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April 1999 Newsletter

Inside this issue

Feature: Quadax and Y2K
Editorial: Compliance Programs
EDI Advantage
Quick Comments
From the Branches
Systems Bits & Bytes
Quality Check
To "Q" You In
HARP Notes

Feature: Quadax and Y2K

by Tom Kish, Executive Vice President

The purpose of this article is to describe the QUADAX Y2K compliance initiative for the users of our products and services, and to report status, progress to date, and completion expectations regarding these initiatives. Due to the broad nature of Year 2000 inquiries, QUADAX is unable to provide individual responses to specific customer, vendor, and trading partner questionnaires. This document, therefore, will service as the official statement regarding Y2K readiness and compliance of QUADAX products.

Compliance Statement

To the best of our knowledge, all QUADAX products identified in this document as Y2K compliant will accurately determine chronological dates and accurately perform all calculations and data manipulations based upon such dates (including, but not limited to, calculating, comparing, and sequencing dates from, into, and between the twentieth and twenty-first centuries, and leap year calculations), so long as all other software, firmware, and hardware used with the QUADAX products provide data properly to the QUADAX products.

Compliance and Warranty

This compliance statement does not constitute a warranty by QUADAX or extend terms of any existing warranty. Warranties for QUADAX products, if any, are set forth in the license agreements that accompany the products or the terms of the license agreement under which the customer makes use of the QUADAX products. The compliance statement refers to the QUADAX products as delivered by QUADAX and does not apply to user customizable features or third-party products or add-on features accompanying or integrated into the QUADAX products.

The Y2K Team

QUADAX has established a Y2K project team for the purposes of (1) assessing the readiness of our software products and support systems for compliance with Y2K date requirements and (2) the definition and management of those projects necessary to assure such compliance. The Y2K team is headed by Gene Calai, Vice President Information Systems who is also functioning as the chief compliance officer. Gene can be reached by phone at 440-777-6300, by e-mail, or by FAX at 440-777-2330. Additional team members include Thomas Kish, Executive Vice President, Kathy Novak, Vice President Quality Assurance, Gina Judson, Manager Technical Support, and other members of both the Systems and Service departments on an ad hoc basis. The Y2K strategy, project management, systems analysis, and programming are all being developed and implemented by this team of in house professionals.

QUADAX Software Strategy

Existing Software (HARP 4GL aka HARP 1.5, Advantage, Quick)
Date conversion algorithms as defined below in item 2.3 have been coded into the existing software products for all sorting, comparisons, decision making, and reporting utilizing dates. All of these products have been, or are being, made compliant with Y2K requirements. Data bases and data entry screens are not being changed to permit entry or storage of eight character dates. These application products are being tested by setting the system date beyond 1-1-2000 and entering test data using year 00. Optionally, these software products can presently be migrated to entirely new products, with new database structures, new entry screens, new software architecture, and additional application functions. This new development supports full native mode eight character date compliance.

New Software Development (HARP 2000 aka HARPO, and LEAP)
These new software products, developed to replace HARP 4GL, Advantage, and Quick, have full native mode eight character date management. This means that all dates can be entered and stored in the MM-DD-YYYY format. All logic related to date classifications, comparisons, sorting, and reporting are based on the full eight character date configuration.

Date Conversion Algorithms
We have used a data processing concept referred to as "Windowing". Windowing logic uses the absolute value of the two digit year (excluding the century), along with other knowledge about the specific date field in question to determine the century portion of the date. If the two digits representing the year are between '00' and '30', the date will be considered as '20XX' where 'XX' is the two digits of the year. Conversely, if the year is '31' to '99', the century will be implied to be '19', resulting in the date understood to be '19XX' where 'XX' is the two digits of the year. Birthdates, of course, are dates that can range back prior to 1931 so that windowing alone will not work. The problem, however, in dealing with these dates has always existed because we have had to deal with births in the 1800's during the 1900's. Therefore, the algorithm used for birthdates is: if the birthdate is greater than the current date (in the format YYMMDD), the century is assumed to be '19XX'. If the birthdate is less than the current date, the century is assumed to be '20XX'. For Medicare patients, the algorithm is modified slightly as follows: if the age using the above computation is less than 10 years and the HIC# does not end with 'C' (child or dependent), the century is set to '18XX'.

