Posted by Art Misita on Thu, Apr 08, 2010
We think this recession needs a kick in the wallet!
So we have reduced our prices for the system for the next 30 days (or so).
Single user version now $495.00 (was $795.00)
Multi user version now $995.00 (was $1595.00)
Multi practice version now $1495.00 (was 1995.00)
Now that is practice management software being offered at a price ANY practice can afford!
But you must buy it NOW before we come to our senses.
Posted by Art Misita on Wed, Apr 07, 2010
We have been working with therapy practices for the past five years, and many of the support calls we receive are related to rejected claims.
In almost all cases, when a claim is rejected by the clearinghouse it is the result of coding problems, not insurance coverage issues. The clearinghouse does not know what coverage a patient has or which diagnoses are acceptable for a particular policy. But they are intimately familiar withe the coding rules for HCFA 1500 claim forms.
There are two particular suggestions that we would make in this regard. First, even though the federal guidelines do not require that you supply your practice name, address and NPI in box 32 if you provide therapy in your office or the patient's home, we strongly recommend that you include that information on claims for office therapy sessions. An increasing number of therapists have reported to us that they have had claims rejected by specific carriers for leaving box 32 blank with "11" in the place of service, indicating "OFFICE". It is easier and safer to supply that information and avoid rejection than it is to argue on technicalities.
The second suggestion we would offer is that you should not show referral sources on claims unless you need to prove medical necessity. A referral source without an NPI, or a referring professional who is not recognized by the insurance carrier is also a frequent cause of claim rejection. If you do not need to provide a referral source, then leave box 17 blank. Don't supply a reason for rejection if you can avoid it.
The Practice Resource will automatically blank the box 17 fields if the NPI for the referral source is missing, but you must make the notation to leave it blank when the referral source table entry for a particular patient contains an NPI.
We are happy to share our experiences with you - we want you to succeed in claims processing since that is part of the reason why you purchased a practice management system to begin with.
Posted by Art Misita on Mon, Apr 05, 2010
Every therapist expects their practice management system to support the billing and collections process. But there are several other features that you should be looking for when choosing your practice management solution.
The table of contents for the "right" system for your practice will include chapters describing support for managing all of the following patient record data elements:
- patient demographics
- emergency contacts
- diagnoses
- therapy session history
- clinical therapy notes
- billing/accounting notes
- administrative notes
- document management for patient-related documents
- customizable forms for patient data collection
- user-defined dropdowns and text boxes to collect data not capture by the system right out of the box
Most therapists do not prescribe medications for patients so medication histories are not in our list, but if your practice includes physicians or other health care professionals who are legally permitted to write prescriptions or administer medications to patients, then a medication history should be added to the list.
You might not choose to implement every one of the listed data elements for your practice. But the system you purchase should give you the ability to make the choice, not to make it for you by not providing the data collection capability.
The following is a brief description of the data elements listed above:
- patient demographics - patient's home and business addresses and home/business/cell phone numbers; referral sources; primary related physicians; responsible parties; third party agency affiliations (like school or judicial district)
- emergency contacts - parents of child patients, neighbors, friends and other individuals to be contacted in case of emergency
- diagnoses - list all diagnoses made by either therapists in your practice or by a patient's physician(s), very useful when searching for research data
- therapy session history - a chronological list of the therapy sessions for a patient
- clinical notes - progress notes written by the therapist either during or after each session
- billing/accounting notes - details of contacts with the patient, responsible parties and insurance carriers related to billing and collections for therapy charges
- administrative notes - notes not included in the above two categories
- document management - you should have the ability to store a wide variety of documents (scanned images, word processing documents, spreadsheets, photographs, videos and documents in Adobe PDF format) related to the patient, allowing you to open those documents from the patient's chart and to print them on demand
- customizable forms - you should have the capacity to design data collection forms for your practice and to store the blank forms in each patient chart, to complete (fill in) the forms and print out the completed forms
- user-defined elements - since it is impossible for any software designer/vendor to anticipate your practice's every need, they should give you the capability to define and add a reasonable number of customized dropdown boxes and text boxes to patient charts
And last, but most certainly not least important - your system and your practice IT environment must both be HIPAA compliant.
