Home Forums Discussions Feedback and Recommendations Superbills

We use EZClaim with AC because the conversion of data is so easy. The downfall is the fact that the only way the diagnosis codes transfer is if the doctor makes the superbill. This makes for frustrating work since we have innumerable patients who pay at time of service or pay other amounts and need a receipt given to them when they pay. What sense does it make to record their payment in another place and then have to re-enter it all later. AC should allow for the diagnosis codes to fill in on the drop down menu when the superbill is made. Also, we have innumerable nursing procedures such as EECP and HOT. The nurses do their own charting and superbills in these cases and I have to manually add these every time making the compatibility of these programs.

Since the last update, the file export from AC to EZ does not carry the diagnosis codes that are entered as permanent in a patients EZ file over and I have to enter those by hand every time. Apparently, AC hasn’t gotten around to changing this but since I bought the billing software based on their recommendation it would be nice if they would support a more functional transition.

I'm not an AC user, but I've looked at it quite a bit and I find the fact that the chart must be signed off to submit ICD-9 and CPT codes to be a dissuasive factor. I'd like the option of sending the bill to the check-out desk without signing off on the chart.

Hi Basheer,

The problem though is that the coding can change depending on what you do with the note. I agree, though, that it would be nice to be able to do something BEFORE the note is signed off, as when I get behind on my charting it kills my cashflow.

We're working on the design of a more comprehensive practice management solution for Amazing Charts version 4. Being able to code and lock the billing before the note is completed isn't something we'd considered, however you have an excellent point. I'll discuss it with Jon next time I talk to him or at the next design meeting. There would have to be a way to "lock" the billing and coding on the note - as what you bill should match what you documented.

In paper systems medical offices work this way every day - the paper superbill with the charges goes to the front for checkout and then to the coder / biller to be billed, while the doc dictates the note and it goes out to transcription, or whatever.

Are you sending the bill for the visit to your checkout desk? or just the copay? Already designed in Version 4 is copay collection up front rather than waiting for the coding and superbill to be created.

Thoughts from the group would be helpful here - we're still at the DESIGN stage, which is the easiest time to change the feature set.

Regards,

V.

We actually only contract with Medicare so when we are billing for out of network benefits there is a co-pay which will vary based on the visit. While we are paperless, each patient walks out our door with a Treatment Plan which they enjoy receiving as it reiterates treatments ordered, supplements suggested etc. With our injury patients these forms go straight to the carrier. On the Treatment Plan there are Roman Numerals which the attending physician circles to indicate to the front desk which code to use for the visit that day. Because the co-pay amount will vary, it is a mess to sort out when it comes to exporting the data efficiently and we end up with several super bills not infrequently.

The bill isn’t sent anywhere after the patient has been seen as the patient often checks out long before we finish our charting. Not all of the practitioners at this group have their charting complete before the patient leaves. Many take notes by hand and chart later or dictate with Dragon Voice. I am not certain what other clinics do in this situation or if they even have these concerns. I have to say that we always have an efficient team when it comes to communication and coordination of the appropriate charges at check out time and locking charts or superbills is not something that appeals to me. I would prefer my staff be enabled to work with the same superbill for one patient rather than having to create many. Perhaps this will be alleviated with the future update. Thank you.

Vincent, thanks for your response. I have always dictated my note and then filled out the paper superbill which eventually was entered electronically. The copay is left to the front desk to collect upon check-in and is independent of the superbill that I create. However, I could always make changes to the bill before it was submitted. My main concern is that I am considering collecting not only my patients' co-payments but their co-insurance as well before they leave. Given AC's current setup, I would have to complete my note before they walk out the door in order for me to complete the coding within AC. Alternatively, I could hand them a paper bill to take to checkout, but then I'll still have to enter it into AC - a duplication.

I simply prefer the flexibility, especially temporally, that I have had in my practice using paper superbills, and I'd like to keep that with an EMR.

Again, I appreciate your response. I would have answered sooner but I haven't visited this forum for a few days.