QUADAX Application Software

QUADAX software products support the two primary application areas of (3.1) Healthcare Billing and Receivables Management and (3.2) Electronic Healthcare Transactions (EDI). Although these products are used in many different operating modes and configurations, the Y2K considerations and issues remain the same for each. Whether our customer is timesharing on the QUADAX system or operating software on his own computer equipment, Y2K software compliance is addressed in a uniform way. This is because the same (single) software product is used to support all operational modes.

Billing and Receivables Management

HARP 4GL
This product is not currently Y2K compliant. Although most practices currently supported by this product will have been converted to the HARP 2000 product prior to January 1, 2000, HARP 4GL will be made Y2K compliant as described in sections 2.1 and 2.3 of this document in a future release prior to third quarter 1999.

HARP2000
This product has been Y2K compliant since the initial release of HARP 2000 version 2.0 in January, 1997. We have been converting HARP 4GL accounts to HARP 2000 since January, 1997, and are presently operating on version 2.07 of HARP 2000. HARP 2000 version 2.10, scheduled for release September 15, 1999 will contain all the functionality necessary to support our entire business base. bringing up new business under HARP 2000 since February, 1998. Application functionality is continuing to be developed and implemented in fully Y2K compliant releases of the software. We are presently operating on version 2.07 of HARP 2000. HARP 2000 version 2.10, scheduled for release September 15, 1999 will contain all the functionality necessary to support our entire business base.

Electronic Loads
Electronic loads provide automated electronic media interfaces of patient information and charge detail into HARP databases from customer computer systems. The HARP 2000 standard electronic interface supports eight character dates and is fully Y2K compliant. Algorithms as described in section 2.3 of this document will be used to convert six character dates as supplied by customer files to eight character dates in the HARP 2000 databases. QUADAX will convert these interfaces from customer files to full eight character native mode operation as our customers convert their systems to produce eight character dates.

Electronic Healthcare Transactions

Advantage
This product supports the import, editing, correction management, transmission, and reporting of healthcare claims and remittance transactions. There are two Advantage software products. Physician Advantage processes professional component transactions (HCFA) and Hospital Advantage processes technical component transactions (UB). Both products are integrated with modules that support the interface of electronic print image claims from medical practice computer systems. These modules are integral to the Advantage product and are considered to be a part of Advantage for the purpose of this discussion. Physician Advantage is Y2K compliant with versions 3.6 and greater. Hospital Advantage is Y2K compliant with versions 7.03 and greater. Algorithms as described in section 2.3 of this document are used to convert six character dates as supplied by customer files to eight character dates as required by the transaction distribution formats (see section 3.23). Advantage is a DOS based product developed in Clipper.

LEAP
LEAP is a Windows based replacement for the Advantage products. A single product supports import, editing, correction management, workflow processing, history and retrieval, transmission, and reporting of a variety of electronic healthcare transactions including claims, remittances, status checks, eligibility, and others for all medical practice settings. The LEAP product is fully Y2K compliant in native mode supporting all aspects of eight character date entry, storage, and management. This software will be in Beta test March, 1999 and available for full functional release in May, 1999. LEAP is a GUI Windows based product developed in Visual Basic. Trading Partner Interfaces This product supports the distribution and receipt of healthcare transactions from our trading partners (i.e. health plans). These trading partners interface in either proprietary formats or one or more of the standard protocols. Generally speaking, proprietary formats are not structured to permit the passing of full eight character dates. The standard formats such as ANSI are better suited for this purpose. Many of our trading partners are modifying their specifications to provide for the processing of eight character dates through the use of the ANSI standard formats. We use the Paperfree mapper/translater software to facilitate migrations to these new formats as trading partners make specifications available to us.

Vendor Application Software

QUADAX uses vendor application software to support Healthcare Billing and Receivables Management for two segments of business that were gained through acquisition. Some of this business has already been converted to the HARP software and most of the remaining business is scheduled to be converted prior to the year 2000.

Billing and Receivables Management

Versyss (Quantum)
The Versyss software is supporting several practices in the Western N.Y. state area (Buffalo) that were acquired with the Quantum Resources acquisition from MED-E America in March 1996. This software will not be made Y2K compliant. The majority of the practices acquired in this transaction have already been converted to the HARP 4GL product. These practices, along with those currently remaining under the Versyss software, will be converted to the HARP 2000 product after version 2.08 which is scheduled for release March 15, 1999.