When your practice management solution provides support for collecting and managing all of those data elements, you have chosen well.
And, in case you have not already noticed, The Practice Resource, Tech 2 Go's therapy practice management system provides every one of the features listed above, and new/expanded features are added to our system every week.
Posted by Art Misita on Mon, Apr 05, 2010
Many therapy practices engage the services of a medical billing service to process their billing and insurance claims. There are many different reasons they offer for having chosen that option. Here are a few that we have heard:
- They are too busy to do it themselves
- They don't understand the complexities of medical billing
- Billing services have better success at collections from insurance carriers
- Billing services are better able to appeal denials from insurance carriers and do not accept them or tolerate stalling tactics
The cost of the billing service, if you are using a typical small local service company is usually 4-10% of gross collections. If you choose one of the larger companies with several billing employees and lots of therapists as clients you will probably need to pay a fee of 8-15% of gross collections. The math is simple. You are paying $4,000 to $15,000 each year out of every $100,000 of revenue for the billing service.
And the sad truth is that the service from the typical small billing company that you are likely to choose is not very good. Many of those people are stay-at-home moms who took a web or CD training course on "How to Make $40,000 Per Year Working From Home". They learned in their course how to purchase software, how to print business cards and how to present themselves as a professional service company. They probably got the bare minimum of training in medical billing policies and procedures. But the one thing most of those people have in common is very little or absolutely no experience when they sign you up as their first (or only) customer. Their success rate in collections is no better than you would have if you just printed and filed your own claims. They probably have no experience in appealing denials or responding to stalling tactics. They are often little more than paid data entry services.
The most successful therapy practices
- Get all of the right tools to use in their own office - they buy a good practice management software product designed for therapy practices and offering many more features that a therapy practice will find useful, not an old or obsolete medical billing system like Medisoft or Lytec
- Design and use the right forms for patient intake, registration and interviews
- Produce letterhead bills and statements for self-pay patients that are complete, accurate and easy to read
- Present a bill and collect charges due from the patient at the time of service
- Collect insurance payments typically in 15 days, but certainly not more than 60 days
- Collect 95-100% of all billable charges by coding claims properly and filing them promptly
- Maximize reimbursements by filing electronically through a reliable clearinghouse
- Preserve patient loyalty by not allowing insurance company tactics to drive a wedge between the patient and the therapist
- Hire employees with medical billing experience and pay them a salary that will encourage them to work hard, remain with the practice and provide a comforting and caring face from the practice to the patient community
A good therapy practice management system like The Practice Resource will allow you to be your own billing service with a time investment of no more than one half hour per day. You will produce patient bills and statements while the patient is in the office for a therapy session, maxmizing the likelihood that you will receive the patient portion of the charges at the time of service or very shortly thereafter. And you will file insurance claims electronically so they are in the insurance company's computer system at the end of the day that you provided the therapy.
And best of all, you get to keep the 4-15% of the revenue that you otherwise would pay to the billing service. You can find a better use for that money - you can pay your office staff better and get better results from them, or you can keep the money in the bank where it can work for you, not the billing service.
Posted by Art Misita on Wed, Mar 17, 2010
As we provide remote product support to our Practice Resource customers each day, we find many who use Firefix as their web browser instead of Microsoft Internet Explorer.
Their reason - Internet Explorer is "full of holes" and Firefox is a much "safer" web browser and less likely to expose you to viruses and malware.
Well, take a look at this article from the ProSecure division of Netgear, a major purveyor of Internet security hardware:
web-browser-vulnerability-report---firefox-leads-the-pack-at-44.php
It looks like the "giant killers" (those who spend most of their days hating Microsoft and all of its products) might need to rethink their acceptance of some clearly flawed acquired wisdom.
You avoid acquisition of viruses by avoiding the web sites that contain the banner advertising and "free" offers that spread that malware, not by avoiding the web browser that provides the most extensive array of features and that is the de facto standard for web browsing.
