August 1999 Newsletter

Volume 4 Issue 4 ©1999

Inside this issue

Feature: Cutting Edge
EDI Advantage
Compliance Corner
Systems Bits & Bytes
Quality Check
To "Q" You In
Miscellany

Cutting Edge

by Durene Motsis

Medicare Sings Our Praises for Y2K Implementation

QUADAX was singled out at the recent Medicare B vendor and submitter Y2K seminar for being a leader in the Y2K implementation process. Hank Termeer, Project Leader for Physician Systems, represented QUADAX at the seminar. Hank reported that Medicare's main concern centered on the number of tests they have received and those that have passed. Hank was told that QUADAX was one of only two ANSI submitters to pass the testing. They also said, of the 6% of the total claim volume in all the tests that have passed, we represent 4% of that or 2/3rds of their EMC claims that have passed.

Medicare sang QUADAX's praises in several instances for being their largest submitter, on ANSI, having passed the test, as well as one of six who are helping with their end to end testing. ANSI is still somewhat rare, so the word has spread that QUADAX is able to submit large volumes of ANSI claims for a wide variety of provider types.

We always love to hear when our hard work is recognized, so congrats to all of those on the QUADAX team who have worked so hard to get us the recognition we have received. Keep up the good work!

We're on the Web

For all you avid web surfers out there, check out some of the new features on the QUADAX home page http://www.quadax.com/. We've incorporated a DynamicNews Engine into our site. This new software allows us to instantly update the content of our home page. Whether it's a regulatory change, product or service announcements, or something of general interest, we'll post the information as soon as we can.

In addition, QUADAX is now a C|Net web affiliate and offers links to the C|Net News and Investing and C|Net Shopper sites. The award-winning News and Investing site provides the latest headlines and up-to-the-minute technology news. Stop by daily to catch up on the latest news in the fast paced world of high technology.

If you're in the market for a new PC, peripheral, or software, check out the C|Net Shopper site. Get the best deals online for PC related equipment and consumer electronics. There's even an online auction if you've got something you'd like to sell.

Coming soon, XPEDITOR on the web. We're well along in developing the system that will let you submit claims over the Internet right through your browser. So check back often...big things are to come.

EDI Advantage

by Tony Petras

More Y2K...

Y2K continues to be the focus of concern for many, and QUADAX receives several requests each day for a statement on the readiness of our products. If you have Internet connectivity, you can obtain a detailed explanation of our position of this upcoming date change by referring to our website at WWW.QUADAX.COM.

As a result of our investigation into the Y2K readiness of the third-party products that QUADAX utilizes, we have discovered the Microsoft DOS versions are "compliant with minor issues", according to that company's official website. Additionally, we have reviewed all of our Physician and Hospital ADVANTAGE users and have determined that there is no need for concern by any of our clients, as to the DOS version in use at their facility.

As to the statement, "compliant with minor issues", Microsoft points out that file date and time stamps will continue to list two-digit years, and the sort from newest to oldest files will identify '00' as the year 2000.

For more information, access WWW.MICROSOFT.COM

For CheX users...

QUADAX continues to support several clients utilizing our eligibility software, CheX. However, QUADAX will not be supporting this system after January 1, 2000. A replacement product is currently in development and will utilize Internet connectivity. Stay tuned to this newsletter and our official website for further information on this upcoming service.

WWW.QUADAX.COM

FYI for Anthem Submitters...

Please be advised that if you tend to use a modifier of 25 on your Anthem claims, QUADAX will pass this data on to the payer, but the payer will simply ignore its presence. There is no impact on your payment when using this code.

Physician Advantage housekeeping...

An on-going effort to keep your Physician ADVANTAGE system current should include the maintenance of your Approval Reports and Remittance Files.

The View/Delete Approval Reports menu item will list every approval report currently located on the hard disk of your Physician ADVANTAGE PC. These reports are in run number order and should be printed and then deleted. When these reports are left undeleted, they continue to take up space on the disk and will also begin to "overlap" from year to year, which will cause confusion to the user. If you need assistance to understand this process, please contact our Help Desk at (440) 979-4090.

For HARP Interface users, Physician ADVANTAGE will retain remittance files similar to the Approval report system. These files should also be marked for deletion after posting. Again, assistance is available by calling our EDI Help Desk.

Customer Satisfaction...

