Home Forums Discussions General Discussion POLL: The best PM to use with AC

Perhaps this is a topic of interest to many.

Give us your vote for PM software, and the vitals such as:

- Cost
- Ease of use
- Level of integration with AC, etc. (double entry work, etc.)

Lytec 11--for our scheduler and PM
But we are a group of 9 physcians -- 5 use AC, one uses e-clinical, and 3 are transitioning to AC

and we have in house billers--

but the Lytec works wonderful for this mish mash composition of providers

What is the cost? And how well does it integrate with AC? Is there much double entry work?

Hi,

We have been using TotalMD (the software, not the cloud version) for 1 year. I don't think it's that great but I have nothing to compare it with. The integration with AC does work, but it took awhile to understand all of its idiosyncrasies (there's a "link" program that has to be on on one of the computers; it's temperamental and we have to restart it about once a week). Now that I understand all the little things have to be in place for the link to run smoothly, it works for us. I'm just starting to use TotalMD with RealMed for electronic claims, and I do like the results - billing workload probably has been cut in half.

TotalMD's support is mostly good. The phone support doesn't always know what to do, but if I email the sales guy (maybe he one of the owners?) he will try to help me.

So I'm not sure I would vote for it since it took so long to really get it going. We thought about switching to another one but the thought of possibly going through the learning process again was too daunting.

I'm going to vote for myself. We are a billing company and we integrate with Amazing Charts. You can use the AC front desk scheduler or ours.

This should come as no surprise as I have often spoken that I work for a billing company and that we integrate with AC so of course I'm voting for myself!

JamesNT

GoBruins,

Cost--about 1000 dollars per provider when we bought the Lytec 11 in 2011, and intermittent upgrades every several years-

Level of integration--currently some providers paper print up AC generated bill and turn into our in house billers, some use the old paper super bill. Once we are all up and running with AC we may start to print up PDF files of AC generated billing slips and X-link from AC to Lytec 11

Office ally. Free. Hard to beat free service. Support is very good.

Office Ally has a PM that integrates with AC? If so, how tight is the integrations? I was under the impression that they were just a third party billing company.

We are a single Family Practice and we use AdvancedMD. It works well with AC and they have good support.

Charlene - what's the cost? And how much double entry is involved?

It's been a few years, but from what I remember, the start up cost was around $800. That included training. And now there is a monthly fee. We use X-link as our interface and there's minimal double entry. Demographics and billing are sent between the two easily.

JamesNT

What is the cost of your software? Is it server or web-based? I'm assuming you're integrated with AC (we have 8 clients on AC). I'm in the market for PM at present time- I own a billing company in eastern Tennessee. Do you train?


Thank you-
Tami

We are using NueMD. This was a choice of our billers. I have no interface with AC. They tried to get me to use THEIR EMR.

I'm pleased GoBruins/Gianni brought this up, and hope to learn from the responses.

Short answer:
PM - OfficeAlly PracticeMate
Cost - $0
Ease of use ? mild level of difficulty (only a guess, I have nothing to compare to)
Level of integration with AC ? none in my practice, but as below I've heard some limited ability, hoping to learn from other users.

Long answer (disclosure ? what follows delves into my imperfect separation or lack thereof between billing and practice management):

My challenge, prior to consider which practice management / billing system to use, it to identify what I need it to do, and then how the work flow will be implemented. Then I can turn my attention to the billing system's features and evaluate them. A bit of iteration is necessary, as for cost-efficiency I often have to adapt to what is available.

Having said that, I identify my billing needs as follow:
The billing codes I submit vary more by payer than by the events unfolding in the exam room.
1.) Traditional Private FFS ? enough ICD9s to support CPTs and discourage probability of an audit.
2.) Medicare (Traditional) ? also for first month of the year, PQRI CPT codes for the first several dozen patients, then no more for the rest of the year. These sometimes change each year, and every January I have to peruse the CMS website to refine the list of codes. I'm lazy, and try to identify the easiest minimalist implementation ? for my FP/general practice, usually the 9 HCM PQRI codes. Also, for Southern California, idiosyncratic additional HCFA form supplemental fields self-referring for any in office tests like EKG or UA (or no payment), and self ordering for homeINR borders.
3.) Medicare Advantage HMO ? it doesn't matter what the patient comes in for, by the time I bill for all the chronic HCC ICD9s, there is sometimes no room past the 8th ICD9 for the actual principle reason for the visit, for which there is no reimbursement anyway ? reimbursement in our local IPA micro-environment is ONLY for HCC codes that affect the capitation paid 12 months later the following year. This takes a considerable amount of physician massaging, as you don't want to waste one of your 8 HCFA ICD9 fields with a lower hierarchy ICD9 trumped by another entered higher ICD9 that gets you no additional capitation.
4.) Medicare Advantage non-HMO ? I have a quandry here. The payer forces us to take it or leave it accept a 10% reimbursement discount from Traditional Medicare, but does not share any of the HCC income they get from Medicare with us. So far taking the time to report HCC ICD9s has not been a high priority for these encounters for me.
5.) Commercial(nonMedicare) HMO ? Pay for Performance bonuses paid 2 years after date of service depend on judiciously playing a somewhat nonsense game here, like going out of your way to code anything close to a URI for which abx not dispensed as a URI, asking about and coding LBP every 6m if you are not ordering an XR, adding PQRI CPT codes for BP range for all diabetics, and more than 2 dozen other ICD9 and CPT codes that are idiosyncratic to my local IPA micro-environment yearly changing bonus reporting system and often have nothing to do with the appointment content. Also inserting prior auth numbers for supplies consumed (IZs, etc) and all non-capitated procedures (trigger finger injections).
6.) About half of my payers are now requiring NDC code submission for reimbursement of consumable injectable meds ? a manual edit of the claim using our current OfficeAlly PracticeMate PM.