Creasy (Billitron)
The Creasy software is supporting several practices, primarily in the Greater Cleveland area, that were acquired with the Billitron acquisition in January 1995. This software runs on the IBM AS400 computer platform. Neither the AS400 operating system or the Creasy software have been upgraded to Y2K compliant versions.

Some of the practices acquired in this transaction have already been converted to the HARP 2000 product. Most of the remaining practices will be converted to HARP 2000 during the first half of 1999. A few practices have requested that they remain on the Creasy software at least through the year 2000. The Creasy software and the IBM AS400 operating system will be upgraded to Y2K compliant versions during the third quarter of 1999.

Vendor Support Software

This software consists of tools and operating modules supplied by other software vendors that are integrated with QUADAX software or operating procedures.

MPE Operating System (Hewlett Packard)
We are currently operating under Hewlett Packard MPE version 5.5 express 4 which is the initial Y2K compliant release of MPE. Version 5.5 express 6 and all subsequent releases are certified by the manufacturer to be Y2K compliant and has been released for distribution. We will be upgrading to express 6 in the last quarter of 1998.

Windows and Microsoft Office
Microsoft Windows 98 and Office 97 are certified by the manufacturer to be Y2K compliant. Windows NT Workstation 4.0 and NT Server 4.0 are "compliant with minor issues" which are not considered to be significant.

Microsoft Visual Basic
Visual Basic is the development environment and programming language used for the LEAP EDI product. Visual Basic 6.0 is certified by the manufacturer to be Y2K "compliant with minor issues" which are not considered to be significant.

Clipper(Computer Associates)
Clipper is the development environment and programming language used for the Advantage EDI product. Clipper was certified Y2K compliant with versions 4.0 and greater. We are installed on version 5.2.

Speedware Development System
Speedware's development tool, Designer, is used to program the HARP software. This product utilizes the full century representation for application development and database design and is fully Y2K compliant. We are currently running version 7.04.

Adager
Adager is the database manager program that is used to support building Image databases for HARP and maintenance of those databases running on the QUADAX computer systems (Partner and Manager). This product is fully Y2K compliant and has been since the January, 1997 release.

DBGeneral(Bradmark)
DBGeneral is the database manager program that is used for maintenance of Image databases for HARP applications running on standalone user computer systems. The manufacturer has completed Y2K compliance updates and versions 7.2.11 or greater are fully Y2K compliant. We are currently installing version 7.2.12 on new systems.

IMSAM(D.I.S.C.)
IMSAM is the software product used to manage access to certain key fields in HARP Image databases. The manufacturer has completed Y2K compliance updates and versions 3.04.11 and greater are fully Y2K compliant. We are currently running on version 3.03.16 and will be upgrading to version 3.04.62 in the Spring of 1999.

ESPUL(RAC Consulting)
ESPUL is the report spooler and print utility used to manage HARP reports. The manufacturer has completed Y2K compliance updates and versions 9.10 and greater are fully Y2K compliant. We are currently running on version 9.11.

SuprTool(Robelle)
Suprtool is an Image data extraction tool used to produce HARP reporting. The manufacturer has completed Y2K compliance updates and versions 4.1 and greater are fully Y2K compliant. We are currently running on version 4.1.01.

PaperFree
Paperfree is an electronic transaction mapping, translating, and transmission system. The transmission system, Gateway Server has been Y2K compliant since it's release. We are running version 1.08 of Gateway Server. The manufacturer has completed Y2K compliance updates for the mapper/translater and versions 4.5 and greater are fully Y2K compliant. We are currently running version 4.1 and will be upgrading to version 4.5 in the Spring of 1999.

Reflection(WRQ)
Reflection from WRQ is the software product used to emulate Hewlett Packard terminals for operation on the HARP system. This product allows a PC to log onto the HP as a terminal device. Reflection is also used for scripting and managing transmissions for PC's to the QUADAX communications systems. Reflection for DOS is not, and will, not be Y2K compliant. Reflection for Windows is compliant in versions 6.5 and greater.

