November 2001 Newsletter

Volume 6 Issue 1 ©2001

Inside this issue

Feature: HIPAA
Feature: Corporate
Feature: In the Know
EDI Advantage
From the Branches
Network Notes
HARP Notes
HARP Service
Hospital Advantage
LMRPs
Quality Check
Quick Comments
Systems Bits & Bytes
Tech Talk
To 'Q' You In

What is HIPAA-compliant Software?

by CEO, EDI Services

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) contains a myriad of legislation. Originally intended to provide insurance continuity for healthcare patients through job transitions and cost reductions in the system through standardized electronic information transfers, HIPAA has definitely put on a lot of weight! With two final rules in the Federal Register addressing Transaction and Code Sets along with Privacy of protected health information, the legislators have just gotten into full swing. Still to come are final rules for Security of electronic healthcare information, rules regarding national standard identifiers for providers, employers, and payers, and rules concerning co-insurance and coordination of benefits among health plans. It will no doubt be several years before the dust settles and all this legislation is in place.

One thing is clear however, final rules for two of the pieces have been completed and the clock is running toward deadlines for implementation. It is highly unlikely that efforts to delay these implementations will succeed. Even Blue Cross, who has been a leader in the effort to lobby congress for delay, now admits that prospects are slim that such a delay will happen. So, since we must go forward without delay ourselves (October 16, 2002 will be here before we know it), we must ask ourselves some questions. One that is very pertinent as we look for vendor solutions to help with compliance is "what are the attributes of HIPAA compliant provider software?" Since the HIPAA legislation is so comprehensive and sweeping, we would expect this list of attributes to be equally exhausting.

Surprise, it is really not that complicated. HIPAA compliant software must do the following.

1. It must support use of the mandated standard data sets, data elements, and coding sets. This means the product must support all the fields, field sizes, and data element values mandated by the standard,
2. It must support data transport utilizing the standard ANSI X12 4010 transaction format standards for delivery of electronic transactions to health plans and receipt of electronic responses,
3. It must document and secure access to protected health information and provide minimum necessary medical information view, and
4. It must utilize the national standard identifiers as they become available.

Xpeditor and XP Online meet all of these requirements. These products are ready to go to work for you today. They are fully HIPAA compliant.

Corporate news

by CEO of A/R Services

On September 27, 2001, Quadax announced the establishment of a new business unit and the restructuring of their existing business into two distinct business units with unique management teams.

Quadax established the Business Services Division, which will focus on providing document imaging and management services, data conversion services, printing and mail processing services to healthcare organizations. Mr. Richard Lowrie of Westlake, Ohio now heads the Business Services Division as Senior Vice President. Mr. Lowrie has held similar positions with First Data of London, Kentucky and ADP in Cleveland and other branch offices. Quadax has already made, and intends to continue to make, investments in technologies that will enable the Business Services Division to provide existing Quadax clients and non-clients with leading edge solutions that will enhance productivity and improve their profitability.

Concurrent with the establishment of the new division, Quadax announced the restructuring of its existing business into two new operating divisions, the A/R Services Division and the EDI Services Division.

The A/R Services Division will focus on providing powerful technologies that Quadax has developed, along with exemplary professional service to healthcare organizations seeking solutions to the complex problems associated with the billing and collecting of medical bills. Currently the larger of the two divisions, A/R Services supports about 300 billing professionals and technicians in five offices in Ohio, and services Clients throughout the Country. John Leskiw, CPA, CHBME, a sixteen year veteran and Executive Vice President with the Company has been promoted to Chief Executive Officer of the A/R Services Division.

The EDI Services Division provides electronic connectivity solutions between healthcare providers and third party payers. Healthcare clients that produce and receive transactional input on paper utilize EDI ("Electronic Data Interchange") to streamline their operations. Quadax has developed state of the art products, including Xpeditor, it's flagship product, which seamlessly link existing computers at healthcare providers with the respective systems at the payer end, to reduce paper and improve transactional throughput and turnaround. Thomas A. Kish, a twenty-six year charter member and Executive Vice President of Quadax, has been promoted to Chief Executive Officer of the EDI Services Division.

