Fall 1995 Newsletter

Volume I Issue 2 ©1995

Inside this issue:

Physician ADVANTAGE
CheX Eligibility Verification
Hospital Advantage
From The Branches
Quick Comments
HARP Notes
Systems Bits & Bytes
Timely Tips
Client Spotlight
Points To Ponder
To "Q" You In
Questions & Answers
Carriers Quadax Supports

Have you heard it over the wires?

by Eric Wahter

Quadax has installed a new phone system in the Cleveland, westside office to better serve YOU, our Client! In an effort to provide
you with the best service possible, we have Invested heavily in a state-of-the-art phone system. This new system has allowed us to personally design a more efficient way to handle client calls. We've added voicemail, and have organized our Customer Service personnel into distinct departments, each with its own group of phone numbers.
(See Below)

So what does this all mean for you?!? Now when you call the designated Electronic Claims service number, for example, your call will automatically be directed to the next available service representative in the Electronic Claims service department. Here you will be connected with an agent specially trained to answer your Electronic Claims questions. The same procedure applies to other types of service calls; if you call the proper number, you will reach someone who can help you with your specific situation. Should all agents in a group be busy when you call, you can easily leave a voice message or select to speak with the Operator for emergency assistance.

HARP calls are treated a little differently. Since HARP accounts are assigned a dedicated Service Representative, the HARP service number prompts you to enter your Representative's three-digit extension which will directly connect you to tthat person's desk.

For those of you who may not have received the new service numbers, they are as follows:

We hope you find this new system convenient and easy to use. As always, it is our goal is to assist you as best we can.

Out CheX

by Sid Solomon

If you are one of the Quadax clients using our CheX Eligibility Verification software, why not reduce your telephone on-line tie-ups & hang-ups by avoiding the peak hours of usage? When inquiring on large batches, the response from the State often tends to be slower in the early morning & afternoon hours, but better from 4:00p.m. on. Keep this in mind and save on your next phone bill!

Physician ADVANTAGE

by: Tony Petras

Physician ADVANTAGE continues to be successfully interfaced with a growing list of medical billing software packages. Practices which have
invested in a computer that prints insurance claims but cannot submit claims electronically, find the ease with which Physician ADVANTAGE can be added to their systems refreshing.

Printing claims to a file, instead of the printer, allows the Physician ADVANTAGE software to "read" these claims and convert them to a format that Quadax can check for accuracy. Claims that pass the carrier-specific requirements are sent electronically to the payers and payments follow in less than two weeks. Claims that contain missing or invalid data are sent back through Physician ADVANTAGE, corrected, and re-transmitted.

If your practice is using a computer to print insurance claims that you then send to Quadax for "keying", you may want to consider the benefits that Physician ADVANTAGE can provide.

IMPROVEMENTS

The number of practices using Physician ADVANTAGE continues to grow as well as the number of ideas for enhancing the product. The following changes, as well as others, will be made available in the newest version of Physician ADVANTAGE released in late October.

• The "Go To" function has been given additional flexibility to allow access to sub-blocks and specific claim detail lines.
• Messages retrieved while connected to Quadax will be sent one time, reducing connect time and duplication.
• The "Filtering" function has been enhanced to allow selection on "release" status.
• An "error count" will appear in the error message window, showing the number of times the claim has gone through the editing process.
• A menu item has been added to the report menu allowing the user to print the most current list of insurance coverages that can be sent electronically.
• Anesthesia-specific items have been added to the Block 19 field, enabling this specialty to use Physician ADVANTAGE.

These are among the new and exciting improvements current Physician ADVANTAGE users are experiencing.

Your comments and suggestions are always welcome. Please fax your ideas to Quadax at (216) 777-2330, attention Physician ADVANTAGE Product Team.

Hospital ADVANTAGE

by: Linda Millheim

Announcing 5.01

In October, Quadax released a new version of Hospital ADVANTAGE with four major enhancements!

• Addition of a Communications Menu replacing the Upload/ Download menus.
• Summary Only option for reports.
• Printing of specific name and address in Block 7 of the UB92 form.
• The ability to print, at the PC level, custom reports for claims sent to the payors which replaces the "Yes" report on SuperQuick

The Communications Menu

The Communications Menu was designed to simplify the exchange of data and allow for some exciting product enhancements in the near future.

The initial conversion transmission log, previously available only through SuperQuick, is now available for viewing on the PC under the "View Claims Transmission Log" option.

The download file and upload file menu options were also consolidated into the new Communications Menu. Now, each is a one-step process, rather than a three-step process.

The "Select Claims to download" step in ADVANTAGE, has been eliminated. ALL errored claims are now downloaded to the PC with no user intervention. This step is now automated on the Quadax Mainframe.

