementation.
•  

• On March 23, President Obama signed heath care reform into law.  Insurance premiums fall like rain (hopefully!)
• Discussion period for EHR stimulus continues.  Congress looks to modify ARRA rules for meaningful use resulting in more attainable CMS incentive payments.
• Bradford-Scott brings live an Ohio EMR client and two Indiana EMR clients on CCHIT certified Sage Intergy EHR v 5.5!

• It expands health insurance coverage to 32 million Americans, guaranteeing that 95% of Americans will be covered.
• It makes health insurance affordable for middle class and small businesses -- including the largest middle class tax cuts for health care in history -- reducing premiums and out-of-pocket costs.
• It strengthens consumer protections and reins in insurance company abuses.
• It gives millions of Americans the same types of private insurance choices that members of Congress will have -- through a new competitive health insurance market that keeps costs down.
• It holds insurance companies accountable to keep premiums down and prevent denials of care and coverage, including for pre-existing conditions.
• It improves Medicare benefits with lower prescription drug costs for those in the ‘donut hole,' better chronic care, free preventive care, and nearly a decade more of solvency for Medicare.
• It reduces the deficit by more than $100 billion over next ten years, and by more than one trillion dollars over the following decade; reining waste, fraud and abuse; overpayments to insurance companies and by paying for quality over quantity of care.

• It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today.  This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more. 
• It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have.  
• It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.  
• It will end discrimination against Americans with pre-existing conditions.
• It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

1. Use CPOE
2. Implement drug-drug, drug-allergy, drug-formulary checks
3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT
4. Generate and transmit permissible prescriptions electronically
5. Maintain an active medication list
6. Maintain an active allergy list
7. Record demographics: preferred language, insurance type, gender, race, ethnicity, and date of birth
8. Record and chart changes in vital signs: height, weight, blood pressure, calculate and display: BMI, and plot and display growth charts for children 2-20 years, including BMI
9. Record smoking status for patients 13 years old or over
10.  Incorporate clinical lab-test results into EHR as structured data
11.   Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach
12.   Report ambulatory quality measures to CMS or the States
13.   Send reminders to patients per the patient's preference for preventive/follow up care
14.   Implement five clinical decision support rules relevant to specialty or high clinical priority, including diagnostic test ordering, along with the ability to track compliances with those rules
15.   Check insurance eligibility electronically from public and private payers
16.   Submit claims electronically to public and private payers
17.   Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, allergies), upon request
18.   Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) within 96 hours of the information being available to the EP
19.   Provide clinical summaries for patients for each office visit
20.   Capability to exchange key clinical information (for example, problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronically
21.   Perform medication reconciliation at relevant encounters and each transition of care
22.   Provide summary care record for each transition of care and referral
23.   Capability to submit electronic data to immunization registries and actual submission where required and accepted
24.   Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice
25.   Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

The “red flags” rule is now scheduled to take effect on June 1, 2010, after another delay announced earlier by the Federal Trade Commission as it considers new legislation that would exempt small businesses, including medical practices, from compliance. The rule mandates the creation of identity theft prevention programs, and will apply to any organization that can be considered a creditor with “covered” accounts (i.e.-commercial accounts that involve multiple transactions). Most providers, many physician medical billing companies and some health plans are expected to comply.

The American Medical Association, American Academy of Family Physicians and other industry groups have weighed in against the rule, on the basis that physicians do not meet the definition of creditors. A completely sensible argument. But medical practices need to proactively engage in some agreed set of identity theft prevention practices.  Incidences of medical identity theft are increasing. Smaller medical practices (which account for nearly 80% of all U.S. practices) may be more vulnerable, as thieves could perceive them to be lower risk targets based on the assumption that they lack the sophisticated security procedures of hospitals or larger health care organizations.

Despite the widespread outcry from industry groups, the actual impact on a practice for complying with the red flag rule may be minimal. The new rule would simply buttress state privacy laws that already require health care organizations to respond to breaches of certain patient information. In addition, there is a great deal of overlap between the proposed FTC regulations and HIPAA, which applies to medical practices or other entities that are conducting electronic transactions. But you should still be vary aware of these red flags. You must be able to protect your patient medical records.