In the Know

by , Newsletter Editor

Why is Quadax the choice of so many in the healthcare industry? Three things: top quality products, excellent customer service, and knowledgeable people.

You can ask any of our customers about our products and service. But not as many are aware of the caliber of those behind the scenes! In the last quarter alone, four Quadax professionals have filled important roles in industry organizations. They are just higher-profile examples of the many Quadax people who are in the know, and working for you.

• Gene Calai , VP of Information Systems. Interex's HP World, boasting thousands of participants, is the second largest computer conference in the country. In August, Gene presented "Creative Ways to Expand HP-e3000 Applications" there. He's also President of local Interex affiliate NEORUG.
  
  Gene has overseen Quadax's implementation of HP-e3000 servers in-house and at customer sites during his 17-year tenure. Those servers are the heart of Quadax's EDI clearinghouse and HARP manager processing, all the while interfacing with customers' and trading partners' computers, the Internet, and our phone system.
   
• John Leskiw , CEO of Accounts Receivable Services. Washington G2 Reports asked John to do a presentation about laboratory billing at their national Lab Institute conference. That annual meeting educates its 500-1000 attendees about the business aspects of operating an anatomical or clinical laboratory, including third-party payers, coding, business types and relationships, documentation and reimbursement. In addition to having a speaker on the faculty, Quadax is hosting a vendor booth and sponsoring this year's "Meet the Experts" reception.
  
  John was invited to speak because Quadax's HARP software includes features that facilitate clinical laboratories' billing in ways that no other software or service does. John has technical reimbursement experience to share with the Lab Institute; at the same time, the conference keeps Quadax in touch with the needs of our laboratory customers.
   
• Brad Daugstrup , VP and Account Executive. Emergency rooms have their own needs when it comes to management, coding and reimbursement issues. Federal and state laws, not to mention a variety of payer policies, directly affect the operation of ERs. Over 100 professionals make up the Emergency Management Organization (EMO) of Ohio, despite its geographic and medical focus. EMO, in turn, is part of the American College of Emergency Physicians (ACEP).
  
  Brad was voted onto EMO-Ohio's board a year ago, while already in his third year of membership. He currently oversees its web site on the side. Brad, through his involvement, also brings coding updates and other valuable information from EMO-Ohio's conferences back to Quadax's Service and Coding departments. That information empowers them to better serve the emergency rooms among our HARP clients.
   
• Tom Kish , CEO of Electronic Data Interchange (EDI). COPAM, the Central Ohio organization of Patient Account Managers, asked Tom to give a presentation this month about how HIPAA will impact their niche of the healthcare industry.
  
  Healthcare EDI clearinghouses are in a position to assume much of HIPAA's burden on behalf of their customers. As such, Quadax has kept a keen eye on those pending regulations. Tom, a key member of Quadax's HIPAA project team, had plenty of knowledge to share with the Columbus-area professionals: coding issues, interfacing with payers and their HIPAA-readiness, privacy and security.

EDI Advantage

by , VP of EDI, Partner

Print & Mail Services

Quadax provides a print and mail service for primary insurance claims to payers that cannot accept claims electronically.

HCFA and UB claims submitted in a standard print-image file, and categorized as 'miscellaneous', are printed overnight, sorted, stuffed, and mailed first class via the United States Postal Service. Claims are out-the-door within 24 hours of receipt.

In addition to the printed forms, a report is produced that details the name, insurance carrier, and total charge of each claim. This report is also marked to indicate those claims which, for various reasons, could not be mailed. Additionally, the incomplete or mis-addressed claim is returned in the weekly mailings to the client, with a cover sheet attached describing the reason(s) that the claim could not be forwarded to the payer.