There's a lot more, but these are those that come immediately to mind.

I would LOVE to turn this all over to a biller, either employed by me, or a third party regional service provider, and just write my note and go on to the next patient. However, I have been pessimistic that an employee at a reasonable wage would be able to understand much of this and execute even a small percentage consistently, and not optimistic that a regional service provider would be willing to learn our micro-environment of local IPA policy. Of course, I'm fantasizing that all I would have to do is write the note, and the biller would magically extract all this information from my note. Never having used a biller/service, my uneducated impression is this is not how it works ? they do not review your notes, the physician still has to code, and all they focus on is ?cleaning the claims? so the idiosyncracies of each payers HCFA field requirements are bounced back to you to supply additional information at the cost of an additional interruption. However, I hope to learn from forum participants that I am mistaken and that there is an easier way.

Left to my own perhaps misperceptions, I felt it would be just more work on my part to choose all the codes, and instead of just entering them myself immediately after seeing the patient into OfficeAlly PracticeMate, turn the data entry over to someone else subject to another layer of potential typos and data entry errors. So I do it myself. I'm not sure what a billing service adds thereafter, but would like to learn. We strive to anticipate to the penny what a patients share of cost will be and collect it up front, so we only send about a dozen bills per month out, which so far hasn't been enough work to fork over 3-7% of collections to a billing company. Perhaps they do the posting to the PM database for others? I suppose I could save part of a staff position if the cost was right for someone else to do this ? but my concern is that I trust my payment poster (who fortunately for me is also my wife) more not to accept suspicious payer write offs and go after payment than I imagine an outside provider would do ? again not having used a billing service perhaps I am mistaken. I need a discriminating eye to identify the 1-5% of unwarranted writeoffs separately from the majority that are just the difference from the contracted rate and my charges. About half of my business is HMO capitation, for which about a dozen commonly performed CPTs (spirometry, joint injections) are carved out as FFS, often happily not paid by the HMO until my poster goes after them, for which I am unsure how an outside billing service would recognize, given that this is ideosyncratic to my IPA micro-environment.

My imperfect solution to date has been using the free OfficeAlly PracticeMate practice management service. Unfortunately, I haven't learned how to integrate this with AC ? I hear rumors it is possible, but I am not optimisitic V6.3.3's limited #ICD9s would allow successful integration, as well as requiring a lot of effort on my part to rearrange Assessment/Plan paragraphs so the ICD9's appear in the correct autopopulated order. I do this all manually. For demographics, only the minimal required information is redundantly entered and updated in AC, and all of it goes into OA. Scheduling is only done in OA, not AC. After every patient is seen, I immediately (alright, 95% of the time) enter the ICD9 and CPTs into OA manually while my AC note is still open, freely rearranging the order of codes as needed for maximization of payment. In fact, as long as my note supports it, I don't even bother to enter any CPTs in AC (except for an E&M level or else no MU credit), just in OA. We signed up for electronic EOB / ERA and direct deposit with all payers using OA ERA, and 60% of remittances are documented here. This is a bit of work for my biller (wife) to view and then manually post in OA to the appropriate accounts as this is not done automatically, but no more work than the 40% of remittances that still are sent to us on paper EOBs. Then we use OA to generate the dozen or so bills we send out each month where we haven't anticipated the correct amount to collect from the patient upon arrival. My staff generally are pretty good at correctly identifying the level of service based on the reason patients call for appts with some standing orders / guidance from me.

That said, I'm always interested in learning a better way from other's experiences, as they might apply to my solo practice, particularly if it would reduce my costs and time. I would estimate that my wife's unpaid time working the billing amounts to about a 75% full time staffer. I look forward to seeing what portion of this workflow might be automated in the rumored future AC practice management module.