Here are some Red Flag identifiers:

• Suspicious documents. Has a new patient given you identification documents that look altered or forged? Is the photograph or physical description on the ID inconsistent with what the patient looks like? Did the patient give you other documentation inconsistent with what he or she has told you — for example, an inconsistent date of birth or a chronic medical condition not mentioned elsewhere? Under the Red Flags Rule, you may need to ask for additional information from that patient.
• Suspicious personally identifying information. If a patient gives you information that does not match what you have learned from other sources, it may be a red flag of identity theft. For example, if the patient gives you a home address, birth date, or Social Security number that does not match information on file or from the insurer then fraud could be afoot.
• Suspicious activities. Is mail returned repeatedly as undeliverable, even though the patient still shows up for appointments? Does a patient complain about receiving a bill for a service that he or she didn't  get? Is there an inconsistency between a physical examination or medical history reported by the patient and the treatment records? These questionable activities may be red flags of identity theft.
• Notices from victims of identity theft, law enforcement authorities, insurers, or others suggesting possible identity theft. Have you received word about identity theft from another source? Cooperation is key. Heed warnings from others that identity theft may be ongoing.
  
  
  If you’re covered by the Rule, your red flag program must:

1. Identify the kinds of red flags that are relevant to your practice
2. Explain your process for detecting them
3. Describe how you’ll respond to red flags to prevent and mitigate identity theft
4. Spell out how you’ll keep your program current.

At Bradford Scott Data Corporation our EMR systems and our medical practice billing software has several built in features that can help you protect your patients from identity theft. Please contact our sales team at : www.bradfordscott.com/medical.php

Medical practices concerned about compliance can learn more at:
http://www.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtml
 

**Last week marked the opening of the 60-day window for public comment about the HHS’ meaningful use” rules.  Input from practitioners and other stakeholders will help to refine the final version, which is expected to be completed in Spring of 2010.

**Since the Health Information Technology Policy Committee’s July 2009 meeting, many practitioners have been feeling uneasy about moving forward with what could potentially be a large financial and human resource investment without more definite and final criteria defining meaningful use. The December 2009 updates do not significantly change the committee’s earlier direction. Variations are minor, and include the ability to implement drug-drug/drug-allergy checks, e-prescribe and check insurance availability electronically.

**While the clarifications are much welcomed, many providers (and some in the health information technology community) see a long road ahead in achieving meaningful use. The first step will be adoption, and providers are reticent to adopt unless they see the potential for a better work flow and improved outcomes for their patients.

**Providers,  now’s the time to weigh in. You can accept the government’s initial effort and be subservient to the criteria, whether they are realistic or within reach. Or, make sure that the seeds are planted now for you to eventually cultivate technologies that remove complexity, are user friendly and have the greatest impact on patient care.

• Health insurance coverage for all Americans
• Insurance market reforms that expand choice of affordable coverage and eliminate denials for pre-existing conditions
• Assurance that health care decisions will remain in the hands of patients and their physicians, not insurance companies or government officials
• Investments and incentives for quality improvement, prevention and wellness initiatives
• Repeal of the Medicare physician payment formula that would trigger steep cuts and threaten seniors' access to care
• Implementation of medical liability reforms to reduce the cost of defensive medicine
• Streamlining and standardizing of insurance claims processing requirements to eliminate unnecessary costs and administrative burdens

Is Your Practice Ready for the Red Flags Rule?

Like many of our customers, we strive to stay on the pulse of industry changes.  For me, reading up on health care trends is about more than staying in-the-know and being able to speak intelligently about the vast changes going on around us.  I try to stay current because our customers depend on it.   Today, I want to share with you my knowledge about an important industry game-changer, and explain what is included in your medical software system to  facilitate a smooth adoption of this new policy for every one of your customers. We know how important your patient medical records are to your practice.

What are some of the types of companies that must be Red Flags Compliant?