Claims are printed from the data provided in the print image, with the possible exception of the movement of the payer's address to an appropriate location for viewing through a windowed envelope. No other changes are made to the content of the data. The customer is responsible for the accuracy of the data.

Coventry/Carelink

Since the changeover of Coventry/Carelink claims from a direct transfer to the utilization of WebMD, Quadax, as well as our clients, has experienced a high degree of difficulty in getting these claims successfully processed at the payer. Quadax is continually working with our WebMD representatives, as well as a variety of individuals at Coventry, in an effort to resolve these issues. As of this writing, we are confident that we are editing and formatting these claims (both HCFA and UB) according to the currently documented requirements of Coventry. However, it may be necessary for clients to review previously submitted claims for non-payment and to re-submit original claims to ensure proper disbursement.

Most of the recent issues centered on the multiple payor ID numbers in use by WebMD/Coventry and the specific requirements surrounding rendering provider number placement and format.

If you have concerns about your Coventry claims submissions, please contact our EDI Help Desk toll-free, at (866) 422-8079.

Payor ID Invalid Errors

Recently, Quadax has tightened the edit on WebMD Payor ID numbers. Clients may be experiencing an increased number of rejections of this type. The dynamics of WebMD's payor list can present a challenge to maintain, but Quadax is trying hard to keep you informed of the currently valid numbers. For reference, refer to our website: http://www.Quadax.Com

The Payer List allows you to view the most current listing of payors to which Quadax can submit claims.

CCI Updates

Keeping up with the Correct Coding Initiative (CCI) policy, Quadax has partnered with Ingenix Publishing in an effort to maintain a current database and to provide comprehensive and timely editing of claims that fall into this category.

The most recent update, however, was not received in a timely fashion, causing us to investigate the problem with Ingenix. This was their reply:

"Ingenix pays royalties to both the AMA and NTIS, and cannot allow open access per contracts with these organizations. CCI is not a public use data set like HCPCS or ICD-9, because of the AMA's involvement. Ingenix must account for each electronic access to any item with CPT codes in it. Clearinghouses will not find this to be any different anywhere else, unless someone is illegally releasing CCI. Providers have a month's grace period, and Quadax will receive updated codes before the end of the month following their release."

Based on this information, we are aggressively pursuing Ingenix and expect to receive this data as soon as possible after each quarter so that our customers can be current within the 30-day timeframe.

From the Branches

by , VP of A/R Production, Partner

Medicare Fee Schedule News

The Centers for Medicare and Medicaid Services (formerly known as HCFA) just released their 2002 Fee Schedule. CMS is projecting that total payments to physicians and other non-physician practitioners paid under the Medicare Part B fee schedule, will increase by 1% in 2002. Although total spending is expected to increase, the factor used to update the payment schedule for services will decrease by 4.8% and the conversion factor will be still lower for 2002, 5.4% below the 2001 levels. The influencing factor was a slowing economy and high levels of expenditures for physicians' services. This resulted in a negative update for the base physician fee calculation for 2002. On a positive note, CMS reports that even with a negative adjustment, the physician payment rates have increased well above the inflation rate under the payment system.

Please refer to the CMS web site for details on the Physician Pay Changes for 2002 and/or the local Medicare intermediary web site for a listing of the 2002 Fee Schedule. The Ohio/West Virginia Medicare web site is www.nationwide-medicare.com.

Managed Accounts Receivable Department News

The division of departments and specialties has become a strong focus in our Managed Accounts Receivable Production Area. This is in light of the insurance companies placing tighter controls in the processing and payment of provider claims.

It is our belief that the Production managers, supervisors and staff will be better able to service our accounts when concentrating on a specialty or limited specialties. Information or problems can be more thoroughly researched or resolved when the application or focus is limited.