Posted by Art Misita on Tue, Mar 16, 2010
Most practice management software is sold with a fixed initial period of support and update availability. After that period expires, you have the option of continuing to receive support and updates by paying some sort of recurring maintenance fee. The obvious questions are (a) why do I need to pay every year and (b) should I keep my support and maintenance coverage active?
Unless you paid more than $10,000 or $15,000 for your practice management software, the software company probably will not realize any profit from the sale of its software to your practice. The initial packaging and shipping of the product to you, the initial installation and training on the use of the product, and the dozens of support calls during the first few weeks probably eat up every dollar that was collected from you as the purchase price. It is for this reason that so many software companies have begun to experiment with 30 or 60 or 90-day initial support periods, charges for installation and for training. Profit might be the goal of a business, but is definitely not guaranteed in the practice management software market.
Software companies must continually add new features to meet existing customers' and new prospects' expectations must also and fix program bugs. Programmers' salaries are just as expensive as therapists' salaries.
Then there are the customers with a high turnover rate for office/administrative staff. In case the software company did not lose money on the initial sale, there are several more opportunities to do so waiting around the bend. Every software company has a long list of stories to tell about practices that should buy erasable business cards since they might go through 3 or 4 (or more) office managers per year. And the software company that includes unlimited support and training must train every one of those new staff AT NO CHARGE! So, one of these revolving door practices can place a demand of 20-50 hours of training time on the software company in a single year. How much profit do you imagine is left over from a $1,000 - $2,000 product sale after the product is packaged, shipped, and training has been repeated 3 or 4 times?
And then consider the customer who calls to say that they just bought twelve new workstation computers for the office and need to install and configure the system on each of the workstations. That translates to another 15-20 hours of support time that the customer expects to receive at no additional charge. Or the customer who calls to say that they cannot access the system from a remote location and their IT consultant assures them that everything was set up correctly on the router and the firewall, so it must be the practice management software that is at fault.
These are not hypothetical or artificial examples. They are very real anecdotal situations and they explain why software companies must charge for support and maintenance and why they must NOT yield to pressure to waive those fees. No software company can survive very long without collecting enough revenue to cover its costs. And no software company's customer benefits from the software company's bankruptcy.
And as for why you should pay your annual maintenance bills promptly when you receive them. Very simple - these are all real examples of real life situations and you could be next. When your database computer's hard drive fails and you need help to restore the database from your external backup, or you lose one half of your staff and need to start training all over again, you need to have someone to turn to, and customers who let their maintenance arrangements lapse find themselves in a very difficult and very expensive quandry.
You probably do not provide your therapy services at no charge and there is no reasonable expectation that your software company should or will do so. Software maintenance is an insurance policy and one that is well worth having in full force and fully paid up at all times.
Your practice management system is just as important to your practice as each of your therapists. Make certain that it is always available, reliable and healthy.
Posted by Art Misita on Wed, Mar 03, 2010
Almost two-thirds of our Practice Resource customer base have our multi-user network version installed. That means that they are running our system on multiple computers concurrently. The receptionist might keep the system open to the appointment schedule, therapists might open the system when it is time to enter their clinical notes, and the office manager/administrator might use it to do the day's billing and electronic claims submission or to produce reports.
What all of these practices have in common is the need for a networked solution. But their specific network needs might be very different.
The simplest network configuration is a peer-to-peer network. That involves the installation of an Internet gateway router (wired or wireless) which allows all of your computers to share your Internet connection and also concidentally allows those computers to access a shared Practice Resource database installed on one of those computers (which we usually refer to as the server/workstation). There is no network operating system, just Windows XP (Home/Pro), Windows Vista (Home/Pro/Ultimate) or Windows 7 (Home/Pro/Ultimate) installed on each of the workstations. You need to configure the Windows firewall to allow the request for database access to pass through the firewall on the server/workstation. This configuration works well for a network of up to 4 or 5 computers, and works best when the server/workstation is set up as a dedicated station and not used any more than is absolutely necessary for processing tasks other than serving the remaining workstations as a database server.