Starting June 1, 2010, the FTC will begin enforcing the Red Flags Rule. This law will require health care providers that are considered "creditors" to develop a written program to identify, detect, and respond to indicators or "red flags" of identity theft. If your organization allows deferred patient payments until services are rendered and insurance is collected, you are considered a "creditor" by the FTC, and the Red Flags Rule applies to you. In order to assist health care providers, the AMA has prepared a guidance document along with sample policies. 

Our EMR systems and practice management system has several built-in tools that facilitate adoption of your Red Flags Rule policy. These include:

• Patient "Dup Check" - Detect duplicate SSN or Last-First-DOB entries in your system.
• Patient Merge - Detect information similarities across all your patient accounts.
• Insurance Eligibility - Detect PHI that conflicts with insurance provider records.
• USPS statements Verification - Detect addresses that conflict with USPS database.
• Scanned images programs - Capture images of your patients driver's license and     insurance card.
• Patient Notes & account alerts - Flag an account in question and keep track of the investigation process.

As your medical office software provider, here at Bradford Scott data Corporation, we are dedicated to your success and we are committed to delivering quality solutions that keep you on the cutting edge of compliance.  Does your medical office billing software and EMR system cover all your needs to help you get ready for the Red Flag rule? Contact us for all of your Physician medical billing needs  bradfordscott.com/index.php

 

I read an article that I find to be proof positive that insurance companies do not care about their customer, just money. A large insurance company, that does a big business in California, sent out increases to select customers of 39%. Most were individuals not part of groups. The company, when questioned, said the increase was due to the recession. They say many young healthy customers lost jobs and could no longer afford insurance coverage. This left them with a larger proportion of older unhealthy customers. Some increases may sound necessary until I read on to an interview with a former insurance regulator.  The interview said that this company is known for making sharp increases to make rates unaffordable to older customers on fixed incomes. The older, sicker customers that have paid consistently for decades drop out of coverage, and the company then offers low rates to the young healthy customers they lost earlier. The purge makes them much more profitable over a short time. It seems, at best, unethical but apparently not illegal. I would be willing to bet no retired executive of that insurance company has to worry about an illness bankrupting them.

In my opinion, health care reform has been stopped. One of the things insurance companies want is for every American to have to buy their products, what they don't want is to have to cover sick people. Does that make sense to anyone?  I am guessing if any law is passed, it will have an out for insurance companies allowing them not to cover really sick people.

Reform has already come to medical offices in the form of the incentive to move to EHRs (electronic health records). If a system meets the criteria for "meaningful use" a large tax break will be available. Electronic claims resolution is another major part of current and future reforms. Bradford-Scott Data Corp. has a very good EHR product, Intergy EHR. It meets all the stage one criteria set out by the government and has a great electronic claims features. For more information about our EHR product call 317-713-2065 or find us on the web at www.bradfordscott.com. 
 

Medicare Claims Not Crossing Over to the Supplemental Insurer

National Government Services is informing all providers, physicians, and suppliers to an issue that occurred starting on or about January 1, 2010, and would have negatively impacted their patients' crossover claims.

National Government Services has learned that due to a system issue with the Common Working File (CWF), some claims are not crossing over to the supplemental insurance carrier for benefits.

CMS states that they are working on this issue and they further recommend that providers do the following; 
 

*         Examine your Electronic Remittance Advice (ERA) or standard paper remittance advice to determine if your patients' claims are identified as having been crossed over to your patients' supplemental insurers. Remittance Remark Code MA 18 will indicate your claim has crossed over to the supplemental insurer.

*        If you determine these claims were not crossed over, you are within your rights to submit claims to your patients' insurers for supplemental payment using methodologies acceptable to those entities.


We have taken support calls on this issue, this is just one example of the payer issues that Bradford-Scott Data corporation attempts to monitor to assist our clients with their medical billing software and claims issues. If at any time you have a question regarding an electronic rejection you have received on a report 05 or from a report 11 (payer issued) Please do not hesitate to contact our support line at (317) 713-2065 and we will do our best to assist you. For information on our Intergy medical billing software follow this link
http://www.bradfordscott.com/med_prod_practice.php