Basheer

OK. Please, please do not get angry with me. Just wanted to add my two cents. I certainly don't want my comments to suggest anyone else is doing anything wrong.

But, the reason we purchased AC besides the many great things was that it is simply the quickest EMR out there. While drill-down EMRs do offer advantages of computerised E & M coding, it is completely offset by the time it takes to finish a note. I pretty much always finish the note in the room before the patient leaves and write any consultant letter. Certainly, I could probably be a bit more thorough if I charted later, but having more time to chart would be offset by the length of time away from the visit. I love being finished with my charting when the last patient is done. I do print the superbills from the chart even though I agree it leaves a lot to be desired.

There is very little room to type notes, which I usually indicate the follow up and any other things such as referrals, etc. The superbill is printed half a foot away from the checkout person, so many times the referral date is in hand before the patient gets to the checkout. (this is uncommon).

The biggest problem with printing a Superbill from AC and VINNY ARE YOU LISTENING? (I say that because last time I suggested it, it would looked upon as one of the weakest suggestions ever to hit the message boards <G>. But, I simply do not understand why when you finish a note and the encounter is through, the window that now occupies the middle of your desktop is the one that says Print Encounters/Send Letter. I do not understand why it does not also say, "Print Superbill." For those of us who have our MAs triage on a separate computer, the downside to this is the patient's name is not right there. So, after every visit, I have to bring the patient name up, right click and choose superbill and print. Just seems like a waste of time if we could move it over.

One last suggestion, if you forget to check a CPT code, AC gets very angry with you and will give you two error messages before you can get away with it or change it. But, the #2 thing to do prior to signing out is the Medical Decision Making dropdown list, which sometimes says low complexity for a patient with symptoms of meningitis on the note while eczema may have high complexity or even not yet set, none of which are good for coding. Maybe I am the only one who does this, but I simply go right past it most of the time. Could it be mandatory to have to change it? Or find a way to improve it.

Thanks for letting me post here. Again, just some thoughts.

Yes, I feel the same way! I am new to Amazing Charts, and with a brand new practice do not have a lot of patient volume yet, but I have noticed this same issue. I want the Superbill to come up at the end of the note, so I can print it out, and give it to the patient as a receipt. #2I do wish that you could print the superbill out at ANY time before finishing the note ideally, with the cpt code placed, I dont know if it needs to be locked or not. But as I am just starting, I have only one computer, which is in reception, not in the room with the patient. So therefore I need to come back out and type the note while the patient is sitting there waiting if I want them to get that superbill. More often than not, I give them a paper superbill as a receipt, and it also shows the ICD 9 codes and the cpt code for them. But in actuality I like the way AC superbill looks for the patient, and it is good for them if they have a deductible and are going to submit it to their insurance company as it is so legible. I think the charting on AC is so fast, it is great compared to some other extremely expensive cumbersome EHRs I have used, and in addition, I like that you cannot close out and lock your note without coding. I think that is awesome. I just would like to be able to print out the superbill at any time, so the patient does not have to wait while I chart. Say for example, you can just open your encounter, then go straight to a "charge capture" button instead of "sign out". This will automatically then paste your charge like 99214 onto the encounter, and the superbill.Then you open your superbill, enter your co pay, and save it to get adjusted balance. Then you print your superbill, and later go back and finish your encounter, and THEN click the "sign off" button to finish and lock your encounter. Again, I think this is key, to have flexibility of opening and coding for the superbill at any time. This would solve the other issue of logging all the co pays or cash collections on spread sheet, schedules by patient name, or what ever way everyone is doing it, which ends up being duplication. Thanks for listening.
Carla FNP
Healing Presence Family Practice
Wilsonville, OR

I would love to have the ability to design my own forms and labels. I currently can do this in my present PM program but, if AC develops a PM module, I would like to do it all from there. Currently I can design my superbills, recall labels, collection letters, etc. If I could do it all from AC I could make a great superbill which would not only have the charge information, insurance info, patient balances and payments but also instructions I have given to the patient and tests and return appointments on it which they would take with them.