Procomm(Quarterdeck)
Procomm from Quarterdeck is the product used for scripting and managing transmissions through the Paperfree Gateway Server. These transmissions are used primarily to distribute and receive electronic healthcare transactions from health plans and other transaction trading partner. Procomm for Windows version 4.7 is certified Y2K compliant by the manufacturer.

Quicken(Intuit)
Quicken from Intuit is the product interfaced to HARP to provide check writing for refund of overpayments.

not Y2K compliant and will not be made compliant. This product must be upgraded to Quicken 99 for Y2K compliance.

NOTE: These softwares are trademarked products of a variety of vendors. The statements regarding these products are informative only and not intended to represent the official status of these products regarding Y2K readiness or compliance. Please contact the vendors individually for official statements regarding their products and Y2K compliance.

Other Suppliers
QUADAX is depending on other suppliers such as basic office equipment, telephone systems, other hardware, utilities, forms, and business supplies to provide Y2K bullet proof products and/or compliance updates as necessary. We are communicating with our suppliers regarding the impact of Y2K on their products and services. We are not aware of any issues in the area of Y2K compliance that will affect our ability to provide our products and services to our customers in a completely accurate and timely manner after January 1, 2000.

Editorial: Compliance Programs -- There's No Avoiding Them

by J. S. Leskiw, CPA (np), Executive Vice President

On November 30, 1998, Inspector General June Gibbs Brown of the Department of Health and Human Services released the fourth set of compliance guidelines. The "Compliance Program Guidance for Third-Party Medical Billing Companies" represents the first quantitative set of standards presented to a "Non-provider" segment of the healthcare industry. This guidance, which was designed to assist companies and individuals that process bills for the nation's health care providers, is supposed to be designed to suggest a means by which the billing industry can work to further prevent fraud, waste and abuse. The Office of the Inspector General ("OIG") feels that this guidance will have a far reaching impact on virtually every segment of the Healthcare industry.

The program was developed by the OIG in tandem with HCFA and the Department of Justice, with significant input from various trade associations and health care practice groups including the HBMA (Healthcare Billing and Management Association) of which QUADAX and I are active members. The Compliance Committee at HBMA spent countless hours responding to initial drafts of the guidelines. When the final guidelines were issued, they were pleased to report that they encompassed virtually all of the changes that were critical to the ability of the billing industry to continue to provide the services that the provider community has demanded through the years, without jeopardizing a company's ability to maintain an arms length relationship with their client providers.

The bad news is that the guidelines were far reaching and very significant in scope of required effort. They represent a new level of required bureaucracy and red tape to implement and maintain going forward. With the intent to provide an environment which drives wasted and fraudulent costs out of the publicly funded healthcare economy, the mechanism implemented could add a cost burden on all health care providers to make sure such inappropriate cash drains do not exist, and to penalize perpetrators when they do.

The published guidance, 30 pages in length, provides seven broad areas that a billing company must address in order to adopt an effective compliance program. Those areas are as follows:

Documenting a written policy and related proceance;
Designating a compliance officer and compliance dures governing a company's position on compli committee with specific (new) responsibilities;
Providing an effective education program regarding compliance issues;
Developing effective lines of communication (to the compliance organization from employees AND patients);
Enforcing standards through well-published disciplinary guidelines;
Auditing and monitoring (of activities likely to produce events of non-compliance);
Responding to detected offenses and developing corrective action initiatives.

In establishing such a program, the company must concentrate its efforts on identified areas considered by OIG to be specific risk areas including; billing for services that have not been documented, duplicate billing, unbundling, up-coding, inappropriate balance billing, inadequate resolution of overpayments, lack of integrity of computer systems, failure to properly use modifiers, routine waiver of co-payments, and improper discounts on professional services.

In considering the reporting requirements of a program designed to detect and report incidence of violation in these and other areas, the OIG has developed a bifurcated reporting requirement. If a billing company discovers credible evidence of misconduct in its own activities, the company should report such conduct immediately to the appropriate government authority. If a company discovers credible evidence of the provider (client) misconduct, the billing company must either (1) terminate the agreement with the Client or (2) report the misconduct to the appropriate government authority.