There is a middle ground you may not have examined. I do the CODING but send my invoices to the biller. This way I don't have to trust them to extract all the necessary information, and I stay better in touch with the billing: for instance, what must be charted to achieve a level 4. A lot of doctors do level 4 work, but only get paid level 3 because they left out a small piece in their work, the coder didn't catch it, or they are not confident in having qualified for this code.

My billing company handles everything else for 6%. They bill primary, secondary, and tertiary payers, they use their PM software which I can access from my desk, they tell me who needs to go to collections, they handle patient phone calls about their charges, and so on. For 8%, they will do all the coding from your notes as well. This is a percent of COLLECTIONS, so it is in their interested to collect every dollar they can. I know the billers personally, and they handle this for half the doctors in town.

This is a very informative thread. Thank you, Mike, for your in depth discussion. This leads to some other topics which perhaps deserve their own threads, but at the risk of a hijack, let me ask here:

1. We do as Chris does and outsource our billing. We pay 6% of collections for the same services he describes. The arguments for in-house vs. out-house (no, that can't be right) billing have been made here over and over. My question is: how much do you think you pay for billing, as a percentage of your collections? For those who outsource, what flat percentage do you pay? For those who do it in-house, it is harder to estimate the cost, but what would be your best guess (including staff time, software, IT costs, stamps and postage, clearing houses, etc)?

2. Mike, could you elaborate on "We strive to anticipate to the penny what a patients share of cost will be and collect it up front, so we only send about a dozen bills per month out"? How do you achieve that? Unless you are only seeing 14 patients a month, it sounds like you are quite successful at it!

1.) 6% of collections is more than the total yearly compensation for my most expensive staffer. I estimated it takes a 3/4 time staffer's worth of work to perform billing/collections, but it would be hard to quantify as my wife graciously does the work for owners equity rather than a salary, while doing other tasks in the office as well. Most of this is just posting the remittances to the accounts to whittle the data down to the dozen or so bills per month we have to send out, and if OfficeAlly (or future versions of AC) could do that automatically and compare against the expected contracted discounted write off ? it would take little time indeed. There is no additional software or IT cost, and postage is <$15 per month.

2.) I keep a spreadsheet for all payers (about 2 dozen ? but realistically 90% of our business comes from half a dozen), and a row for each E&M 99201-99215 (realistically, 90% of business comes from 99203 99204 99213 99214). When my biller posts reimbursements and notices that something increased, she updates this spreadsheet ? or if we are lucky enough to get an updated fee schedule from the payer, then we update this at that time. For Medicare, we just check the CMS website at the beginning of the year. We actually have entries for every CPT we ever billed and every payer, but those get updated haphazardly when we have a particular interest. For the most part, however, 6 payers x 4 CPTs = 24 entries for 90% of our billing. I average about 14 patients a day, not per month. My staff has standing orders from me as to which of those 4 most common E&M codes are most probable for a visit depending on the patient's age and complaint ? and the code chosen in the end is different <3% of the time. Lots of these are 99214s for interval f/u of patients on meds for 3 or more chronic problems. 2 days before the appointment, my receptionist calls the payer and finds out what the patient's copay and remaining deductible are, looks up the contracted reimbursement for the anticipated CPT service, determines the patient's share of cost, and calls the patient with a reminder that they have an appt 2 days hence and to bring the exact share of cost anticipated. Over the last 5 months my PM shows an average of 20 bills sent per month, corrected to 15 per month when accounting for multiple bills for the same DOS. Every month we refund about 6-12 patients when what the payer told us in advance was different from the eventual EOB we received. Although it sound like a lot of work for my receptionist, I think she keeps notes in their demographic tab of who has met their deductible or has no deductible, so a call to the payor for every patient is not necessary for those, which along with our capitated folks who only pay a copay, probably brings the payor calls down to half or less of patients to be seen. If we know the patient is coming back in <3months and there is a balance/credit due, most patients elect to just apply it to the next visit.

Mr. Summerlin,

Can you provide us with a ballpark figure(s), please?

Tami,

We are moving to TotalMD as our line-of-business software. The price will be whatever you negotiate with them.

We are using the server-based version of the software. Our automation requires we have the database in-house so we can interface. We host the software for our clients via Terminal Services, however.

We use SQL Server Integration Services for all automation including integrating with AC.

JamesNT

What specific figures were you wanting, Dr. Webb?

JamesNT

James, do you have your own interface or use TotalMD's?

We use Allofactor, a small billing and PM company out of AL. They are able to use the exported info from AC and bill, scheduling etc taken care of by Allofactor.

Mike,

I think your previous post above is a perfect example of why physicians should do the coding instead of billers or a billing service. And I am confident that you and your wife are much more efficient than any billing service could ever be.

