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.
Posted by Art Misita on Sat, Dec 26, 2009
Every week a health care therapist decides to take the plunge into private practice - either starting out fresh out of school or after working for another practice for a while and deciding that the time is right to try entrepreneurship.
So they visit their local commercial realtor and find the perfect small office space, just the right size for a therapy room and a reception area. The next call is to the telephone company to arrange office telephone service and probably Internet service. They go to their local office furniture outlet and but a few pieces of attractive, but affordable furniture. And then they either purchase an answering machine or voice mail service, a photocopier or all-in-one printer/copier/fax machine, and one or two computers for the office, or they round up castaways from friends and family members that will suffice for a while. Microsoft Office and perhaps QuickBooks will get them through.
Finally they go about spreading the word among friends, colleagues and former patients that they are in business and welcoming patients in their new practice.
It might look like they have closed the startup circle quite properly, but we would suggest that they need to add one more item to their practice technology suite - a practice management system.
Let's define exactly what a practice management system is, and what it does for your practice.
We will use The Practice Resource, the practice management system developed and marketed by Tech 2 Go, as our model for this discussion. The "complete" practice management solution automates the management of all of the critical data required to manage your practice - patient records, appointment scheduling, patient and insurance billing and collections, therapy notes and documentation, document management, practice financial tracking and analysis and personnel records management. And as the standards are defined and released by the federal government, outlining the requirements for a national electronic medical records (EMR) system, it is critical that the practice management system provides the necessary procedures for bringing your practice into the loop on this pending federal mandate and that you have the necessary tools to participate in the EMR data exchange.
You have a diploma hanging on the wall that proves that you are trained to provide therapy services to patients in your chosen discipline. You probably also have a license issued to you that permits you to practice in your state. But a therapy practice is much more than just so many therapy sessions provided per week. It is a business and needs to be run as a business. And for a business to be run successfully, it must be organized and must use proper business procedures - you need the right forms, the right files, the right inputs and outputs to allow you to keep on top of the information flow that your practice will generate.
You need to be able to
- Capture information from your patients when they pay their first visit to your office - their intake information. This includes demographics, responsible party data, insurance coverage and contact information.
- Capture your evaluation findings and progress notes during your therapy sessions.
- Schedule patient appointments with an appointment scheduling system that is integrated with your patient records and can share data with your Outlook calendar, your PDA or your smart phone.
- Generate invoices or payment receipts for self-pay patients, preferably to be handed to the patient at the time of service to assure prompt payment.
- Generate insurance claims for patients with insurance coverage and to submit those claims to the insurance companies as quickly as possible to shorten the time from therapy to payment.
- Submit your insurance claims electronically via a clearinghouse. Do not waste your valuable time re-keying data (that you have already entered into your computer) into an insurance company web portal. With a practice management system you enter the data ONCE and it flows to all of the necessary places automatically.
- Collect copays from insurance patients whose policies provide for collection of copays, and to track those patients who have not paid those copays at the time of service.
- Generate and mail accounts receivable statements usually on a monthly cycle to patients with outstanding balances to speed up collection.
- Track therapy session activity for patients being treated under a managed care authorization to assure that you are not treating them "free of charge" because they have exceeded the limits of their authorizations. You need to request extensions or replacements of those authorizations before they are exceeded to avoid non-payment.
- Bill third party agencies such as school districts responsible for certain patient charges on the proper forms and on the proper calendar cycle.
- Prepare year-end tax reports requested by patients listing therapy payments made to you during the year to assist them in filing their personal tax returns.
- Prepare and distribute referral reports to referring professionals usually including information from your therapy progress notes.
- Comply with an increasing number of government agencies, health care professionals and other individuals requiring that documents from your practice are digitally signed to prove their provenance and to prevent unauthorized modification or tampering.
- Maintain and manage your patient records with a system that is fully compliant with HIPAA privacy regulations and standards.
- Generate an awareness of the referral sources of your patients and the value brought to your practice by each of those referral sources. You need to thank your referral sources for their referrals.
- Analyze the profitability of your practice and its components (patients, therapists, procedures, payment forms, diagnoses, service locations) so you can make the right choices to help maximize your profits.
- Organize patient records and documents on your computer to facilitate quick retrieval of individual patient documents when needed. This should include the capability of storing scanned documents, images, videos, digital photographs, Word documents, Excel spreadsheets and documents in Adobe PDF format on your computer network and accessible from the individual patient charts.
Operating a private therapy practice, and doing it properly, involves much more than you ever anticipated when you decided to start up your practice. The good news is that the right practice management system will help you perform all of these tasks with a minimum amount of your scarce free time, leaving you free to do what you need to do - provide therapy services to your patients.