Clearly, adoption of a compliance program will result in a billing company accepting a greater degree of responsibility for detecting and reporting events considered by OIG and therefore HCFA to be acts of fraudulent, abusive or wasteful billing practices on behalf of the respective provider client. Indeed, HCFA expects the billing agent to report the nature and extent of the activity so that they may assess the impact and consequences, whether those acts were perpetrated by the biller or by the provider.

Adoption of a compliance program by a third party biller is strictly voluntary, which is the OIG's way of stating that they are not forcing the private service community to adopt this program that is virtually guaranteed to be very expensive to implement and operate.

They go on, however, to say that while strictly voluntary, "the existence of an effective compliance program could mitigate any action taken against a billing company caught in subsequent wrongdoing" as they choose to define wrongdoing at the time of occurrence. By so stating, they have effectively taken away a billing company's ability to choose to not volunteer. Considering the opportunity for the Justice Department to levy a penalty as high as $15,000 per occurrence, and the likelihood that inadvertent errors (by the provider client or the billing company) could be construed as fraud or abuse, the risk associated with non-participation is far too great for a biller to consider non-participation as a viable alternative.

While the future of healthcare in America and the governance thereof is still in question, what is clear is that the "witch hunt" mentality regarding perpetrators of "fraud" and "abuse" that began a couple years ago is now snowballing out of control. Recent successes in related actions initiated by the Justice Department on behalf of HCFA only feed more fuel onto the fire. Billing companies, like providers, are being forced to err on the side of conservatism to avoid the scrutiny of the OIG and the Justice Department and their abundance of punitive weapons.

As billing companies assess the respective impact of this guidance on our businesses, we will conclude that voluntary participation is the only real option that there is. Non-participation is far too risky considering the potential threat of losing our businesses through civil or criminal action. Therefore, billing organizations need to quickly react to this guidance and begin to create a program that contains all of the critical elements. Paper documentation will not be enough. To be effective, a plan must be a working organizational reaction to the guidance.

As providers that utilize the services of a billing company, be prepared for the impact of this new requirement. Creation and implementation of a compliance program will not be transparent to you and your practices. The burden of the cost of implementing such a plan will ultimately be passed on to the user client. In addition, the client should expect changes in the routine processing of their billing activity, as the specific risk elements of the plan forces billing companies to modify routines that were established over the prior two decades. These changes may simply be administrative such as verifying certain critical billing data. They may be legal such as formally documenting a policy regarding coding, and adding it to the service contract. They ultimately may be financial such as modifying a billing approach that is now considered questionable. Remember, one of the significant services that your billing vendor provides is to identify potential areas of concern and provide you with alternatives to minimize that exposure. Although the outcome of that process may be less revenue to the practice and/or higher costs of processing, consider the magnitude of the alternative !

EDI Advantage

by Tony Petras

Y2K Update

Many of our clients that submit claims by creating a file out of another billing system are going through software updates that result in the printing of dates in an 8-digit format, i.e., 01/01/1999. Please be advised, this is considered a change to the format of your print-file, and as such, QUADAX must be notified prior to your implementing this update. Otherwise, your claim data may be interpreted incorrectly and could result in rejections or incorrect payments.

Before any changes to the printing of your claim forms is performed, check with us to ensure proper submission.

Medicare Facility Code

Fortunately, Medicare has postponed indefinitely the requirement to provide a hospital facility code in Block 32 of the HCFA form when the place of service is not home or office. Eventually, Medicare will begin to require this. Therefore, you should make plans now to test this change with QUADAX. The code should print on the line above the hospital name in block 32 and should be prefaced with the code HSP to identify the number as a hospital code.

Approval Reports

A friendly reminder to again be sure to print and retain the approval reports from Physician Advantage. These reports are your confirmation that claims were sent to the appropriate payer.

The reports are available by choosing off the main menu, Print Reports & Claims, then View/Delete Approval Reports.

The reports are listed in Run Number order. The run number is the Julian Date and will correspond to Sunday's date. The report accumulates through the week, and is considered complete on Mondays. Be sure to print this report each Monday, then delete it by pressing the <F7> key. The January 1999 Julian runs are 003, 010, 017, 024, and 031. February begins with 038 and continues each 7 days, i.e., 045,052, 059, etc. If you see reports with numbers greater than 100, be advised that these are last year's reports. If you would like more information on how to identify approval reports, please contact our Help Desk at (440) 979-4090.