The following are the departments or specialty groups that have been established and an overview of the managing staff:

• Department of Pathology - Sharon Lloyd manages the Pathology Department with the assistance of Judy Lopez. Together they have 39 years of medical billing experience. In addition to managing the pathology accounts, Sharon is also responsible for our Youngstown office.
• Department of Independent and Clinical Laboratory - Ann McLemore manages the Independent and Clinical Laboratory Department with the assistance of Becky Brown and Kris Sidoti. Combined they have 37 years of medical billing experience. Ann oversees eight independent and clinical laboratory accounts many of which operate at a national level.
• Department of Dermatology - Jean Eddy manages our dermatology accounts. Jean has over 17 years of medical billing experience of which seven have been directly involved in the area of dermatology.
• Department of Emergency Medicine - Sandy Whitmer manages our Emergency Medicine Department with the assistance of Edwina Smith, Ann Stack and Pat Yama. Their combined years of experience totals over 61 years. You go girls!
• Department of Anesthesiology - Sandy Whitmer also oversees our Anesthesiology accounts with the assistance of Shirley Kutney. Shirley has been involved in medical billing for over 13 years many of which have been directly involved with the anesthesia specialty.
• Department of Internal Medicine and Cardiology is managed by Karen Michalczyk with the assistance of Heidi Dietz. Their combined years of medical billing experience totals over 27 years. Karen has been directly involved with our cardiology accounts for over 13 years.

Sue Young and I are closely monitoring departmental activity and our clients' A/R performance to ensure that optimal results are continually achieved.

Network Notes:

Microsoft Windows XP^® / Internet Explorer^® 6.0 and HARP Online

by , Network Support Specialist, Partner

When you connect to HARP Online via the Internet, a Java^® applet (a mini program) is downloaded to your web browser which emulates a terminal connected to one of our mainframe computers; thus allowing you to run HARP within your browser.

As a result of litigation between Microsoft^® and Sun Microsystems^® earlier this year, Microsoft has ceased all future development involving Java (Sun's "universal" programming language). Microsoft's new operating system XP, and its embedded browser IE 6.0, are currently shipping without Java support.

Does this mean you won't be able to use HARP Online if you download IE 6.0 or upgrade your PC to Windows XP^®? Not necessarily. Here's the scoop:

If your current version of Microsoft Internet Explorer^® browser supports Java and you upgrade to the new version IE 6.0, then you'll have no problems running HARP online; your previous Java virtual machine will be incorporated into into the new browser automatically.

Similarly, if you upgrade your present operating system (95/98/ME/NT/2000) to Windows XP^®, and have been using Java, your new system will work just fine.

"But what if I buy a new computer that comes with Windows XP?" you might ask. All is not lost. Some PC vendors are pre-loading Java on their new machines. But even if your new machine lacks Java, the first time you browse to a page that requires Java, IE 6.0 will inform you that you need Java installed and ask you if you'd like to download it. Simply respond "Yes" and your browser will automatically go to Microsoft's download site, retrieve the necessary files, and install Java. Once this process has completed, you should be all set to go. Microsoft^® promises to provide this service for the next 7 years.

You can also install the Java virtual machine on a new Windows XP machine by going to: http://www.microsoft.com/java/vm/dl_vm40.htm and following the directions.

HARP Notes:

Fair Warning: The OIG Focus for 2002

By , Compliance Officer, Partner

The Office of Inspector General (OIG) has issued a Work Plan for fiscal year 2002. This plan is a part of the OIG's mission to "improve HHS (Health and Human Services) programs and operations and protect them against fraud, waste, and abuse." Within the Department Health and Human Services portion of the plan, the Centers for Medicare and Medicaid Health Services projects focus on:

• Medicare hospitals,
• Home health,
• Nursing home care,
• Physicians,
• Medical equipment and supplies,
• Laboratory services,
• End Stage Renal Disease, and
• Others

The physician component of the work plan addresses ten areas of concern.

