Home Forums Discussions General Discussion Practice Management question

Our small clinic is researching AmazingCharts as a potential replacement for our current EMR.

I like what I see so far, but have met the point where I really need to research PM products, too, and price them, and do due-diligence on them.

I'm looking for suggestions about which PM products to look into.

FWIW, we're a small primary care clinic, 3 physicians and 1 NP, with a single location.

Thanks in advance for any suggestions!

Are you using any PM system at present?

I use EZ Claims the software is relatively inexpensive and use their package with Availity clearinghouse. Availity is free of charge. Once set up you can electronically bill to almost every insurance company and get direct deposit and electronic remittance from All the major insurances BC Aetna Humana Medicare Medicaid. The people have been great to work with as well.
Jeff

John,

First, welcome to the board.

Folks using AC tend to fall into 4 groups when it comes to PM, and much of that depends on how you are currently/plan-to handle billing.

In-house biller - they use an in-house system, which may or may not have an interface with AC. Lots of choices here, and I'm sure happy/unhappy users will chime in.

Out-house biller - they take paper superbills and do billing on their system. In my experience this may show as the numerically smallest cost, but also generates the most headaches, frustration, no usable PM, and IMHO the lowest gross billing amount of the choices.

Out-sourced billing - the good ones have some level of integration with AC, and provide the practice with 24 hr access to claims scrubbing, electronic submission, reports, billing information, re-submission, and business data visibility.

The fourth group you ask? They have a biller/PM they aren't happy with and are looking for a new one.

So tell me ... other than the billing end of things, the "Practice Management" software that AC is missing is ... what?

In other words, will I be wanting better PM software to run financial reports and analyzing the business end of things?

(Thanks, BTW, for the quick and useful replies!)

If you want to consider an in-house solution, then I would look at either TotalMD, Lytec, or MediSoft. Those seem to be the ones with the least amount of hate-to-love ratio.

If you wish to out-source your billing, then I would like to, of course, recommend my own company. You can see our website address and so forth below.

JamesNT

Hi John,

You may have seen this list of PMs that can link to AC. http://amazingcharts.com/services/interfaces/practice-management/

I would look at the ones that don't have an asterisk after them as they will have a direct link and don't need an interface.

There is a benefit to the chaos level in an office in having the medical staff learn the ehr at a different time than when the billing staff learn the PM.

I hope that you are not in a situation where you will have to stop using the PM you have without future access. The best scenario is where you can keep using your PM for your old charges so you don't have to do a migration and your staff can stay efficient with software they know until it's not needed. Transition means decreased production.

As you may know, AC is pursuing a relationship with a secret PM vendor that would probably have an optimal link and essentially be integrated. If you could wait a while and use AC with your old PM, you might be happier with the choice AC makes for the PM. Why it is taking so long to establish this relationship, I can only wonder. But for me, my wife is happy using our old PM until AC unveils the new PM vendor. Happy wife, happy life.

We're currently using Allscripts MyWay ...

If you haven't heard, Allscripts is not supporting MyWay anymore, and wants to transition everyone (with significant expenses) to Allscripts Professional. We were never too happy with the product, and with this happening, we are DONE with Allscripts.

But ... MyWay does EMR and PM ... so we'll need both. We do outsource our billing to a small, local company. We have no reason to leave them, though we are open to all options.

So ... we are open to all options. The only thing about a transition to AC that I'm nervous about is the billing end of things.

So ... please let me know how you all handle it. Integrated outsourcing is looking more attractive. What would I be missing if we went to an option like that compared to an integrated system like I have now?

Hey John,
Sounds like you have a similar clinic to ours. We outsourced our billing to an AC approved
company due to the 5% pricing. We had some concerns and brought back in house and found
that no one will go after denied EOBs like yourself. Most billing companies seem to promise the world
and send through the quick easy ones and don't go after denials. Our income jumped considerably
with a part time biller and PM software Advanced MD.

Of course we are waiting waiting waiting for ACs PM. Please oh Please.