1999 Procedure/Diagnosis Codes

The carriers are now utilizing the 1999 Physicians' Current Procedural Terminology (CPT®) and ICD9 codes. Some carriers, Medicare for example, have instated a "grace" period, meaning that they will accept codes that were valid in 1998 but are now deleted, until March 31, 1999. Be sure to update your system to avoid CPT® code invalid errors.

New Transmission Routines

Our system's staff has been busy implementing a new approach to the submission of claims to the carriers. The "Gateway" server schedules the connection to the payers throughout the day, and sends the claim files automatically. This process allows us to get claims in to the payers, in less time, with increased dependability. At present, more than 50% of our transmissions utilize this new process.

Register for New Claim Types

QUADAX is constantly adding to the list of insurance carriers that receive claims electronically. You can always obtain the current list by choosing, from the Print Reports and Claims Menu, Print Current Payers List. Keep in mind, that some of these payers require the completion of a registration form. For details on which payers require prior registration, please contact our Help Desk at (440) 979-4090.

Question...

Can your billing system create a separate file of just secondary claims? If so, would you like to be able to submit these claims electronically? Contact our Help.

Quick Comments

by Margo McCarthy and Janet Browning

Claim Batching Guidelines

The following guidelines were contained in a memo sent to all hardcopy clients in September.

Claims must be batched by claim type. There may be up to 50 claims in a batch and you may submit as many batches as you like.
All claims in the batch must be numbered in the lower right hand corner. Number each group starting with "01, 02, 03..." All unnumbered batches will be processed under PREMIUM SERVICE for an additional 5 cents per claim.
QUADAX furnishes you with computer printed yellow batch control sheets. We MUST have on e of these sheets on each batch of work we process. Please mark the appropriate claim type on the right hand side of the batch sheet. Please watch your supply and contact the EDI Help Desk 440-979-4050 when you need more.
Also, please remember normal cut-off is noon on Tuesday each week.

Medicare CLIA Number Requirement

QUADAX has refined our edit regarding the reporting of CLIA numbers on all Medicare B claims. Due to documentation recently made available, we are now able to check for the presence of the CLIA number for required tests. Previously the CLIA number was passed to the Medicare carriers if present on claims, but an edit was not in place to ensure it was on the claim if needed. Claims containing procedure codes which are not waived tests under the CLIA requirements, will receive Error No. 61 - CLIA number missing/invalid if the CLIA number is missing or not in the proper format. Also, certain tests are waived if they are followed by the QW modifier. Please refer to the Medicare B newsletters for updates on these codes.

This edit applies to Medicare carriers in Ohio, West Virginia, New York, Illinois, Michigan, Pennsylvania, Kentucky and Virginia. DME claims are not affected by this edit.

From the Branches

by Mary Jo Leskiw and Pat Nomm

Buffalo

The Buffalo office is pleased to announce the following promotions ---

Jean Henry has been promoted to Day Supervisor replacing Tommie Kolbe who has given birth to her second child, Nicholas. Jean has worked for QUADAX for over a year and came to us with a solid medical billing background, having worked for a local hospital for several years.

Heathre Litz has been promoted to Evening Supervisor. Heathre came to QUADAX two years ago after having spent eight years working for a nearby hospital.

Darlene Weber is now filling the position of Compliance Coordinator, having been an account manager at QUADAX for two years. She was previously employed at a physicians office.

We also wish a warm welcome to our new employees:
Barbara Mackey, Christine Henry, Eleasha Nawrocki, Terry Bailey, Cathy Fourby, Debbie Lipinski, Shannon Johnson, Angela Porter-Marrow, Amy Myers, Christi Niziol and Trina Gullo.

Congratulations go out to two newly marrieds, the former Jennifer Fadely, who is now Jennifer Caetano and Darlene Warda, who recently became Darlene Weber. Congratulations also to Diane Kociski, part of our Data Entry Department, on the announcement of her engagement. Newly promoted Account Manager, Lois Radder, became engaged during the recent holiday season and so has Alyssa Micoli.

The Buffalo office is expanding in another way with anticipated the arrival of new babies - Mothers to be are Tara Ziemann, Kelly Claus and Christi Niziol.

Congrats To All!