The next level of complexity involves the installation of what we usually refer to as a "true" network with a network operating system such as Microsoft Windows 2008 Small Business Server or Microsoft Windows Server 2008 Standard. In this configuration there is a dedicated server that runs the network operating system and can handle a much larger number of attached workstations (perhaps as many as 20-25 workstations might be common in a therapy practice using this configuration). The dedicated network model usually also includes the implementation of shared disks, a higher-volume version of the Microsoft SQL Server database manager, shared devices such as printers and scanners, and an intranet messaging/communication product such as Microsoft Exchange allowing email between and among internal users as well as outside parties.
In both of the first two configurations, the Practice Resource application is installed on each workstation and the database is installed on the server/workstation or the network server. As a result there is a lot of network traffic generated by database queries and updates. Both of those configurations can also be set up to allow remote access to The Practice Resource database from remote workstation computers which have The Practice Resource installed on them such as your computer at home or the laptop computer you carry around with you. The Practice Resource "finds" the database through a connection over the Internet. The remote access is much slower than local access within the office, but it works and gives you access to your system from anywhere that you have a high-speed Internet connection (like your hotel on a vacation or business trip).
And then there is an option that few of you might have heard about - a terminal server configuration using Windows Server 2008 Remote Desktop Services. On a terminal server network all of the processing is done for all concurrent users on a dedicated terminal server computer. The Practice Resource application is not installed on any of the workstations. Instead those workstations (remote and local) attach to the application running on the terminal server using the Microsoft Windows Remote Desktop client application that is included with Windows. There is no database traffic sent to/from the terminal server and the workstations. Only screens and keystrokes are transmitted back and forth. Remote access is virtually just as fast as local access. The cost of a terminal server network is the cost of the terminal server computer (which needs to be selected and sized to provide the speed and capacity of the application load that it will be expected to service) and its operating system (which can be Windows 2008 Server Standard plus terminal services access licenses in a sufficient quantity to cover the maximum number of expected concurrent users).
We have several terminal servers running The Practice Resource in our customer base and all have reported total satisfaction with the environment. Some profiles of those customers: (1) a practice in Illinois whose bookkeeping and claims processing is done by a family member in Florida; (2) a practice in California with users accessing the system from their offices as well as from their homes; (3) a practice in Florida with several therapists providing home health care to patients and updating the system at the end of the day from their home computers; and (4) a practice in New Hampshire with dozens of therapists around the state providing therapy to local schools and updating the system at the end of the day with their therapy activity and clinical notes. The terminal server is the perfect configuration for a mixed local and remote access network with a significant amount of remote traffic. And the best news - workstation computers do not have to be big and powerful - they are not where the real work is being done. Your older workstations will work quite well on a terminal server network.
Whatever your network requirements, Tech 2 Go certified network specialists are happy to work with your local IT consultants to help you to build the right environment for your practice.
Posted by Art Misita on Tue, Mar 02, 2010
One of the new FAQs of our business relates to a method of capturing patient signatures for the CMS-1500 form boxes 12 and 13.
Most practitioners are content to have a signed CMS-1500 form in their patient's chart folder, but in anticipation of the implementation of electronic medical records storage in the database and the eventual requirement to be able to transmit that signature that you normally claim to be "on file", an increasing number of our customers have expressed an interest in acquiring a signature scanner that they can use to capture the patient's signature in the office and then to be able to transmit it as part of an insurance claim or in response to a request for proof by a regulatory agency.
So we have done some research and have identified the SigLite 1X5 Digital Signature Capture device from Topaz Systems, Inc. (http://www.topazsystems.com/), available with a USB interface and selling for approximately $100.00 from various sources on the web. It comes complete with a soft stylus/pen and a replaceable overlay, includes all necessary drivers and interfaces with Microsoft Word so you can easily save the scanned signature in The Practice Resource patient document library. We also found many other signature capture scanners that sell for three to four times the price, but this model seems to be quite affordable and more than adequate for the typical therapy office - our primary customer base.
As technology marches on, so does the expectation level of regulatory agencies. Here is one item that will very likely be on the office requirements short list very soon
Posted by Art Misita on Mon, Mar 01, 2010
Have you been computer shopping lately? Windows 7 is the operating system that is currently being offered on virtually every new workstation computer and notebook from every major manufacturer. Microsoft has effectively killed Windows XP Professional and the sainted "XP Downgrade Rights" are all but a distant memory.