Jim McCauley, Vice President of EDI Sales, informs that Camden-Clark Hospital, after switching to QUADAX's Hospital and Physician ADVANTAGE products has realized a significant reduction in A/R days. Candy Fleak has commented to Jim that the Hospital is very satisfied with their decision to utilize the solutions from QUADAX.

Anthem Acceptance Reports

QUADAX has been informed by Anthem that some of our clients are expressing a concern about the receipt of the confirmation reports.

These reports are received electronically here at QUADAX, and contain details about claims that have been accepted and rejected by Anthem. It has always been our policy to report to you those claims that were rejected by the payer. The accepted claim detail is on file in our Cleveland office, but due to the massive quantities of paper that would be required to print these, and in an effort to keep our fees as low as possible, we have chosen to simply archive them.

If, from time-to-time, you find that you need some of the detailed information provided on these reports, we will be glad to reproduce it for you on an as-needed basis.

Compliance Corner

by Catherine Sicker

With the advent of the Office of Inspector General's "Compliance Program Guidance for Third-Party Medical Billing Companies," it became apparent that our clients should be concerned about their balance billing policies. Some physicians routinely waive co-payments and deductibles or provide "professional courtesy" to colleagues and friends. Both practices have been identified as specific risk areas for billing companies. This issue may be addressed at the federal and state level.

The OIG published a Special Fraud Alert in the 12/19/94 Federal Register that stated "Routine waiver of deductibles and co-payments by providers, practitioners or suppliers is unlawful because it results in (1) false claims, (2) violations of the anti-kickback statute, and (3) excessive utilization of items and services paid for by Medicare." Providers who routinely waive Medicare co-payments or deductibles are misstating their actual charges. For example, if a provider bills Medicare $100, but routinely waives the Medicare co-payment, the actual charge is $80. Medicare should pay 80% of $80 ($64), rather than 80% of $100 ($80). The outcome of the provider's waiver is that the Medicare program is paying $16 more than it should for this service. A provider could, in certain cases, also be liable under the Medicare and Medicaid anti-kickback statute. 42 U.S.C. 1320a-7b(b) . The OIG stated that the waiver might be viewed as remuneration that induces patients to use a provider's services.

In addition to federal restrictions, providers should also be aware of possible fraud and contract issues regarding waivers under Ohio and insurance law. The Ohio Revised Code implies that waiving co-payments and/or deductibles is insurance fraud. O.R.C. 2913.47 .

The federal anti-fraud statute does allow providers to grant waivers in limited situations; the physician may forgive the co-payment/deductible in consideration of a particular patient's financial hardship. This hardship exception must not be used routinely but occasionally to meet the financial needs of a particular patient. A good faith effort must be made to collect all co-payments and deductibles. Ohio law does allow the waiver of co-payments in the following two circumstances: if the health benefit plan expressly allows such a practice or for any professional services rendered to another physician. O.R.C. 4731.22(N)(2). This exception is not extended to the physician's family or employees.

Everyone (physician, staff and billing service) must be made aware that an "Accept Insurance Only" designation should seldom be used and only with great prudence.

Systems Bits & Bytes

by Gene Calai

Promotions!

I am proud to announce several promotions within the QUADAX Systems Department.

Mark Sprowls has been promoted to Director of Information Systems. Mark has been with QUADAX for over 10 years and will now direct Computer Operations in addition to HARP 2000 product development.

Phil Conard has been promoted to Manager of Development and Support. Phil started at QUADAX in 1993 and previously managed HARP Production. In his new role, Phil will get the opportunity to manage new product development.

Mark Gerbershagen has been promoted to Production Support Coordinator. His duties include coordinating the technical support activities of primarily the HARP product line.

John Daley has been promoted to the position of Computer Production Manager. John has been doing an excellent job at QUADAX for many years operating our AS/400 and now will add HARP 2000 to his forte.

Steve Ryant has been promoted to second shift Operations Supervisor. He started with the company back in July of 98, and joined the Operations department in November of that same year as a first shift operator.

Congrats and good luck in your new positions!

New Personnel

Matt Bender has been added to the Systems Department since the last edition of this newsletter. Matt graduated in May from Cleveland State University with a Bachelor's Degree in Information Systems. He is currently in our training program, learning how QUADAX systems provide solutions for our customers.