In the future, Communications Menu options will enable Quadax to send.information back to the PC for customer's use. We are now working on a payor submission report and electronic remittance with automated secondary billing.

Summary Only Option for Reports

With Version 5.01, it is possible to get a detail summary of all imported or exported claims in ADVANTAGE, without the automatic printing of all claim's detail.

When the Detail Report option from the Reports Menu is selected, a prompt appears asking - "would you like to print only a summary report?" You can use the no default or select yes.

If yes is selected, the system will print a one page summary giving total claims and total dollars by inpatient and outpatient for all payers with a grand total provided.

Printing of Specific Name and Address

Quadax responded to customer requests to add a feature that gives control of what can be printed in Block One of the UB92 form. In the past, the name and address of the company or facility using the system were plugged and Block One could not be accessed.

The new feature functions with a table, can be built and maintained containing provider numbers, facility name, address and phone number. When adding claims on ADVANTAGE, the table can be used to plug the desired data in Block One. Hard copy UB92 forms can then be printed either single mode or global mode.

Please call customer support at (614) 882-1200 with questions concerning ADVANTAGE Version 5.01.

Retrieval Update

With Versions 4.09 and 5.01, the claims retrieval feature is available at the PC level. Therefore, it is no longer necessary to log into SuperQuick to retrieve; simply key in requests from the retrieval option. The request will automatically be sent the next time an upload is executed. Retrieved claims will be placed in a file and will appear on the PC with the execution of the next download file option. Claims with dates of service over three months from the current date require a weekend processing.

From the Branches

by: Tom Cully & Kevin Ellison

Opportunities, Opportunities, Opportunities

Like most companies, Quadax seeks opportunities for our staff to grow and rise to challenges presented. As mentioned later in this issue, University MEDNET presents Quadax and our staff with some outstanding opportunities and unique challenges.

Providing quality client service is a top priority for Quadax. A key person for the MEDNET implementation will be our Client Service Liaison, Catherine Sicker. Some of our clients may recognize the name. For the past seven years, Catherine has served as the Office Manager of our Columbus branch office. While the clients and the Columbus office staff will miss her, everyone agrees that this situation will present some fascinating challenges for Catherine. She will be able to draw upon her significant experience as she helps serve our newest client.

Our ability to make this necessary change is a tribute not only to Catherine, but also to the entire staff of the Columbus office. Our supervisors and staff know that the days ahead will be trying. They also know that those days present opportunities for all.

In our Kettering office, we have added a new anesthesia account and several pathology accounts, in addition to the new database for Anesthesia Associates of Dayton. Though the account changes have been hectic, the staff has been great. Joan Cook, who resides in our Fairborn branch, has recently been promoted to supervisor of that office - Congratulations Joan!

In the midst of all the growth and changes in the office, the staff and clients have been flexible and supportive throughout. A special thanks goes out to all!

Growing and Moving

As our branch offices continue to add clients and staff, our need for more office space grows. Such is the case for our Youngstown office. With the recent addition of our new client Associates in Anesthesia of Youngstown, we have moved to a new facility. This new office space is adjacent to Western Reserve Care's Northside Hospital.

Moving is always a challenge, from physically moving office furnishings, to redesigning office layout, to changing voice and data lines, there are hundreds of items to coordinate. We appreciate the cooperation of our PARTNER clients during our moving days.

Our Youngstown office staff will now be twice as large. With the renovation of that space nearly complete, our Youngstown staff is forming relationships with the new Quadax employees servicing the Associates In Anesthesia account. We look forward to continued growth in Youngstown as well as throughout the company.

Our new Youngstown address and phone numbers:

Quadax, Inc.
2911 Northview Boulevard
Youngstown, Ohio 44504

(216) 759-4600
(216) 759-4555 Patient Inquires
(216) 759-4444 Fax Line

Quick Comments

by: Janet Browning

Electronic Claims Help Desk

When calling our new telephone number for Electronic Claims -(216) 979-4050, providers can expedite their
call by having some basic pieces of information readily available. The information listed below will aid our representatives in researching your question and providing a timely answer.

