Mandatory HCFA Change

For the first time since 1990, medical providers who seek reimbursement soon will be required to use the new CMS 1500 claim form.

2006 brings two important changes to the way health claims are submitted and processed. A new provider identifier number will replace all other health plan provider identifiers, and a new claim form that includes a place to report the new provider identifier will replace the current HCFA 1500 form.

The Centers for Medicare and Medicaid Services (CMS) have created a new single provider identifier. This “National Provider Identifier (NPI)” will be used in all standard electronic transactions. The purpose is to encourage electronic transmissions by simplifying the claims process. It will allow physicians to submit claims to all health plans in the U.S. using one NPI. Beginning May 23, 2007, all HIPPA-covered entities, such as health care providers, health plans and health care clearinghouses will be required to submit their claims using the NPI.

In order to submit claims with the new NPI, the National Uniform Claims Committee (NUCC) has created a new 1500 Health Insurance Claim form. The new 1500 Claim Form includes a place to report the provider's NPI along with 40 other minor changes.

Beginning Feb. 1, 2007, the new 1500 Health Insurance Claim Form will replace the current HCFA 1500 form, also known as the CMS 1500 form. The new form was released on Dec. 1, 2005, for testing and transition preparation purposes.

NUCC Recommended Transition Timeline for the Revised 1500 Claim Form

• October 1, 2006: Health plans, clearinghouses, and other information support vendors should be ready to handle and accept the revised (08/05) 1500 Claim Form.
• October 1, 2006 – February 1, 2007: Providers can use either the current (12/90) version or the revised (08/05) version of the 1500 Claim Form.
• February 1, 2007: The current (12/90) version of the 1500 Claim Form is discontinued; only the revised (08/05) form is to be used. All rebilling of claims should use the revised (08/05) form from this date forward, even though earlier submissions may have been on the current (12/90) 1500 Claim Form.

The NUCC strongly recommends that providers contact their health plans or clearinghouses/ vendors prior to submitting a claim on the revised form to ensure that they are prepared to accept the new form.

The NUCC is recommending this timeline, in part, to complement the transition from the UB-92 to the UB-04 that will begin in March 2007. In addition, the early transition will allow the industry to implement the revised 1500 Claim Form and ensure its function prior to the May 23, 2007 deadline for reporting the NPI.

How will this affect you?

If you are interested in learning more about the upcoming HCFA changes or if you’re interested in learning about a very affordable way to always stay current with medical forms, new AMA medical codes and current medicare coding rules... Please contact us today for a live demo!

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Patient Power

Plano doctors and researchers have joined forces to cure a nagging malady: Medical billing and scheduling

Frustration favors both sides of the waiting room, as doctors juggle packed calendars and patients wait days -- even weeks -- for appointment openings.

That's expected to change, thanks to new technology.

"We believe Plano is the ideal testing ground," said Peter Voutov, chief technology officer for La Jolla Digital LLC.

The Plano firm develops software that frees doctors from cumbersome paperwork and administrative worries. And its newest innovation stands alone.

"Ours is different," said Voutov, referring to MDConnection.

And he may be right.

While hospitals have enjoyed scheduling software for years, smaller clinics have made do with less expensive systems.

La Jolla Digital's latest product is still in its formative stage, but a handful of Plano physicians are testing MDConnection in their daily practice. The Web application allows patients to manage their medical accounts without wading through voice menus or awaiting callbacks from overworked nurses.

In short, it empowers patients to handle their own affairs.

"That makes the system different because you can interact with the practice," said Voutov, whose firm gained its footing last year. That's when Plano and San Diego researchers developed medical software that provides physicians and patients affordable, understandable solutions for managing clinical and patient information.

The newly introduced product supplements Practice Manager, the firm's practice-management system, which frees doctors offices from administrative paperwork.

What makes the latest offering unique is its patient component. No longer must they wait for the next available operator or feel uneasy about the payment process. Instead, they can manage their own accounts without leaving the living room.

By logging onto the Internet, patients can schedule appointments, pay bills and review their medical records. Appointments are immediately reserved on a physician's schedule, with an automated confirmation sent to the patient.

Hospitals have enjoyed similar amenities for years. With a few keystrokes, doctors and nurses access patient records and manage accounts. But those systems cost between $30,000 and $100,000, with management and maintenance boosting the tally by up to $50,000 annually.

Privately held La Jolla Digital hopes to free users from such complications by hosting the service on a central server.

When the pilot phase ends, more physicians are expected to sign up, with up to 100 anticipated by year's end.

"We believe Plano physicians are good and on the forefront," said Voutov, as to why the Collin County docs were selected before those in other markets.

As computer users become more comfortable with interactive Web sites, Voutov believes the medical realm stands to benefit. "We automate the process and give more freedom to the patient. We handle everything."

Contact staff writer A. Lee Graham at 972-398-4266 or grahaml@scntx.com

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La Jolla Digital Simplifies Patient Management With Launch of MDConnection

New Web application lets patients manage their medical records, appointments, insurance and bills associated with their physician’s practice

PLANO, Texas – La Jolla Digital, LLC, a medical software development and hosting company, today debuted MDConnection, a platform independent, web-based patient management application that saves time and money on administrative tasks associated with running a practice.

Acting as a virtual assistant, MDConnection is HIPAA compliant, private, secure and is available online, any time of day, to help physicians and patients spend less time managing medical records, appointments, insurance and the billing process.

“Physicians across the country have told us they are always looking for ways to minimize time and money on administrative work involved with running their practice." says Peter Voutov, La Jolla Digital’s chief technology officer. “We created MDConnection to revolutionize practice management software and bring the power of a large online community to the private practice.”