New Responsibility

In the past, Computer Operations was a department of its own separate from Information Systems. Recently the decision has been made to merge Computer Operations into the Information Systems department. We believe this will help QUADAX improve our operations by applying systematic solutions to the day-to-day operation of our business.

The Internet and QUADAX

The Internet is the big buzz these days in the media because most of the world now uses it on a regular basis. I like the Internet because it is an interactive media, you have control over the content and ability to view whatever information you choose.

You may be wondering about what QUADAX's plans are for the Internet. Well, we have had a web site http://www.QUADAX.com since October 1997. We use our site for marketing, product information and e-mail purposes. Some of our future plans include publishing our product documentation, release notes, providing important business information for our clients and web enabling HARP and our new product XPEDITOR. If you have ideas about anything that you would like to be able to access from the QUADAX web site, please e-mail me. We are in the planning stages, so the more ideas I receive, the better the product can be.

HARP 2000 Report Downloading, Work Lists and Paper Reduction

Since the early days of the computer, we have heard the promise of the paperless office. Well the opposite has happened. Everyone requires an ever-increasing amount of information, usual in a paper format to do his or her job. I would like to make HARP users aware of some enhancements to the software that can help reduce the amount of paper in your office, as well as increase your productivity.

Report Downloading
Report Downloading is the name of a complete system we have developed to significantly improve your access to reports generated by HARP. All reports that are generated in HARP are stored on the QUADAX Mainframe computer.

What does this mean to you?
You can view your reports immediately after they are generated. You do not have to wait until the paper report is sent to you.

Go to the View/Print Reports option under Reporting on the Main Menu. HARP will then present a menu that will allow you to view different reports. Demand Reports are the reports you request via the Select Reports option. Processing Reports are the reports that are generated by the Interim Close, Monthend Close and Remittance Processing. If you have a Load or Electronic Interface, you can also view these reports on-line.

What functionality does Report Downloading give you?
You can view the reports on your screen and you have complete searching capability. Let's say for example you are viewing a Charge Audit Report and you are looking for charges entered for Joe Williams. You can use the Find String feature to look for "Williams". This will find the first occurrence of Williams, place it in the middle of your screen and highlight the string Williams. Isn't that much easier than having to scan through a huge Charge Audit Report by hand?

The View Reports option has very flexible printing capabilities. You can print the entire report, one page of the report or a range of pages. The print out can be directed to the System Printer or your Slave Printer. You can even control the number of copies!

If you just need to view the report, the function keys have been placed to make it a breeze for you to page up and down through the report.

Work Lists
Work Lists are another way that we can reduce our paper usage. Work Lists consist of a system-generated file of Account or Ticket Numbers that can be accessed while using the HARP Select Account Window. The Select Account Window is the screen that is used on all screens where you access patient data. Work Lists can be generated from several HARP Processes, including the Patient Report. Let's say for example, you have a segment of patients that need to be contacted because they have a particular diagnosis code. You can select a Patient Report to locate these patients having this diagnosis code and send it to a Work List. Once the Work List is generated, you can access it via the Select Account Window. Then you could access the Demographic or Inquiry Screen and make the necessary phone calls to the patients.

What are the benefits of a Work List?
First of all, reduced paper usage. By using the file of Account or Ticket Numbers you can access all of the same information that a Patient Report prints, but on-line. Thus, it is more timely and accurate. Secondly, you do not have to wait for a paper report to arrive on your desk. As soon as the job creating the Work List is complete, you can get to work! Finally, it makes you much more efficient. You do not have to enter Account or Ticket Numbers by hand. They are already loaded into the Work List, you just touch a function key and the system enters the number for you! Please contact your Service Representative with any questions about how to use Report Downloading or Work Lists.

Quality Check

by Jodi Africa

The HARP 2000 software continues to evolve with new features and enhancements. Detailed below are the highlights of our latest releases: Please contact your Service Consultant with any questions regarding implementation of these features.