The good news is that Windows 7 Professional is a really solid, well-tested operating system. Windows 7 is possibly the most extensively tested operating system that Microsoft has ever released. (Vista gave the software giant a whole lot for which to atone in our humble opinion). And much of that testing was done by Microsoft customers and partners, not just internal staff eager to earn promotions by saying whatever the top floor wanted to hear.
Microsoft has added the exclamation point to the XP Pro obituary by announcing officially that the company will end support for Windows XP SP2, Windows 2000 Server and Windows 2000 Client on July 13, 2010. (Perhaps they will do something similar with Office 2000 so a ton of local law firms will reach into their piggy banks and upgrade their aged Office 2000 installations to Office 2007 in time for Office 2010 to make its retail debut). Windows XP SP3 (the last service pack for XP) is still being supported, but there is no threatened end date as yet.
One suggestion that we would make, however. Stick to 32-bit processors for workstations for the coming year. While 64-bit machines are becoming very popular, there are still far too many bugs in the 64-bit versions of Windows 7, SQL Server and Office for our comfort. Our practice management software, The Practice Resource, will run on a 64-bit platform, but we have found a large number of unpredictable and inexplicable product failures when running on 64-bit platforms that do not occur on the 32-bit versions using the exact same functions. SQL Server database updates, for example, simply do not work every time on 64-bit machines the way they do with absolute reliability on 32-bit machines. It is also still very difficult to find 64-bit drivers for some printers and other peripheral devices (especially older ones - more than a year old) that you might wish to migrate to your new computers since they still work fine and otherwise have no need for replacement.
Few corporate IT departments upgraded computers to Vista since its negative reputation was established very soon after its release, but it is beginning to look like Windows 7 upgrades will not be delayed quite so long in light of the looming deadlines for termination of Windows XP support this time around.
Microsoft might continue to release critical security updates for XP SP2, but they have not said that officially. The official position of Microsoft is that it is time for Windows XP to exit stage right.
An upcoming blog article will include some of the hardware/software offerings from Hewlett Packard that offer some very attractive savings as part of their Windows 7 upgrade campaign. We will also offer some very useful tips to help you to get the most performance and value from your office network.
Posted by Art Misita on Sun, Feb 28, 2010
Every week we are asked which clearinghouse we recommend for practices that are just starting to consider filing insurance claims electronically. Or a customer will ask whether our electronic claim transmittals are compatible with their current clearinghouse, but then we find out that they are not very happy with the service provided by the existing service provider.
For years we avoided recommending any single clearinghouse, believing that most clearinghouses were just as capable as any other. But we have reached a new conclusion after working with dozens of clearinghouses over the past five years. They are not all the same, and one clearinghouse appears to have emerged as the one that we can endorse without reservation - www.officeally.com.
We currently have more than 100 practices using our Practice Resource software, and several of those customers use Office Ally. We have never received a single complaint about their service. We have one customer who has been using Office Ally for more than five years with total satisfaction. And several others who have recently started with them and who report only positive experiences.
Jose Rivas, Office Ally's Enrollments Manager, personally supervises the setup and initial training of every one of our customers that we recommend to them. Their executive staff have always done whatever it takes to assure that even the most complicated problems encountered by therapists in submitting claims have been resolved favorably. We do not receive any sort of remuneration from Office Ally. We ask only that they treat our customers professionally, promptly and courteously.
And the best news of all is that Office Ally's clearinghouse services are absolutely FREE! As long as a sufficient percentage of a customer's claims are filed with commercial insurance carriers, Office Ally will process even Medicare and Medicaid claims at no charge to the therapist. Commercial carriers pay clearinghouses to process claims, providing the revenue that the clearinghouse needs to remain in business. Medicare and Medicaid do not pay for claims processing, so most clearinghouses charge for processing those claims. But Office Ally does not, as long as the percentage of commercial claims is sufficiently high.
So, when you are looking for a clearinghouse to process your electronic claims, www.officeally.com is the right one for you. And The Practice Resource is the right practice management system to create those claims for electronic submission.