EMRLink does not cost extra. You just need to have it running on the server computer. Whenever you sign off on an encounter in AC, the diagnosis and CPT codes will automatically go into TotalMD. You have open up totalMD later to create the claim. You can click "create claims" for all codes that do not yet have a claim or you can go to each patient file in TotalMD and create the claim one by one for each encounter. We do the latter.
You can import 835 remits (no extra cost). But we chose to not do that for several reasons. We do get ERAs through Availity but I manually post payments into TotalMD. Since most of our claims are were scrubbed at Availity before going to payers, most of the posting is straightforward. So I don't mind posting manually.