Your practice, your business, needs all of these tasks - these jobs - to be performed by someone (or something) in your practice. They are not optional. But they can be performed by your practice management system, as long as you have one installed and as long as you use it properly and faithfully.
And you do not need a large staff to qualify as a practice management system user. The single practitioner (with or without a clerical assistant) benefits from a practice management system just as much - and often even more - than a larger practice. You are all in the same business and you all have the same requirements. You all need to become and remain organized. You all need to manage the financial aspects of a private practice. You all need a practice management system. Probably a lot more than you need that framed lithograph that you saw in an art gallery on your recent vacation.
A good practice management system is intuitive. You know what you do for a living. You know what the daily data elements are that you need to manage. With the right practice management system you need only to be shown where to put the data, because there is already a place that has been provided for everything that you need to capture. You just need to know where it goes.
The right time to install a practice management system is TODAY. Get it up and running before you are overwhelmed by the information flow. Put it in place the day you start up your new practice. Start out doing things the right way, the organized way. Have it in place to help you as you grow. You might decide to always be a one-person practice or you might decide to expand as the opportunity presents itself. Your practice management system will support you whichever path you follow.
And practice management systems are not all beyond your limited budget. Check out The Practice Resource, The Affordable Practice Management System For Therapy Practices.
Posted by Art Misita on Tue, Dec 22, 2009
Every IT consultant can keep a crowd entertained with customer "war stories" accumulated over a lifetime in this business. But there is one such story that I will never forget, and that is still every bit as relevant today as it was when it happened thirty-five years ago.
I owned a software company that developed and sold car rental software. One of my first customers was a used car rental business in New Jersey. They had installed one of the very first IBM PC's ($5,000 for a computer with a 10 MB hard drive and two 5.25 inch floppy disk drives running the original Microsoft DOS operating system).
One day I got a phone call from their office manager. Their hard drive had failed and IBM replaced it. The IBM support person also reinstalled the DOS operating system but we had to reinstall our software and recover their database form their backup diskettes. In those days their database backup required three diskettes to fit the full backup. I asked the office manager for the backup disks to restore the database and she handed me one diskette. I told her that there should be three diskettes and she smiled and proudly told me that they had found a way to save money and time on diskettes by just leaving the same diskette in the drive every time the backup program asked for the next diskette. So, every day their backup used only one diskette - over and over again. I had the unpleasant task of telling her boss, the owner of the business, that he had just lost two years worth of data due to his staff's ingenuity. He started advertising for a new office manager the very next day. And the following week the replacement person started re-entering two years worth of rental contracts and payments from paper copies in their files.
Another story will bring home the point of this article very succinctly. One of our customers in the travel industry faithfully ran their backups every night, changing the backup tape before leaving for the day. They had a hard drive head crash and the drive was replaced by a local hardware consultant. They asked us for our assistance in restoring the database for their reservation system which we wrote and maintained for them. We asked them to mount the backup tape in the tape drive and the tape was blank. So were the tapes for the past five days (they maintained a set of five tapes and recycled them each week). We checked the backup logs and found that the backup had been failing every day for almost three months. We had instructed the client in the proper backup procedures and at the top of the list was "check the backup log for last night to be sure the backup ran successfully - if not, call Tech 2 Go". Needless to say we never heard of any backup failures and the one day they needed the backup the most it was blank. And they lost more than three months worth of business transactions.
The backup drive - whether it is a USB memory stick or an external hard drive, or any other sort of backup device is an insurance policy for your business. It is meant to keep you from losing data. It is meant to get you back up and running when your drives fail. But you need to run the backup software every night as a scheduled task, you need to verify that it is running properly, and you need to be sure that someone reliable is making certain every day that your insurance policy is "paid up".
You need a backup plan that provides for keeping backup files off premises so that you can recover your data in case of a fire or theft of your computer hardware.
First you need to purchase an external backup device that wilk hold your daily backups. We recommend a USB external hard drive such as the Western Digital My Book Essential. It is reasonably priced and will easily store a full week's backups on a single drive.
Next you need reliable baclup software that is capable of managing multiple backup files on your external hard drive. For that we recommend Acronis True Image Home 2010. This is the product that we use to backup our own systems. We set it up to backup the full C: drive once per week, and then to create incremental backups on the remaining six days per week. Incremental backups save only those files that have been changed since the last full backup. With True Image Home, our weekly full backup runs for about 2 hours at 2:00 AM and saves 180 GB of disk files. The daily backups on other days runs for about 10 minutes at the same time early in the morning when nobody is using the system.