So ... AvancedMD is the program you use for billing ... a couple questions:

1. Is it affordable?

2. Would AC + AvancedMD (or other PM system) be all that would be needed? In other words, would I be able to run financial reports, demographic reports, Meaningful Use reports, etc. with one or the other systems?

Oh ... and is workflow at the front desk hindered by having two systems, or would an add-on PM system be just a "back-office" issue?

Those two you can get out of AC. The MU reports per practice, per provider, per visit are especially helpful in MU implementation.

There is the extra work of entering the demographics twice, maintaining 2 sets of demographics, and entering charges into the PM, which might require a superbill.

But the workflow at the front desk can be better, because you can get a PM that has better scheduling, batch eligibility, call reminders, portal for payments and scheduling, claims scrubbing, automatic payment posting, billing statements that humans can understand, and improved aging/collections. You can get better business management reports for profitibility. It all depends on what you can find and pay for.

Really, the best PM is more important for your business than the EHR.

Does AC keep a list of practices to call, or visit, to see first-hand how it works?

We're also looking at e-MDs, which would be more "one-stop shopping" ... and offers complete data integration from our current system ... but would be about 20x more expensive.

I'd really like to see how it works in person, in a clinic like ours.

Anyone know of a list like that?

If you give a rough idea of where you are located, you might get some offers here. I don't think AC pays practices to be a demo site like other EHRs, which a fancy kind of marketing.

The free 3 month trial has worked very well. Put it onto a laptop and bring it into a visit with a friendly patient at the end of the morning or afternoon and you'll get the hang of it.

Another thought John,

I wouldn't think of this as the last time you are picking an EHR or PM. It would be nice if true, but the consolidation in EHRs is just starting to get serious.

Consider getting the EHR that will be the easiest for your providers to master. Sometimes there are particular bells and whistles that are deal makers or breakers, but you have several personalities to please, so simple wins.

If you are going to bring billing in house, then you have the problem that your office manager is probably not a biller (I'm guessing since you outsource billing) and possibly cannot train a biller, which you don't have the time for. You may need to get a PM that a local biller is familiar with, so James' rec is a place to start. Just depends on what is available, cause you are taking on a huge transition.

I will chime in just with my two cents...

There is a downside of experimenting with the EMR and PM (primarily billing) at the same time. If the EMR fails it would throw your billing into a chaos. And that hurts..

Give you a quick example. I have used Medisoft for a long time for billing. We switched to an EMR/PM vendor few years ago. We did not import any billing data to the new system. So all patient accounts were split up into two different bills. Three months later, we couldn't deal with the EMR any more and gave it up. At this point we had to reenter 3 months of billing and payments data back into Medisoft. It was a royal pain.

Lesson learned for me: I wouldn't touch my billing system until I am fully comfortable and settled into my EMR. Yes I have to enter patient demographics twice in to two different systems. But that is once for every new patient which comes to the office and I am willing to live with that. At least I know if the EMR does not work out my billing would not take a hit.

I agree with Gupta and I would take it a step further...

Initially I was eagerly awaiting the AC PM module with plans to bring everything into one system, thinking that it would ease workload with only a small increased cost from what I had been doing (Office Ally).

However, I think the pros of having a separate PM system outweigh the cons. An EMR change or malfunction could jeopardize the bottom line in a major way if your patient accounting is affected. I decided to go with a cloud-based PM system so that I don't ever have to worry about losing any account information. I still like the idea of keeping my EMR in house.

If all it takes is a 2-minute daily export for peace of mind, it's worth it to me. The cost will be the same regardless.

John,

We have several providers under one roof, and having Lytec 11 as our PM has allowed us to combine our data base and schedule. I think even if AC came out with a PM combining data bases with multiple providers would be difficult at best. Some of our partners are still paper and one uses eCW, but we all use Lytec 11 and we have in house billing.

Similar to jimmie, we have a PM called TotalMD that was started by some people who left Lytec. It's nice that you can add as many practices that you want to TotalMD, no need to pay for additional providers and use 1 server to host all practices. (We only have 2 practices.) Of course, this is the license version. If you go with their cloud based option, you would have to pay per provider.