Release 2.08

• Utilizing Patient Reports to Populate Worklists**
  The Patient Report Selector may now be used to select tickets/accounts to be placed on an existing worklist. The worklist must first be created through the worklist maintenance screen. Options are available to add tickets to an existing worklist, or to overwrite the existing worklist with new tickets.
• Procedure Report
  A new report is available to print Procedure file information containing a client's procedure code and price. Several selection options are available, allowing the report to be customized according to the client's needs.
• Roster Billing Enhancements
  In order to allow for specific procedure pricing to be set up for individual Roster accounts, the ability to define multiple Roster insurances has been added.
• Aged Accounts Receivable Detail
  A new option called Output Format has been added to this report. Selection options are Summary or Detail. When detail is chosen, the report will produce a detail list of tickets contained in selected rows and columns. The Detail option is intended to eliminate the need to perform the Split File function.
• Hold Ticket Report Enhancements
  Several new options have been added to the Hold Ticket Report. These options allow Hold Ticket Reports to be utilized in place of Patient Reports for the purpose of managing tickets on hold.
• Hospital Facility Codes
  Provider numbers for Hospitals (a.k.a. Facility Codes) may now be stored in Client Maintenance under "Hospitals". These codes are entered by Insurance Category and will print in Block #32 of the HCFA 1500 form. Medicare initially announced these numbers would be required in 1999, but implementation of this requirement has been delayed due to resources being allocated to Y2K issues.

Release 2.09

• Operator Security Enhancements
  Phase I of new Operator security has been implemented. The Main Menu has been updated to show all features. While some features listed on the main menu are no longer available to all operator types, some operators have gained access to certain functions. Menu selections that are not available for the current operator type are displayed in half bright and marked with an "*"
• Interest and/or Late Payment Fees**
  Clients now have the option to charge late fees or interest on accounts due from patient. Late fees will be added at the time a statement is generated, and will appear under a separate ticket on the account. The fees are controlled by the billing group, and can be a percentage or dollar amount. Time period variables can be days, weeks, months or years.
• Overpayment/Credit Balance Management**
  A new feature is available with this release to facilitate the management of overpayments and credit balances. When activated, this feature allows information that is entered on the Receipt or Inquiry screen to be used to print overpayment letters to be sent to insurance companies or patients. The system will then automatically produce second letters and writeoffs if overpayment remains unresolved.
• Roster Invoices and Reporting
  Ten additional fields may now be selected to print on a roster invoice. Also available is a new Roster Summary Report, which can be printed on demand. This report will list each roster account and print a summary of service counts and amounts by the entity chosen.
• Spreadsheet Files Available
  Users can create a special file when running either the Accounts Receivable Summary Report, or the Aged Accounts Receivable Report. This file can then be downloaded to a PC for the creation of a Microsoft Excel^® spreadsheet.

To "Q" You In

by Janet Browning and Mary Jo Leskiw

Flu and Pneumonia Vaccines

** Reminder **
Although HCFA approved new codes for flu and pneumonia vaccines as of 1/1/99, Medicare carriers could not begin processing these for payment until 4/1/99.

To ensure prompt payment for the upcoming flu season, make sure your fees are updated as follows:

Note: 90732 (Pneumococcal polysaccharied vaccine (adult dosage) - remains a valid code.

This change does not affect the current administration codes. Providers should continue to use G0008 for the administration of the flu vaccine and G0009 for the administration of the pneumococcal vaccine.

Medicare Newsletters

Recently we have been receiving many requests for copies of the Medicare newsletters. QUADAX does not receive a newsletter for every client, and copying them would be time consuming, not to mention quite costly. Therefore, we thought it would be helpful to publish the Nationwide Medicare website whereby the newsletters can be accessed and printed in your own office. That website is: www.nationwide-medicare.com.

We hope this well help everyone attain current copies of Medicare's newsletters.

Miscellany

Thought Provokers

"If at first you do succeed, try something harder." -- Ann Landers

"As long as you are going to think anyway - you might as well think big." -- Donald Trump

"In the business world, everyone is paid in two coins: cash and experience. Take the experience first; the cash will come later." -- Harold Greene

"Never say more than is necessary." -- Richard Brinsley Sheridan

"The art of being wise is the art of knowing what to overlook." -- William James

Lighten Up!

One day a doctor, a farmer, and the president of an HMO arrived at the Pearly Gates. St. Peter hesitated, because heaven is getting kind of full. Finally, he told the doctor, "You may come in, for you have taken care of the sick in their time of need."

Then he turned to the farmer and said, "And you, too, may enter, for you have grown food to nourish your fellow man. Then St. Peter turned to the HMO executive. "Well, I guess you can come in too - but only for three days."