We have set True Image Home to produce a daily backup log, WHICH WE CHECK EVERY MORNING, and we have the software set to send an email to my email address in case of a backup failure.
Scheduling daily backups is a critical task. Checking every day to be sure those backups are running successully is just plain smart business practice.
It might not sound like a capital offense was committed when someone says that they skipped the backup because they had to get to the theater last night to meet a friend. But we can guarantee you that the one morning that you will need the backup volume the most is on the morning following the night when it was not run.
Your business probably supports you and your family and your employees' families. Protecting your business data ought to rank fairly high on your list of priorities.
Posted by Art Misita on Mon, Dec 21, 2009
Recently one of our therapist clients made the statement that 90% of all therapy practices are viable but that a much smaller percentage are profitable. That conversation stimulated a discussion in our office about the importance of profitability and how technology might be used to help therapists to improve their bottom lines.
All too often a therapist, when asked about their revenue stream, will present a number - the amount that they "billed" in the last month, or quarter or year. Since most small business owners understand that profit is generally defined as income less expenses, they will also include their total expenses in the disclosure. Simple - amount billed less expenses equals profit. But there is a huge hole in that formula. And that is because amount billed is really a meaningless number in the health care business. It is amount collected less expenses that equals profit. Understanding the gap between billing and collection is the key to understanding why profit is often unattained. Reducing that gap is the key to making that profit appear on the financial statements for the practice.
In an entirely "self pay" pay practice, bills or statements are presented to responsible parties and hopefully they remit their payments of the amount billed in full on a timely basis. When that happens the profit begins to show on the financial statement. There are many therapy practices that treat all patients on a "self pay" basis, and their profit is more or less easy to predict and to measure as long as their collections are steady, timely and successful.
But in our current economic climate it is far more common for the majority of therapy practices to accept health care insurance in partial or full payment of a patient's financial obligation to the therapist. And that is where the billing and collections gap begins. Some insurance policies, particularly those that are usually referred to as "executive benefit plans" issued to high-income corporate executives might pay amounts close to the amount billed by the therapist, and might pay them promptly, but those plans are rare and are quickly disappearing as the premiums for those plans keep increasing. More commonly insurance companies will pay less than one half of the amount billed by the therapist, and that amount will be paid by the insurance carrier only after the policy holder's annual health insurance outlay has reached the annual deductible amount. Herein lies the real reason why the amount billed less expenses equals profit calculation fails the reality test. The amount collected less expenses that equals profit yields the real profit amount, and that is almost always a much smaller and often negative result.
There is possibly very little that a therapist can do to overcome the collections gap. But the profit calculation still includes the expenses amount and the therapist has a reasonable amount of control over that number. You make your practice profitable by keeping your expenses at a level that can be supported by your collections, not the reverse (as too many small business owners try to do).
Also, when dealing with insurance companies you also find that certain procedures are accepted for payment only when the presented diagnosis matches the insurance carrier's list of approved diagnoses for the reported procedure. Diagnosis X might be rejected by the insurance carrier but Diagnosis Y might be accepted. When both are legitimate diagnoses for your patient you improve your collections by using the right diagnosis (as defined by the insurance carrier's past claims approvals/denials). You "play the game" using the insurance carrier's rules since they are the players who control the outcome (unless you believe that you can manage to operate a practice that does not include acceptance of insurance).
And this is where technology becomes one of your best allies in managing your financial success. A good practice management system will help you to analyze your billing, your collections, your procedure and diagnosis coding, your payment turnaround time, the profitability of different procedures and diagnoses based upon your actual historical data, and will help you to steer your practice in the direction that will help you to maximize your profits. A good practice management system will help you to identify which patients are profitable and which are not, which therapists generate profit and which do not, which procedures are profitable and which are not, which diagnoses are accepted by insurance carriers (and you collect the fees billed) and which are not. In the end you might find that having two more therapists will dilute your profits, not increase them. Or you might find that one of your multiple disciplines generates significantly more profit than another and that you should realign your expansion plans.
A simple report, generated by your practice management system, containing a few simple columns could help you to move your practice from viability to profitability:
- Patient
- Therapist
- Procedure
- Diagnosis
- Duration of Therapy Sessions (Time Spent)
- Amount Billed
- Amount Collected
- Writeoff Amount
- Form of Payment
- Insurance Carrier
- Days Between Billing and Collection
And, if you do not have a practice management system, then you should seriously consider purchasing and installing one. Technology can easily become one of the most valued members of your management team - freeing you up to do what you do best.