Frankly, it all sounds confusing, and I see this as a major reason NOT to go with AC ...

Even if the dual systems work eventually, the switching hassles, and thus the switching costs, are high, and dealing with two customer-support services has got to increase the headaches by more than just 100%.

Very frustrating. The outsourcing of billing services seems like a good alternative on the surface, but as some have noted, decreased collections seem a certainty. I'd prefer to keep billing as close as possible our own business.

Yup!

Thank you John for bringing this up. AC has tried mightily to do what you want, and we are all waiting to see who the PM vendor will be. Your last comment is another incentive for AC to get the deal done asap. Most of us are stable and comfortable with our PMs, so I'm not looking to use the new PM immediately anyway. I'm on the other side of a canyon from you.

eMD is a good choice, more intuitive than eCW. Not as highly rated on the KLAS awards as AC, but that is a small sample size. A lot more expensive, but money isn't the most important thing.

I hope I was wrong about possibly your office manager not being a biller, as ramping up an in-house billing team for 4 providers will be a lot harder and more dangerous than picking your PM. You might want to master a few carriers in-house while using outside service for the others and gradually transition to all inside as you train new billing staff on whatever PM you get.

Good Luck!

John,

When I originally researched EHR's in 2011, I was just about ready to look at an alternative EHR to AC. Our office was all paper based for the records, except one provider using eCW. We had all been using Lytec for our PM/schedule for years. The most difficult dilemma was having 7 providers interested in starting AC, and figuring out how to best handle this. We have 5 currently using AC, and three soon to start, and we each transitioned one at a time.
I thought we could all be on one shared data base and share notes and such, but found that we all had to individually purchase a license.
We have all transitioned into having individual "EHR pods". Each physician decided on his own computer needs and maintenance of their own specific "EHR pod", and we all share the cost and maintenance of the Lytec server, not unlike how we run the business.

Your situation sounds similar to ours in the sense that you are all under one roof and have multiple providers, but with an added twist of having to also institute a PM for all to utilize that plays well with AC, if I understand your situation.
My advice is figure out the EHR and PM that best fits your current business model.
I have not used any other EHR, but looking back for the past year and half, makes me wish I had started AC 10 years ago with how well this simple little EHR has worked for me personally. I cannot speak for my other 4 partners, but I think they are very satisfied with the transition from paper to AC.
If you are close to Montana, I would be happy to show you our setup anytime.
I think one advantage you have being under one roof is to be able to cost share in a mutually utilized PM, if you decide to go with AC.

1. Buy AC
2. There are zillions of billing programs. Last practice, Medisoft (great billing system). Currently using Medware (great billing system). Ever open another practice, maybe go with Lytec (great billing system).
3. If I mentioned double entry to my staff after seven years, they wouldn't know what the term is. Double entry is COMPLETELY overrated.

John,

One other thought, is that one can use Xlink with Lytec and AC. I know of an office in town just starting AC and using X link to sync with Lytec PM. One of the disadvantages of not having X link, which is minor in my opinion, is not having the schedule on AC, and if the demographics need updated or changed my nurse has to do this in AC as well. I am actually looking into the cost and if not too expensive, I may give it a try and will let you know.

I still laugh at everyone's issue with double entry - takes only a few seconds and really is not a big deal. My staff copies insurance card for biller - enters info in AC and attaches to paper suberbill (Gasp I know) - puts in box for biller - if address was changed it is written on superbill. Really is no big deal.

I agree with Steven. Double entry is no big deal. We use AC and Medisoft. I'm not a big Medisoft fan because of the cost, but my staff knows it inside and out. I actually like having the double-checking of my coding and billing that happens when they enter info from AC into Medisoft. They pick up a lot of missed revenue that way.

Dave
FP

I agree with Bert, Jimme, Dave and everybody. Double entry is not an issue. I wouldn't even bother with an interface with PM.