1. Beneficiary Access to Preventative Services The OIG will evaluate the beneficiaries' access to these services.
2. Advance Beneficiary Notices The OIG believes that the use of the ABNs varies widely among practices and particularly with respect to noncovered laboratory procedures. HARP is designed to store an ABN indicator at the charge line level and has the ability to verify the Local Medical Review Policies (LMRP) to determine the need for an ABN.
3. Physicians at Teaching Hospitals The study will determine if providers are in compliance with the Medicare rules determining payment for physician services provided in the teaching hospital setting.
4. Billing for Resident's Services This review will determine if hospitals have correctly used residents' physician identification numbers (PIN) to bill Medicare.
5. Physician Evaluation and Management Codes The OIG continues to focus on the correct coding of evaluation and management services not only from a documentation standpoint but also to determine if the Medicare carriers are identifying incorrectly coded services.
6. Consultations The OIG will assess the appropriateness of physician consultation services and financial impact of any inaccurate billing.
7. Inpatient Dialysis Services The agency will examine if physicians are physically present with the patient at some time during the dialysis as required by Medicare.
8. Bone Density Screening The investigation will review the impact of the expansion and standardization of Medicare coverage of bone density screening.
9. "Incident-to" Services The OIG will evaluate the conditions under which physicians bill "incident-to" services.
10. Reassignment of Benefits The study will examine the use of staffing companies and how this practice affects emergency room physicians. The OIG will also identify any vulnerabilities in relation to Medicare reassignment rules.

More information about the complete work plan is available at www.os.dhhs.gov/oig.

HARP Service

by , HARP Application Support Manager

HARP Help Desk

A service that the Application Support Department provides is manning the HARP Help Desk. Each day a different member of the department is on the Help Desk.

When to use the HARP Help Desk:

The HARP Help Desk should be used when your assigned Service Consultant is out of the office and you have an emergency situation that needs to be addressed immediately. An emergency situation would be as follows:

• System goes down without warning
• Users are "aborted"
• Can't log in via the ASP Portal
• Operator Code already in use and needs to be reset
• Users are "stuck"

How to contact the HARP Help Desk:

The HARP Help Desk can be contacted directly by calling 440-777-6300 and asking the operator for the HARP Help Desk. They will then transfer you to the correct person. Another way to contact the HARP Help Desk is after first trying to get in touch with your assigned Service Consultant and finding yourself in their voice mail. If, after listening to their message, you need immediate assistance, press "0" and you will be transferred to the operator. Once there, ask to be transferred to the HARP Help Desk.

Hours of Operation:

The HARP Help Desk is operational during our normal business hours of 8:00am - 5:00pm Eastern Time (excluding lunchtime) Monday thru Friday.

HARP New Account Set-up General Information

The expected turnaround time for a new HARP account is 3 weeks from the receipt of a completed HARP set-up packet.

There are some critical elements that must be provided before a new HARP account will be started. Those critical elements include:

• New account set-up sheets completely filled out with all questions answered.
• Completed Billing Group set-up sheet.
• Completed Physician set-up sheet.
• Completed Insurance Company Code set-up sheet for each insurance company that will be a part of the new HARP account.
• If the new account is a standalone, then a Total System back-up tape must also be provided.

For more information regarding what a complete set-up packet includes, please contact the Application Support Department.

HARP Excel^® File Loading

Procedure File Updates:

We now have the ability load a fee schedule or make updates to an existing fee schedule from an electronic Microsoft Excel^® spreadsheet. Please note that Multi-Link Procedures cannot be loaded or updated using this feature. The utility program matches specific column headings to specific fields in the HARP account procedure structure. The column heading must match exactly for data to be loaded. In addition to the specific column headers there are a few minimum pieces of information that are needed in order to load fees in this manner. They are:

Procedure (Key) Code, Procedure Description (cannot contain any commas), Physicians' Current Procedural Terminology (CPT®) Code, Price, Unit value if something other than 1, Type of Service (if using at the procedure level) & Place of Service (if using at the procedure level)

If you don't already have an electronic Microsoft Excel^® spreadsheet but would like to use this feature, an electronic Excel template is available. In addition to the template, a listing of the specific column headers is available. If this is a feature that you would like to learn more about, please contact the Application Support Department.