I wonder how many extra patients you would have to see every day to pay for the relative inefficiency of a billing service.

I also have a wife who runs the business so I only have to run the practice, and a spoiled man I am.

The profits of insurance companies depend on having so many complex rules that only the motivated, focused, determined, capable people can accomplish it. That is why the rules are always changing.

Anyone who graduated from medical school is capable, and has probably chosen a spouse that is capable. I think it is like in school, some are determined to master something while most are willing to just do enough to pass. And, I just don't see how the profit motive incentive for a billing service can compare to the "this is our money" incentive your wife brings to the practice.

Obviously, we cannot all master coding and inhouse billing, but there is low hanging fruit worth picking. And more importantly, some of our spouses could make better use of their time outside of practice, whether that means income or not.

We use Medware (now Sage or even something else). Have used since 1996 -- started as a DOS program, now it runs on my server in SBS Essentials.

Staff is used to it, it has been rock solid, and support has been good, despite some comments to the contrary on this board.

There is no interface with AC -- in some ways this is a blessing, since when AC goes into a tailspin, as it does from time to time, we can still function as scheduling and billing is done by Medware (and Office Ally for electronic billing.) There is some duplication of effort in having two programs, but it seems to be pretty easy for the staff to work out.

I do my own coding, my wife relies on our in-house biller. Doesn't seem to make much difference. We don't get any rejections for inappropriate codes, and so far as I can tell, don't get downcoded.

I'm not anywhere that far in using a PM, etc. I inherited a billing guy who get sout information on handwritten superbills.

Serene,

We built our own interface using SQL Server Integration Services.

JamesNT

@JamesNT You are extemely helpful and crazy knowledgable!! I've read most of your posts here and I appreciate what I've learned. But now I'm so confused! You are a software developer and you voted for your own software above, but now you are switching from your own system to TotalMD? Or you created and use TotalMD in your business? Or you use two systems? You're not waiting for the PM in AC to utilize a fully integrated system?

I'm a billing business owner as well and am looking for a new PM system. I have 8 clients on AC. Not sure if I can wait until the PM is done on AC though. I guess since you're so high-tech knowledgable, I'm looking to see if maybe I can copy what you do (I'm in E. TN - not in competition with you)

Thanks for all your posts!

Tami

James is all of that, but Chris@AC has said in the product update last month that the PM vendor will be announced in September.

Hopefully it will.

YAY! Maybe I can hold off then .. hope it's soon!

Thanks @DanWatrous

Tami,

To answer your other questions:

I did not vote for my own software, I voted for my company. We are currently migrating to TotalMD from a system we bought from another vendor years ago. We did not make TotalMD. TotalMD is made by a company called Dentimax.

My company has been in business for over a decade as a medical billing company. We have our own interface to Amazing Charts that I wrote so the decision for Amazing Charts to contract with a PM may be what Amazing Charts needs to do, but doesn't affect us. We have over 85 clients and only a quarter of them use Amazing Charts so we have to be flexible enough for the rest.

JamesNT

NOT MEDISOFT

Anything that involves McKesson can be a nightmare if you don't have a reseller who really has your back. Support from McKesson or their resellers is always at a price.

It has a nice scheduler that we have prefer over the AC schedule, but it is expensive and clumsy. We have continued to use it but not happily.

It will be nice to see what AC comes up with.

Good luck

anyone have guesses to which PM ac is planning to "partner with"? when they do announce it we could use feedback from anyone that already uses the chosen PM if it's worth changing to.

also everyone here doing double entry? what percent using x-link and if so satisfied?

Doesn't the bottom one actually give the name?

Chris announced that they would have a PM partner designated as the one they would concentrate on as their main interface. At the end of the update she does say they would have a Kareo PM interface done by the end of the year. Not completely clear as they continue to work on interfaces for a variety of PMs - X-link, etc.

The following is my opinion:

The purpose of having a PM partner is that for those who need a PM, the following are accomplished:

* The PM Partner will offer purchase and support discounts for AC users.

* The PM Partner will update AC on any database changes so when a new version of the PM is released, AC will already have the interface in place. With other PM's, AC is not aware that any interface needs an update until people start complaining that things don't work anymore. The reverse is also true.

* New EMR users that buy the PM will be pushed to AC and they will be offered pricing discounts. See the first point.

* AC and the PM partner can work together to standardize IT requirements in an attempt to lower support costs (assuming the PM partner is also an on-prem software).

* The PM partner and AC can corroborate on meaningful use.

JamesNT

Tiny footnote on altapoint brochure *not a product of nor endorsement by Amazing Charts.

No announcement yet?? This is crazy!

Well, the have to proofread it first.

JamesNT

Casualty of the government shutdown???

Gene

Are you really surprised that an announcement has not been made regarding the PM?

Look at the history of announcements and promises.