Leslie

Excellent points. I worked with another EHR in which, the patient education handouts were attached to the superbill when printed out, based on the diagnosis code. This means a lot to patients to be able to take something away with them. While using AC, I end up handwriting out "Home Instructions" or Use Griffiths or some other source of education. I could write the individual instructions in more detail in the plan, and then print the note for the patient, but again having some professional looking Education specifically to the diagnosis like Sinusitis, or Bronchitis, or Low Back Pain, would be very helpful.
Carla, FNP
Healing Presence Family Practice, PC
Wilsonville, OR

Finally, someone agrees about the printing of the Superbill from the last window! Thanks. With easy things like that Carla, make sure you PM Vinny. That doesn't take a whole lot of code. The other stuff, probably.

OK, two workarounds. Leslie can tell you I never do workarounds, but they are my favorite. <G> Since, biller and receptionist like paper superbills and I refuse to take the steps to do it -- what we were talking about above -- I don't know much about what you and Leslie are talking about. Besides, I hate that the description of the codes (the long paragraphs explaining E & M coding) are on by DEFAULT. I don't really see the need for it. One thing I wish AC had more of were options/preferences. OK, my two ideas. Let me know if they are helpful:

1. If you wanted to have handouts not associated with the Superbill, you could make them all PDFs, then make a patient named Handouts. You could import all of them into that chart. So, at the end, you could pull up that patient, browse to imports and print out a PDF. Just an idea. Of course, if you did that, name the patient AAHandouts, so it would be at the top by default. Of course, all of these pdfs could be on your desktop, but who knows.

2. Again, you would know better than I if this idea would work. But why not do a hundred templates in Addendum with all of your instructions. Then, with or without the instructions, you could open the addendum from the person's chart and type something in like a diagnosis or whatever, then click save. It will then tell you it was saved to the chart and allow you to click OK (an added step I could do without), next it will ask you if you want to make a Superbill. You could say yes and give that as your interim Superbill. Could you?

But, if you opened the Addendum window from the patient's chart, and right-clicked and chose a template that wrote what you wanted which could be tailor made, then you could make a Superbill and print out an Educational sheet.

Please let me know. Another thing that drives me crazy is how difficult it is to set up notification on here. I still think it should be by default.

Oh, and oh yeah, welcome to AC Carla. And, you are right; it is still the fastest EMR ever.

I currently run off Superbills on my Okidata printer which are preprinted (costly) multipart, continuous run sheets. The specific insurance, address, etc. info on each patient was designed to print in designated areason these pre-printed forms from my PM program. Each morning the ladies run the patients scheduled for that day. It has any copay or patient balances printed out so that they can get those payments as soon as the patient checks in (although they could also get this info right from the PM screen at check-in). Also on the Superbill are a list of all of the CPT visit codes with their descriptions. Then I have separate sections of other commonly used CPT codes such as the immunizations, procedures I do in the office, and labs done here. I circle the CPT codes at the end of the visit and manually enter the appropriate ICD-9 codes next to them. The right side of the form has sections where I write the basic instructions given to the patient, such as "Amoxil 875 mg twice daily", "Check your BP daily and record it for me", "Increase your Lantus to 35 units at night".....The bottom section is for referrals, tests and return appointments, all written in maually. Because I complete and print my notes from the exam rooms, the check out person usually has all the above information before I take the Superbill up to her but, once the Superbill is in her posession, she checks off on it everything that I ordered, writes appointment dates on it for the patient and schedules their return visit. When all is completed, the patient then gets the bottom copy and the billing clerk gets the original. It would be dandy to be able to do all of this from AC with a personally designed Superbill upon which one could have all the information the patient and the biller would both need.

Leslie

Guys,
I think the real issue here is that there are two different types of invoices needed here.

One for us internally if we wanted to pass off an invoice with lots of office stuff type of visit with description and modifiers and the like. These could also be useful to give patients who pay in full and then submit their own bills for reimbursement to a carrier we don't PAR with.