Referral File Updates:

We now have the ability load a referral file from an electronic Excel^® spreadsheet. The spreadsheet must use the Courier New font with a size of 8. In addition to the specific font & size, the width of each column must be a certain length and must be in a certain order. This utility program can only load a referrals' UPIN provider number. All other provider numbers would need to be entered by hand. If you don't already have an electronic Excel spreadsheet but would like to use this feature, an electronic Excel template is available. In addition to the template, a listing of the specific column widths is available. If this is a feature that you would like to learn more about, please contact the Application Support Department.

Hospital Advantage

by , EDI Service Specialist, Partner

This issue, I'd like to share some of the web sites I find helpful:

General Info

• Unique Physician Identifier Number (UPIN) database on-line
• Centers for Medicare and Medicaid Services (CMS, previously HCFA)
• MediCode, the ICD coding authority
• Office of the Inspector General (HHS OIG)
• RxList, a pharmacy portal
• American Medical Association (AMA)

HIPAA

• Official HHS site on Administrative Simplification
• HIPAA dot org portal
• Bricker & Eckler and OHA's HIPAA Privacy site

Commercial

• WebMD / NEIC / Envoy

CHAMPUS

• Official CHAMPUS home page

Ohio

• Medicaid
• BWC
• Medicare & Blue Cross
• Home Health
  

West Virginia

• Medicare
• Home Health

Disclaimer: Though we expect you'll find these references useful, the links above do not constitute endorsement by Quadax.

LMRPs

by , VP of Quality Assurance, Partner

What is LMRP?

LMRP stands for Local Medical Review Policy. These are policies that are developed by the Center for Medicare and Medicaid Services (formerly HCFA) which are issued by local Medicare carriers and intermediaries. The carriers and intermediaries interpret these policies and implement their own unique version into their claims processing system. The most common type of policy dictates a set of diagnosis codes that can be used with a set of Physicians' Current Procedural Terminology (CPT®) codes that will support medical necessity.

LMRP & HARP

LMRP Editing is a feature available within HARP. It is an add-on module that can benefit many practice types. When activated in a HARP account, each claim's CPT® / ICD9 code combinations are edited during insurance processing.* LMRP editing is often used in conjunction with editing for an Advance Beneficiary Notice (ABN) indicator.

• Each charge line that does not indicate the signature of an ABN will be looked up in the LMRP database for an active policy.
• If a policy is found, the date of service or billing date is checked against the policy's effective dates.
• If an active policy is found, the ICD9 codes associated with the CPT® code are then checked starting with the primary diagnosis.
• The edit will continue to check each ICD9 (up to 4 per charge line) until either an ICD9 that supports medical necessity is found or there are no more ICD9s to check.
• If no ICD9s are found on the charge that support medical necessity (per the policy) then the charge will be flagged.
• Charges that do not pass the LMRP edit are generally split to a new ticket and placed on hold.
• Documentation for the LMRP feature is available, please contact your Service Consultant or access HARP documentation via www.Quadax.com for more information.

*Note: Some HARP accounts also perform LMRP editing in the load process.

LMRP Database

The LMRPs issued by each carrier and intermediary for a region are unique. The policies currently maintained in our database are as follows:

*These are set up only as partials. (i.e. Laboratories).

Network Notes:

Microsoft Windows XP^® / Internet Explorer^® 6.0 and HARP Online

by , Network Support Specialist, Partner

When you connect to HARP Online via the Internet, a Java^® applet (a mini program) is downloaded to your web browser which emulates a terminal connected to one of our mainframe computers; thus allowing you to run HARP within your browser.

As a result of litigation between Microsoft^® and Sun Microsystems^® earlier this year, Microsoft has ceased all future development involving Java (Sun's "universal" programming language). Microsoft's new operating system XP, and its embedded browser IE 6.0, are currently shipping without Java support.