Cleveland West

We have recently reorganized our Cleveland West Production Management Staff and in the process, we were fortunate to hire Ann McLemore and to recruit Judy Verbinsky from within the company. Ann brings to QUADAX 14 years of healthcare experience and is now the Manager of our Insurance Follow-Up Departments I and II. Judy has been with QUADAX for over 10 years and has previously worked in the Service Department as well as managed the Youngstown branch. Judy is now responsible for the Charge Entry and Receipt Posting Departments as well as being involved in practice management.

The newly reorganized Production Staff also includes: Karen Michalczyk - Manager of the Treasury, Patient Inquiry and Insurance Follow-up III departments with over 13 years with QUADAX; Sandy Whitmer - Manager of the Emergency Medicine department has ten years of experience with QUADAX; Sue Todten - Manager of the Training and Quality Control departments as well as support management for some of our branch offices. Sue has been with QUADAX for 6 years; and Loretta Spicer - - Manager of AS400, Pathology, Coding, and Claims Mailing departments. Loretta has been with QUADAX since 1995 but has over 25 years of experience in healthcare.

The Production managers have worked closely with the staff to make our account work more efficient and productive. Each of the managers is an asset to the Production Department. We wish them success in their new positions.

Beachwood

In June of '98, our Miles Road location moved to a new location in Beachwood, Ohio. And in February, our Accounts Receivable/Payable and Personnel office followed suit. All phone numbers stayed the same, but the addresses changed. Please see below for the new information.

Orangewood Place
3690 Orange Place, Suite 270
Beachwood, Ohio 44122

Human Resources & Accounts Payable/Receivable
Phone: (216) 765-1144
Fax: (216) 765-0984

Production/Billing
Phone: (216) 831-3173
Fax: (216) 292-3313

Systems Bits & Bytes

by Gene Calai

New Personnel

I would like to announce the addition of three new staff members, Mark Lightbourne, Jason Crane and Lauren Plasterer. Mark is a graduate of Tiffin University and is assisting us in the EDI area. Jason graduated from Bowling Green State University and is heavily involved with HARP 2000. Lauren graduated from Kent State University and is currently being trained on QUADAX operating systems, database management systems, programming languages and business applications.

HARP 2000 Design Strategies

Group Design
HARP 2000 was designed by a very diversified group of people. Representatives from several QUADAX staffs were involved in the design. Executives, Service, Systems, Production and Operations all participated in the design meetings.

Ideas from our entire customer base
Beyond just using our own ideas, we have also incorporated hundreds of ideas from our customer base. We have kept all of the enhancement requests from our previous versions of HARP and have incorporated these into HARP 2000.

Years of Medical Billing Experience
The group of people involved with the design of HARP 2000 have several hundred years of Medical Billing Experience. Some of these people have worked at QUADAX their entire careers and others have been involved with Medical Billing at several other institutions. This created a very dynamic mix of opinions, which have helped HARP 2000 become the most functional and feature rich Medical Billing and A/R software in existence.

Years of planning
Our group design for HARP 2000 began in 1994. Ever since the start we have continued to use the group design strategy. It has allowed us to design very user friendly software that takes advantage of powerful automated processes to reduce the labor associated with receivables collection.

Totally redesigned database
When we began designing HARP 2000, we decided that it needed a totally new database structure. Therefore, we created a new database. Our new database eliminates restrictions and, of course, all dates are stored in eight-character format. And now that all of the programs are written in Speedware 4GL, it is very easy for us to modify the database for new enhancements.

Virtual Masters
A Virtual Master Database is a database that stores like tables such as diagnosis codes that can be used by multiple billing databases in one common database. This helps to increase accuracy and reduce time in setup and maintenance of all databases. Virtual Masters allow us to start up new accounts in a very short time frame.

Batch processing systems
During the process of analysis and designing HARP 2000, we spent many hours discussing how we could improve the system. One of the many areas that has been improved is the batch processing systems. All of them have the power of previous versions with new capabilities to help automate processing, reduce labor and increase your cash flow! You cannot find a physician billing and A/R system that has features that can match HARP 2000!

Corrfigurable Entry Screens
HARP 2000 Entry Screens can be modified by the user to increase entry speed. Fields can be added or removed as necessary. All Entry Screens also have user parameters that allow the screens to adjust to entry needs and help automate processing.