Two: as a quick reciept type thing with minimal amounts of stuff on it to hand a patient as reciept for their copay for their own records or to give their HR dept for applying to the "flexplan" or what have you. These should not be a detailed, it's nobodies business what the Dx or Modifiers were. It should be kind of barren.

The best analogy I can come up with is that in database programs like QuickBooks, one has the ability to design within reason their own forms that start based of a QB's based template. Now I have a about 4 other forms of reciepts and the like. It would be nice if AC would look at QB and intergrate some of their useful and friendly ideas such as this.

The other QB's like feature I have wanted and suggested forever is a save, back-up button that makes a properly formatted back-up to whatever source the user cares to send it to, such as external drives and the program even half remembers where you like to send your back-ups for the next time. And when restoring it is just as simple because QB has already saved it just the way it likes it. Now simply pick the source of the back-up from restore and presto, there's your company and all it's data, just as you left it....Now that is a customer and user friendly feature.

Paul,

I have an idea. I don't know if it would work, but you could run it by Vinny.

I pay for offsite backup. You know I am a backup control freak. But, anyway, when you back AC up, it compacts and encrypts all of the databases into one file, then uploads it to the offsite vault.

When you do this, a copy of this is automatically put in your AC folder or wherever you basically want it to go. Since, my computer gets backed up nightly, that is a couple of other backups of AC. So, I could technically, I believe, import that file back to AC if there were a disaster. It's the same file I would be downloading from the offsite place.

So...I think the major part of the $250 is for the prvilege of using the offsite place in Texas. So, what if for a nominal or no charge, you would be able to set up AC to do this same process without being allowed to upload it. When you send it, you see the process, and then it is loaded into your web browser. The same thing could happen without your being allowed to send it. You would get the same error message you get now, which is that you have not subscribed to offsite backup. But, at that point the encrypted compressed file would be saved to your hard drive. This is a simple one or two click process.

Anyway, you may want to look into. Not sure if it would be feasible, but I don't see what it couldn't.

Paul,

Actually, I tried it today, and it worked easily. I was given the option to retrieve the offsite backup or use the one on my PC. I chose the PC one which was the backup from last night so it was up to date. I did move my databases from the server first. I unencrypted them and uncompressed them, and boom, all the databases in the folder. It doesn't back up AmazingMeds for some reason.

I don't see why this couldn't be done for no charge as the infrastructure and technology is already in place. All they would have to do is block your ability to upload it to the offsite place.

Bert,
This is probably what QB does, just much more out of the average user's sight. I simple choose where I wanted it go. So once, long ago, I browsed to my E: external Hard Drive, made a folder for QB back ups and now every night I back it up, boom I just click a few time thru the windows to choose the same old place I always use and it adds another backup copy to that folder I setup long ago. New backup made, compacted and or formatted just as QB likes it, with that day's time and date. Simple, Elegant. It just seems to me that you are very right about the tech being there. But it has not be setup to use it on our own external drives for free. Choice is the only real problem here. The choices have been left out, why?

I think to be fair it hasn't been left out on purpose. My strong guess is that the entire system was designed and intended for offsite backup. The generation of the same encrypted and compressed backup is just a byproduct of that.

The beauty of utilizing this local copy is that it is encrypted and compressed. I always cringe a little when I hear people's taking it home with them unencrypted.

My suggestion would be to not worry about why it isn't available but to strongly encourage Vinny to look into it. It's all in how you look at it. Rather than have an offsite backup for $250 annually that could be used locally, think of it more like a local backup which is part of the program like QBs and if you want to upload it, you pay the annual amount.

I have tried it over and over with success, but of course, I have the offsite backup, and maybe I am missing something. So, run it by Vinny. It would be a nice feature to advertise to future purchasers.

Vinny,
What is the ETA of Version 4? I need to change my way of billing ASAP (end of Dec>2007) HELP!!

Does anyone else do this...

When I get swamped, I handwrite my note on a form and scan it in. Then I pull the patients chart and write the diagnosis and cpt code and print the bill. Icollect the copay, and note that on the bill. Takes me no time, expecially with tourists

Gerald