I am a new user with AC but has been eyeing this product for more than 5-7 years (and it quadrupled in price!). It is not even close to being perfect (and I do not know of any) but the simplicity is the key to this software.

I can understand each provider needing to buy a separate license, but would expect that all providers in the same group would share the same database. Isn't that correct? Jimme are you suggesting otherwise in your post?

Anil,

We have chosen not to share the AC database, and I am not sure how one would share the database with multiple providers. As I understand it AC software is designed really for solo practices and not big and beefy like a Lytec PM software that can handle 15,000 to 20,000 patient accounts.
Also, for logistic reasons, retirement, sickness, moving to a different practice, it is cleaner and simpler for each of us to maintain and run our individual EHR pods.

How do you see each others patient's then? Do you import/export charts to each other? Also wouldn't that make the staff crazy until and unless you have zero cross-over. Like the person scanning in documents etc has to go to log to separate practices. I thought AC lets you share database by creating different users.

Anil,

We are still figuring all of this out, and really not much different than when we were all on paper.

We have one pediatrician and one pulmonologist who we do not share call with.

The rest of us are internists or FP's who take a week at a time night time phone call for each other, except one who still does hospital stuff and takes his own call all the time--the one who has eCW. So it is a bit complex.

When we are gone on vacation, our nurse has access to our records, so will go to the doc on call to handle questions. The nurse will document and take care of each situation, and may print up by paper or send thru updox the most recent med list or note to show to the covering doc. We really do not cross cover much so we are really like a bunch of solo docs. I often will remote in every day or two when I am gone to take care of scripts and keep the workload to a minimum when I get back from vacation, and most of my partners do this as well.

I think the individual EHR pod works the best too, because if I want to do an upgrade and Dr X or Z does not, or do my back up a certain way, I can without having to get a consensus to do the everyday charting the way I want.

This system works for our type of individual practices and not a lot different than how we ran things on paper.

I believe you can designate different users on AC but if you are an MD, I think only one user in that category per license, but your other users are designated as nursing or front office types. I am not sure how to handle a NP or PA however.

I hope this helps.

NP/PA need their own license if they want to prescribe under their own name.

Sandeep is correct but just to clarify, a physician, nurse practitioner or Physician's assistant all require a license whether full time or part time. Again, Sandeep is correct; where I want to escape confusion is you could have a PA who works Fridays from 8 am to 10 am and only sees patients for obesity and never writes a script, this PA would require a full license.

PA or NP or Doctor do not require a separate license if they work instead of AC user. For instance, doctor can be in the office not seeing pts at all, pa can work under his own user without paying for license. If Doctor sees at least one pts that day then pa should pay for license. My understanding is that it was built in for locum tenens situation.

Actually the question I have is not about if each physician (or prescriber) needs a license. If there is a group of 3 physicians and they are all willing to buy three licenses, would they need to set-up 3 practices and 3 databases or they can be set-up as one practice with 3 licensed "prescribing" users. It seemed from prior posts that the latter is not an option. This would be weird if true. Just curious although does not apply to me as I am solo.

Anil,

I just realized I did not answer your question about the staff's response to how we handle this. No, it does not drive the staff crazy. We are a PLLC-- professional limited liability company. We are not a corporation. Quite frankly I would not want to set it up as you suggest. The beauty of a PLLC is that it reduces liability if partner X or Y gets sued, the whole office is less likely to be involved, and if you have one data base and a corporation Dr X's suit will likely be yours, or yours his.
The cross coverage issues can easily be handled even having separate EHR data bases and the liability reduced by not mixing the data base in my opinion.

Anil,

By far, the most common set up is one practice with one database and one or multiple users, all of which require a license.

Thanks Bert, I thought so too. So it appears practices who have set-up multiple databases is by their own choice not by AC limitations. That is what I was trying to clarify for other users.

Thanks Jimme, although I had seen the PLLC designation, I never bothered to learn the difference. Now I know because of you. It seems to be a good way for practices which are essentially separate with some cost sharing. I assume you file only one corporate tax return.

It all comes down to how many providers will be using a system.