• Name of provider
• Quadax Client Code
• Quadax Run number
• Insurance Company claim submitted to
• Patient Name(s) of claims in question

Nationwide Medicare B

Quadax is now submitting to Medicare in the ANSI format. As such, certain specialties must format key data elements in order for Quadax to pass the information to Medicare. (This requirement is for hardcopy claims sent to Quadax for keypunch, as well as electronic print files.) If you submit claims for Chiropractic, Podiatry, or Ambulance, please use the following formats:

CHIROPRACTIC: Initial treatment date, date of last xray, and levels of subluxation must be indicated in Block 19 of the HCFA 1500 form in the following format: INT-01/03/95 DOX 01/03/95 SUB-C1,C7

AMBULANCE: New data elements must be entered for Ambulance Condition. Ambulance conditions must be indicated in Block 19 of the HCFA 1500 form in the following format: AC-09,06. Condition code 09 must be on all claims. Other conditions should be indicated as necessary. Origin and Destination of trip must also be indicated in Block 19, in the following format: ORI-BAKER NH DES-CLEVELAND CLINIC

PODIATRISTS: Please refer to the August '95 Medicare Newsletter regarding new modifiers to be used effective October 1, 1995. These modifiers are used to report routine foot care, treatment of mycotic nails and waiver of liability. These modifiers should simplify your billing.

HARP Notes

by: Kathy Novak

HARP Users

Did your know that there are now 59 credit adjustment codes and 35 debit adjustment codes available???? If you are interested in adding some new adjustment codes to your database(s), please let us know by calling your Service Representative at (216) 777-6305.

QUICKEN

If you have a PC as a HARP/MED terminal and QUICKEN PC software, you may have all you need to print your own refund checks!! We can set your database up to record all debit refund adjustments from HARP or MED in a file, ready for input into the popular PC application software, QUICKEN. QUICKEN will automate the check register and print checks on a local printer. If you have the QUICKEN software and want to get started with refund printing, give us a call!

Duplicate Claims

Over the past several months, Nationwide Medicare has intensified its efforts to reduce the number of duplicate claims being submitted for processing. Quadax has worked closely with Nationwide to streamline our technical procedures to protect against sending duplicates. Here are some procedures you can follow to reduce duplicates:

• If you are re-submitting a claim which was previously denied by Nationwide, be sure to make the appropriate corrections in HARP/MED to resolve the denial.
• Be careful when using the "Claim Open Ticket" option on the Inquiry screen. You could be sending another claim for a ticket that is currently in process at Medicare or has already been paid by Medicare.

Together - we can make it better!!

Systems Bits & Bytes

by: Gene Calai

The Quadax Systems Department welcomes a new addition to its Staff! Tom Suver is hard at work developing new electronic claim types for our customers. Good Luck Tom!

Quadax has purchased a new data communications server to improve file transfers between you, our Clients and the Quadax mainframes. This new system will run TBBS, a bulletin board software program, and will provide faster, more reliable connections. In conjunction with the new system, we are developing new communications modules for both ADVANTAGE packages. Implementation plans will be released in the coming months.

As always, the Systems Staff is constantly developing new solutions for our customers. One new project that will interest some of you is the new Scheduling System. Design and analysis of the project has been completed and the programming of the project has begun. The initial release date is currently planned for the first of the new year.

CLIENT SPOTLIGHT

by: Durene Ursem

October 1st marked the exciting addition of University MEDNET to Quadax's Manager customer base. University MEDNET is a 110 doctor multi-specialty practice with locations throughout the Cleveland area. I spoke to Brian Quinn, the Vice President of Finance at University MEDNET, to get a feel for how Quadax was doing thus far. I asked Brian what the circumstances were that pointed University MEDNET in the Quadax direction. He said they had made the decision to bring up a new billing system themselves. In the process of evaluating vendors, they came to the realization that it would be several years before they would have a billing system up and running. During those years of implementation, University MEDNET would not be able to adequately service their patient's billing needs with the outdated billing system they had in place. Therefore, they needed an interim solution to address those needs.

Brian mentioned that they looked at many different vendors. What made Quadax the one of choice? "REPUTATION" he said. At the elimination stage of the decision making process, University MEDNET had been working with other University Hospitals groups and had been receiving positive feedback about Quadax's performance. When asked what University MEDNET was hoping to accomplish by switching to Quadax, Brian replied, "improved service to our patients, improved cash flow, and improved management reporting." I then asked Brian, how Quadax was doing thus far. Brian said it was a little premature to comment on Quadax's performance to date. He did however say, that "the level of effort and dedication from the Quadax staff he has seen thus far has been great!"

I was interested in knowing if there was an area where Quadax has been able to provide an immediate improvement for University MEDNET. At the time of this interview, Brian commented that he had just received his first set of reports from Quadax, and "the information contained in the reports is going to be extremely valuable to our organization to help us manage our organization."

University MEDNET presents the Quadax staff with some excellent opportunities and challenges. Both Quadax and MEDNET are committed to providing quality client service. Bringing the two together to work toward a common goal will undoubtedly ensure SUCCESS!