Summary

As you can see, we have put a tremendous amount of time, effort and thought into HARP 2000. For the future we have more plans to improve the product, and we are always open to your suggestions.

Quality Check

by Jodi Todten

Our newest version of the HARP 2000 software, is growing rapidly with both New Users & New Features.

We have moved approximately 80% of our Manager service clients to this new software 90% of our Partner service clients.

The HARP 2000 software has many new & exciting features.

Here is just a taste of what's included:

Payment Arrangements
The Payment Arrangement feature allows patient accounts to be marked when a payment agreement is made between the provider/billing service and the responsible party (patient). Based on information entered on the payment arrangement screen, arrangements are managed automatically by the system. Patient statements will print information explaining the minimum payment due and the deadline to make a payment. Patient accounts will be moved to collection or placed on a work list if payment is not received.
Work Lists
Work Lists allow the creation of user defined lists of account numbers and/or ticket numbers which can be brought up one after another through the Account Select Window. The accounts can then be reviewed by the user and marked with actions taken. Multiple Work Lists may be created to handle collection calling queues, insurance review, tickler files, etc.
Encounter Number Logging
This feature allows tracking of charges by encounter number. When activated, a new field will appear on the left side of the Charge Screen for entry of an encounter number.

A report is available to manage Encounter Numbers titled "Encounter Number Report". This report may be ordered to report on charges with encounter numbers which are Duplicate, Missing, or All.
Entry Screen Customization by User
The Demographic, Charge Entry & Inquiry screens allow the user to select & display which fields they would like to be displayed. This feature facilitates streamlining the entry process by removing fields not needed for ceratin practice types.
Relative Value Units stored & reported by Procedure
Relative Value Units may be defined by procedure. These RVUs will print on Third Party Reimbursement Reports to improve comparison analysis.

These are just a few of the new features you will find in HARP 2000 There is much much more coming soon.....

To "Q" You In

HCFA and Y2K

In January, the Health Care Financing Administration (HCFA) wrote a letter to Health Care Partners addressing the Y2K issue and their compliance.

The letter stated that HCFA's system will be ready on time and will be able to process acceptable claims. They are confident that all Medicare claims processes will be ready and able to function come January 1, 2000, so that you can be paid promptly. Even though HCFA is confident that they will be ready, they are also making contingency plans to continue operations if unexpected problems occur.

HCFA will however, only be able to process your claims if your system is able to function in the Year 2,000 as well, and they urge to act now on getting your system Y2K ready. Patient management systems, clinical information systems, defibrillators and infusion pumps and othermedical devices, even elevators and security systems all must be ready.

Additional useful information can be found at their web site, with inforamation on medical devices available on the Food and Drug Administration's web site.

What can you do to avoid potential Y2K pitfalls?

Become aware of how the Year 2000 can affect your system.
Assess the readiness of your hardware and software.
Update or replace systems, software problems, and devices you decide are critical for your business continuity.
Develop a business contingnecy plan in the event something goes wrong.

All QUADAX products are Y2K compliant, and HCFA is ready, now you need to do your part to be sure that you will continue to be paid!

HARP Notes

by Catherine Sicker

Management Info on Third Party Reimbursement

HARP 2000 now has the ability to provide management information on actual third party reimbursements to determine if they are within an expected range. This feature should be used to monitor insurance payments from contracted payers who have agreed to pay based on a published fee schedule. Expected Reimbursement amounts may by defined by Reimbursement Category, by Procedure, or by both elements. Fields are available on the Procedure Screen to retain expected reimbursement dollar amounts and to specify a variance parameter. The variance parameter is used to establish an acceptable range by percentage or dollar amount for which the actual payment is compared to the expected reimbursement dollar amount.

After expected reimbursement amounts are set up, a report can be generated on demand or incorporated into Account Processing (Interim or Monthend). This report, the Expected Reimbursement Report, has a variety of options including selections for 1.) Payments by receipt date, receipt month, charge date of service, or charge month, 2.) Specific procedure codes, 3.) Specific Reimbursement Category, or 4.) Specific variance. The report will display actual reimbursements that are outside of the established variances.

If you are interested in utilizing this management tool, please contact your Field Service Representative. In order to implement this enhancement, QUADAX will require evidence of the third party fee schedule with the contractual reimbursement amounts by procedure.

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