About the Author

Sheldon Needle is President of CTSGUIDES.COM, a free web site offering reviews, ratings, tools, and expert advice to help companies select software. Sheldon is a former CFO, consultant and software designer who has published more than 20 guides on software selection.

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By Sheldon Needle

5010 is not only a date 3,000 years in the future: ANSI 5010 is the newest version of the HIPAA transaction standards regulating electronic transmission of medical and healthcare transactions. The existing standard is called 4010, and 4010 does not support ICD-10 coding.

The current coding standard for diagnosis and procedure coding is the ICD-9, and it has outlived its possibilities –it limits the number of new procedure and diagnostic codes that can be created.

This is how the CMS.gov (center for Medicare and Medicaid services, at: http://www.cms.gov) defines the ICD-10:

About ICD-10
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:

1. ICD-10-CM for diagnosis coding
2. ICD-10-PCS for inpatient procedure coding

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

The transition to 5010 is supposed to happen by January 1, 2012. This means that electronic transmissions including claims, eligibility inquiries and remittance advices must be made in a 5010-compliant format. Healthcare providers, health plans and clearinghouses for transactions are all expected to upgrade their transmissions. Non-compliance may result in claims denied or slower payment.

Systems that are certified as ONC-ATCB for 2011/2012 are already 5010 compliant. If you are contemplating buying a system that is so certified, you do not have to worry about the software compliance, but you do need to educate your staff, including yourself, if you are the physician or the P.A., on what the differences between 4010 and 5010 mean to their everyday work.

If you are using old medical software that has not been updated, or are contemplating installing software that is not certified as ONC-ATCB for 2011/2012, you need to update to a newer version, or face delays and uncertainties in your billing and claims submission. In other words, do some serious upgrading, or else!

By Sheldon Needle

Should you consider integrating your current Medical Practice Management System with a new EMR, or must you shift to an EMR that includes medical practice management functions?

Practices which are relatively new to software as a management tool sometimes do not realize the very different functions that a PMS (medical practice management system) and an EMR system offer:

A PMS is used for managing administrative, billing, scheduling, and budget related (financial) information, and an EMR is used for managing clinical, patient related information How feasible is it to integrate these two functions to produce reliable information for your practice, and to fulfill government reporting requirements.

Let us assume that you are a practice ahead of the wave, and you transitioned long ago to a medical billing software and medical scheduling system. You are very happy with it. It works for you and for your patients. Now the world, and the government, are at your door, and is pushing for a more total solution: an EMR / EHR.

Do you have to ditch the practice management system that you worked so hard to install and to customize to your needs and replace it with a total solution – an EMR that incorporates financial and billing capabilities? Or is there a way to keep you medical Practice Management System and integrate it safely with an EMR minus its billing and scheduling capabilities?

Here are some issues you must consider before you can answer this question:

1. Your Practice Management System is a business system, and your EMR will be essentially a clinical system (although a full EMR will include Practice Management functions). Unless you are looking for hardships, you need the 2 systems to talk to each other in a transparent manner, and you need the possible upgrades to work in tandem. One thing this might suggest: if you are interfacing a PMS with an EMR, you had best be dealing with well known systems that are very regularly upgraded, and whose interaction with other systems are constantly monitored.
2. A single database for financial and clinical patient data would, theoretically, provide the best and most reliable data-mining capabilities for your practice. But what if your Medical PMS is very effective? Perhaps you can live with the two databases, or you have a way to periodically reconcile the two databases. Or perhaps the functional users of your databases are so different that you can live with the minor incompatibilities? Evaluate these issues closely before making a decision. Don’t throw away the baby with the bathwater.

Read the complete article at CTSGuides.com.

Ease of Use is a major factor to keep in mind when choosing medical billing software.

Here are some important considerations regarding ease of use, security, and other factors when comparing medical billing software options:

1. When you start using the medical billing software, moving from one screen or one function to another should be intuitive and make sense to you, the user.  Do transitions from screen to screen proceed logically?
2. Is there a simple graphical interface between different modules of the medical billing software?
3. What about data security and HIPAA compliance?  Is it easy to make backups of your software? Can you password-protect sensitive data from unwanted users?
4. Can the medical billing software track insurance policies and data?
5. Are there customizable templates for standard functions within the medical billing software modules?
6. Can several staff members access the medical billing software program simultaneously?
7. Is there a web-based component to your system, so that users can have  password-protected access to your  system from different locations?
8. Are the templates easy to customize for a specialty practice?  For instance, if yours is a cardiology practice, you will need different types of templates than a dermatology practice: hypertension templates, cardiac cath templates, etc.
9. How easy is it to import data from outside sources, such as HHS and other government agency sites?
10. How easy is it to fill out standard forms?  Are HCFA forms easy to fill out?  What about easy access and analysis of CPT and CDT codes ?
11. Are interfaces with external sources easy to set up from within the billing and scheduling system?
12. How difficult will it be to import data from simple software sources, like Microsoft access spreadsheets (with xls extensions)?
13. How difficult will it be to import data from paper sources?  Is there any OCR facility available for scanned data?
14. Data conversion: how difficult will it be to convert data that is already on some other medical practice or medical billing system (perhaps one that you practice has outgrown)?
15. Does the software allow for multimedia attachments, such as pictures, scanned documents, x-rays, and even voicemails and files?
16. Does the software have a “free-trial” option so that you are not locked in to the system before you have seriously tried it out?
17. What are the training options that come with the software you are considering?  Is there a human tech-support contract option that comes with the software, or is training available only online?  Is there a person that is assigned to your company to provide tech-support?  How expensive is it to buy additional tech support time for you and your staff?

No one likes to think about everything that can go wrong, but you do need to do serious planning so that things will go smoothly with your medical software implementation.  Invest the time in comparing systems up front, so that you will eventually choose a medical billing system to fit the needs of your practice.