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HL7 FAQ's

Q: What is HL7?

A: "Health Level Seven". "Level Seven" refers to the seventh OSI layer protocol for the health environment. It is a protocol for data exchange. HL7 is the industry standard protocol for the interoperable transfer of medical data which is the technology used to receive and process data. Data is sent in real time mode, with only new and changed information being exchanged. Hospitals and other medical institutions typically use many different types of systems to communicate with one another. Everything from patient records to billing information, is tracked and recorded in computer systems. In order for these different types of systems to communicate with each other, they use a standard like HL7.


Discrete Recordable Transcription FAQ's

Q: What is DRT?

A: DRT is an acronym for "Discrete Recordable Transcription". A DRT enabled EHR takes transcribed output and enters it directly into the patient’s clinical chart as discrete recordable data, meaning the documentation can be queried for statistics, graphing, reporting and contributes to a “Full EHR” system.

Q:How can I get my transcribed dictation into an EMR without disruption to my practice?

A: Doctors will be able to continue dictating (if they so desire) the patient visit with no change whatsoever to the way that they are currently practicing medicine. The data will enter into the proper chart elements via HL7 technology.

Q: Will my transcribed progress notes meet meaningful use requirements?

A: Yes. The data will be automatically translated into EHR as discrete recordable data

Q: Why have so many attempts to implement EMR in practices failed?

A: In a New England Journal of Medicine publication," Off the Record - Avoiding the Pitfalls of Going Electronic" it is noted that template based documentation may distract from the important cognitive work of providing care, limiting thoughtful review and analysis. "Although completing such templates may help physicians survive a report-card review, it directs them to ask restrictive questions rather than engaging in a narrative-based, open-ended dialogue."

Q: How can I prevent EHR implementation failure?

A: A concise plan with an attainable goal, a strong support system for guidance and training will result in a “phased in” approach and a successfully implemented EMR.


Billing FAQ's

Q: Why should I outsource my billing to your company?

A: Professional billers know the industry inside out and have the right tools to get the job done.  In addition, office billing-costs (salary, employee benefits packages, Workman Compensation insurance, etc) can be eliminated or substantially reduced. You no longer have to worry about the billing getting done, when your biller or another staff member calls in sick and everyone has to attend to the business of taking care of the patients while the billing and coding goes to the back burner. The facts are that cash flow will improve with consistency, while certain costs will be reduced or eliminated.

Q: How much is your service going to cost me?

A: The fee agreement is based on what is collected, not what is billed. Contact us for details.

Q: How will you maximize my reimbursement?

A: With state-of-the-art tools, knowledge in medical billing and because our total focus is billing, claims management, carrier specific guidelines and organized follow up strategy.  Clients see immediate improvement in cash flow.  Unlike in-house office billers, which can be distracted be the daily operations of the office, we are able to totally focus on your account receivable and we are also compensated based on what we collect.  Therefore, we work very hard to maximize collections.  This means that the job gets done correctly the first time.

Q: What is included in a full service agreement?
  1. Capturing patient demographics and insurance information.
  2. Posting charges
  3. Editing claims
  4. Billing Claims
  5. Follow up work
  6. Patient Statements
  7. Appeals when needed
  8. Turn over to outside collections when needed
  9. Reimbursement Annual Fee Review
  10. Remote Terminal Access with Appointment Scheduler (included in service)
Q: What is the process for billing?
  1. Superbill (Encounter form) are either dropped off, mailed or FTP uploaded to secure site.
  2. Charges are entered and claims are edited.
  3. Claims are submitted.
  4. Electronic submission reports are reviewed for errors.
  5. EOB's payments arrive at practice, copies are sent or lockbox is set up with your bank so that payment go directly into your bank account - we receive the paperwork (EOB’s) - bank deposit reconciliation.
  6. Insurance carriers' payments are posted.
  7. When applicable, secondary claims are billed.
  8. Patients are billed and payments are posted.
  9. Monthly practice close and reports are generated and delivered to your practices with services invoice.
  10. Monthly all outstanding open charges are followed up with carriers.
Q: How often should we send our information?

A: This is up to you. Whatever works for your practice, works for us. A consistency schedule is required to keep a steady cash flow.

Q: What is your collection rate?

A: Our goal is 97% to 100% of the allowed amounts stipulated in contracts with the insurance carriers. All unpaid claims over 61 days are followed up monthly and, when necessary, the appropriate appeals are filed.   This is a team effort of your staff and ours. Our best success stories that are told are when your staff and ours work together to collect co-pay, coinsurance, deductible and outstanding account balances. The 70% percentile quarterly practice analysis, that we provide, shows how your financial statistics are averaging. We have systems in place that work.

Q: Are patients' statements included in the service?

A: Patients' statements are sent out electronically, on multi-color paper with return envelopes. Practices have the option to indicate credit card payments on the statements and whether patient mailing forwards to the new addressees.

Q: What reports are included?

A: The standard monthly reports are Practice Charges and Payments Analysis; A/R Totals subtotaled by carrier and Patient Aging. There are many reports available data can be summarized or detailed in many different customized ways and formats.  We can discuss any special reporting needs.

Q: What software do you use to manage the billing process, do we have to purchase license and will we have the option of EMR?

A: We use McKesson, Lytec with LytecMD EMR option.

Q: Will my data be secure?

A: Yes!  All billing data is backed up to a separate storage device. The Data Server is protected by fire-wall hardware, virus and malicious programs software. Strict user password policies are also maintained.

Q: How will my claims and payments be processed?

A: The majority of claims go out electronically. Medicare, Medicaid and Blue Shield claims go directly into your state intermediary, while other commercial claims go out via Emdeon, formerly WebMD. Most claims are adjudicated within 7 to 12 days from filing the claim. The Remittance Explanation of Benefits (EOBs) are received electronically and automatically posted into your database system for most major carriers. Secondary claims or patient statements are generated at this point. The follow up work is done at the same time to remits are posted, as opposed to given to another person or put aside to due later when there is time!

Q: What is involved to sign up for your service?

A: Once we have agreed on the terms, three documents must be prepared. The Billing Services Agreement outlines the terms as well as our mutual responsibilities. The Business Associate Agreement is A HIPAA document stipulating HIPAA requirements and a Practice Profile is completed to captured all of the pertinent group and provider I.D.’s such as tax ID, NPI numbers, state license, etc.