MDConnection includes an advanced scheduling module – an essential tool that lets patients schedule real-time appointments for themselves and family members with their physician’s office, saving valuable time for both the patient and the medical practice. An intuitive step-by-step method guides the patient through the appointment booking, from choosing their physician to selecting a convenient time. The appointment is immediately reserved on the physician’s schedule, and an automated confirmation email is sent to the patient.

MDConnection also features an online bill payment module that allows patients to pay medical bills using a credit card or an electronic check. The billing module keeps patients informed about the status of their medical bills, which aids in the practice’s collection process.

Other time-saving features include an online patient medical record and administrative tools that allow patients to keep their personal contact information current. Since all of MDConnection’s online tools directly interact with La Jolla Digital’s Practice Management system, the medical practice benefits from the updates patients make to their current insurance, contact information and medical records.

MDConnection is an extension of the company’s new and improved Web-based Practice Manager, a leading practice management system released by La Jolla Digital earlier this year. Both MDConnection and Practice Manager utilize the same architecture and intuitive user interface and work together to seamlessly manage a medical practice. This powerful combination creates the ultimate practice management solution for physicians with practices of any size.

About La Jolla Digital, LLC
La Jolla Digital, LLC is a privately held medical software development and hosting company headquartered in Plano, Texas with engineering and testing facilities in San Diego, California. La Jolla Digital provides physicians and patients with a modern, affordable, easy-to-use solution for managing clinical and patient information. Obtain additional information by calling toll-free 1-866-856-6827 or by visiting www.lajolladigital.com.

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Web-based practice management system can streamline your operations

Administrative simplification mandated by the Health Insurance Portability and Accountability Act (HIPAA) has forced us to evaluate our needs for a practice management system (PMS), particularly if existing software does not comply with the standard electronic data interchange (EDI) claims format. The number of clinical functions related to the PMS has led practice administrators to demand compatibility and accessibility to meet many goals with a single solution. That solution should yield accessibility, efficient workflow, lower overhead expenses, increased revenue and more satisfied employees.

Accessibility
A Web-based PMS can improve front-office operations by unifying clinical and business workflows. When electronic medical records (EMR), e-prescriptions, electronic charge capture, lab-order systems and others are stand-alone applications, the administrator must struggle to integrate them to avoid duplication. Integration may involve costly programming, ongoing downloads and information technology staff.

For example, a PMS handles patient registration. Once a medical practice purchases an EMR, employees need to enter patient insurance changes into both systems. This can lead to an accounts receivable nightmare if they don't update information accurately.

Practice-management applications that use the Internet can ensure that patient information is accessible at any time from any location by physicians and appropriate staff. Groups with satellite locations must consider the cost of communication among sites to a client-server PMS within the organization.

A Web-based PMS allows physicians on call to log in over the Internet wherever they are to obtain patient records or review medications, orders and test results. The administrator can review staffing allocations right from home.

Workflow
Technology innovation is where a leading medical practice shines. From the first point of patient contact - scheduling and eligibility verification - through closure - prescriptions and order management - a rules-based PMS manages patient encounter workflow.

Lower expenses
Payroll makes up the highest cost in any medical practice. Technology can help reduce staff by automating routine tasks and freeing personnel for patient care, collections and follow-up of unpaid claims. HIPAA has increased practices' monthly claims clearinghouse fees. A Web-based PMS that offers e-claims:

• Cuts out those fees;
• Enables the back office to send HIPAA-compliant claims directly to payers;
• Can provide integrated claims-reporting data, enabling the billing manager to monitor EDI transmissions; and
• Properly translates claims into the 837 formats.

Increased revenue
A Web-based PMS allows a practice to obtain patients' insurance eligibility information online. A billing clerk can obtain a list of ineligible patients to review prior to their appointments, avoiding denials for ineligibility. Integration between the appointment schedule and payers' eligibility information can bring cost savings. A practice can also get key billing information regarding referrals and co-payments.

Improvements in managing the revenue cycle maximize payments by scrubbing data and editing invalid and missing information to ensure clean claims. Nightly EDI transmissions by the PMS vendor ensure consistent cash flow. The system identifies unbilled and rejected claims instantly.

Workforce satisfaction
Traditional practice management systems are reactive. Personnel must generate reports to review missed appointments, schedule changes and overdue recalls; track missing test results and open orders; and manage unpaid claims adjustments, aged accounts, unbilled claims, missing encounters and inactive claims.

Database changes to update the tables in a client-server PMS depend on staff entering hundreds of ICD-9* changes and updating hundreds of CPT** code changes annually, as well as other data critical to claims payment.

A Web-based practice management system can provide a proactive dashboard that brings key information to employees' desktops, enabling them to take action on issues before they become problems. A common database with valid CPT, ICD-9 and HCPCS*** codes is at the fingertips (or mouse-click) of physicians and data entry staff, promoting correct and accurate coding. A comprehensive, rule-based scrubbing engine brings alerts to operators, giving them information to make decisions before validating transactions.

What are the obstacles to consider?
As with any technology change introduced in a medical practice, the learning curve and level of enthusiasm for a Web-based PMS will vary depending on the attitude and aptitude of the staff.

If the practice has a pro-technology culture and employees use the Internet at home, they'll learn quickly. However, many medical offices do not have access to high speed Internet connections. Many medical employees lack Internet access at home or don't use the Internet at all. This segment of the population poses a significant challenge with respect to training.

The traditional client-server platform gives medical office staff the responsibility to back up and safeguard data. The change to a Web-based application may worry the practice manager who will no longer have "real data" stored on site. One solution to this concern is to contract for a CD copy of practice data on a monthly basis.

By Nancy M. Enos, FACMPE, CPC, CCP