Emergency Physician Of The Year,

The Ohio ACEP EPIC Vol.10 No. 3

John Bradford, D.O., FACEP, a Quadax Client, was this years' recipient of the Ohio Chapter ACEP "Emergency Physician of the Year" award. This award names the emergency physician who the membership decides exemplifies the highest standards of professional service and is considered a clinician of unusual merit.

Dr. Bradford is currently a Senior Staff Attending Physician at the Akron General Medical Center, as well as the Emergency Medicine Residency Program Director. Dr. Bradford is also an Associate Professor of Emergency Medicine at the Northeastern Ohio Universities College of Medicine.

CONGRATULATIONS DR. BRADFORD!

Timely Tips

• Just a reminder -- ALL claims submitted electronically must contain provider numbers as issued by the carrier. Any questions you have regarding format or placement of these numbers can be directed to our Electronic Claims Help Desk at (216)979-4050.
• New electronic payor coming soon! We are currently testing electronic claims to DayMed, a large Dayton, Ohio area HMO. Watch your mail for further information.

Points To Ponder

• "The best preparation for work is not thinking about work, talking about work, or studying for work: it is work."
  WILLIAM WELD
• "Some people are so busy doing the immediate and the urgent that they never stop to think about the important."
  LEADERSHIP NEWSLETTER
• "There is only one boss. The Customer. and he/she can fire everybody in the company from the chairman on down, simply by spending his./her money somewhere else."
  SAM WALTON, founder, Wal-Mart

TO "Q" YOU IN

by: Jim McShane

Medicare has new requirements with regard to the filing of claims for providers' interpretations of diagnostic services monitoring the performance of the heart. As some of you may have encountered, Medicare has become diagnosis specific for select procedures.

Any provider performing interpretations of the following procedures: Doppler Echocardiography (Physicians' Current Procedural Terminology (CPT®) code 93307-93308), Pacemaker Analysis (CPT® code 93731-93836), Signal - Averaged EKG (CPT® code 93278), Holter Monitoring Services (CPT® code 93224-93227), will only be considered for payment with a particular range of diagnoses acceptable for each service. Medicare has published a list of these accepted diagnoses. If you would like a copy, please call an Insurance Follow Up representative at (216) 777-6300, and we will send you this information.

If you do not have the opportunity to incorporate these diagnoses into the charges, our Insurance FollowUp Department receives the denial that arrive from Medicare. With a simple inquiry form letter sent to you, we ask if one of these codes may be used for your patient. Please take the time to fill these out and return them.

Of course, these diagnoses do not fit every situation. When this is the case, according to Medicare, the patient is not liable for the charge. An Adjustment must be made on the patient's account. A judicious use of these approved diagnoses, along with a respect for the integrity of medical reporting and the Medicare system, makes this a powerful tool in the hands of the physician.

Used correctly, the patient charges would be processed faster and more efficiently, reducing anxiety. The provider would benefit from a faster and more effective management of receivables. Anytime a provider and patient are served well, we here at Quadax benefit too. It's a win, win, win, situation.

Questions & Answers

The Ohio State Medical Association July, 1995

According to the Ohio State Medical Association's July newsletter, the following are some frequently asked questions and their answers.

Q: Should I maintain a standard fee schedule for all my patients? I am often required to discount my fees because of contractual arrangements for managed care plans. Sometimes these amounts are lower than the Medicare reimbursement level. What are the implications of this issue to my practice.

A: Every practice should maintain a single fee schedule or a standard charge for each CPT® code that applies to all patients. There should never be confusion about what to charge a patient. A single fee schedule enablesl the practice to easily track the amount of write-offs or losses incurred as a result of contractual agreement and respond, renew, discontinue or negotiate additional payment for services.

Q: On occasion, I recognize that a financial hardship exists with my patients and I am willing to write off a certain portion of my fee. Are there Medicare rules and state laws which apply to this situation? What would happen if I am audited by the carriers?

A: "Routine" waiver of coinsurance and/or deductible amounts by providers is unlawful under Medicare regulations. Coinsurance and deductive amounts seek to provide a cost sharing on the part of the Medicare beneficiary. In addition, Medicare states the coinsurance and deductible amounts "encourage the patient to cooperate in limited costs by not incurring unnecessary expenses and to take an interest in the reasonableness and necessity of all services."

Electronic Claims Supported by QUADAX

KEY:
HC = Hardcopy
PA = Phys Advantage
HP = HARP
SQ = SuperQuick
** = Quadax exclusive
IP = In-patient
OP = Out-patient
Hosp = Hospital
Phys = Physician

NEIC HOSPITAL/MEDICAL PAYER LIST OCTOBER 1995

HAPPY HOLIDAYS FROM ALL OF US AT QUADAX