Does this mean you won't be able to use HARP Online if you download IE 6.0 or upgrade your PC to Windows XP^®? Not necessarily. Here's the scoop:

If your current version of Microsoft Internet Explorer^® browser supports Java and you upgrade to the new version IE 6.0, then you'll have no problems running HARP online; your previous Java virtual machine will be incorporated into into the new browser automatically.

Similarly, if you upgrade your present operating system (95/98/ME/NT/2000) to Windows XP^®, and have been using Java, your new system will work just fine.

"But what if I buy a new computer that comes with Windows XP?" you might ask. All is not lost. Some PC vendors are pre-loading Java on their new machines. But even if your new machine lacks Java, the first time you browse to a page that requires Java, IE 6.0 will inform you that you need Java installed and ask you if you'd like to download it. Simply respond "Yes" and your browser will automatically go to Microsoft's download site, retrieve the necessary files, and install Java. Once this process has completed, you should be all set to go. Microsoft^® promises to provide this service for the next 7 years.

You can also install the Java virtual machine on a new Windows XP machine by going to: http://www.microsoft.com/java/vm/dl_vm40.htm and following the directions.

Quality Check

by , Quality Assurance Manager

In today's healthcare environment providing a quality product to our clients is essential. The Quality Assurance team at Quadax reviews the quality of new software and software enhancements relating to the HARP product and coordinates the implementation of new HARP releases. The goal of Quality Assurance is to…

• Provide the best possible products to our clients by ensuring Quality Standards are met.
• Document systems and enhancements in an easy to understand format to preserve and share knowledge on the HARP system. This documentation is available in many formats including the Internet, CD-ROM, and hardcopy manuals.
• Support and train Quadax Service Consultants and Production Managers in an effort to provide outstanding customer service and reduce production inefficiencies.

If you feel that Quadax is not meeting these goals, please contact me by e-mail or contact your Quadax Service Consultant.

Recently, there have been some important changes to HARP. Listed below are two of these changes that were included in HARP 2.14, the last major release of HARP.

1. Arguably the most critical report generated from HARP is the Management Letters. This report is generated monthly and gives you an overall financial picture of your accounts receivables. With HARP 2.14, the Income Analysis section of the Management Letters was enhanced to provide a comparison of the current month to a six-month average. This change will provide for a quick analysis into current accounts receivables. In addition, a new Encounter Statistics section was added to the Management Letters. This section will begin to provide key statistical analysis at the "patient encounter" level to further analyze production reporting.
    
2. A new report, called the RVU Report, will show information about specified charges and their RVU amounts. An RVU is the unit of measure from a relative value scale. This scale is an index that assigns a relative value to each procedure code for services on the basis of resources related to the procedure. An RVU system is a way of weighing various medical procedures for rate setting purposes. The RVU report can be ordered by date of service or by billing month, and it may be summarized by a variety of reporting entities such as physician or insurance company.

Quick Comments:

Local Medical Review Policy - Friend or Foe?

by , EDI Marketing Coordinator

Medicare means well... really, they do. Local Medical Review Policies are established to insure consistency of care and coverage to Medicare subscribers as well as reduce the workload for fiscal intermediaries by allowing them to forego individual claim determination. By applying the "formula" of LMRP to claims submitted, a carrier can adjudicate the vast majority of claims quickly and automatically, while maintaining Medicare's commitment to appropriate, medically necessary care. Medicare does not dictate the regulations, but rather requires that LMRP developed by each intermediary be consistent with national guidance, scientific evidence and clinical practice.

This means that there are as many sets of local policies as there are carriers or intermediaries - increasing the muddle for providers who may bill more than one contractor.

CMS (formerly HCFA) considers LMRP an administrative and educational tool to assist providers, physicians and suppliers in submitting correct claims for payment. If you've been frustrated by denials based on LMRP, or spent hours wading through the stacks of policies, you may think it absurd that they are meant to be helpful. But, the problem isn't the policies themselves - the problem you face is to organize the policy information in a meaningful and handy way, for easy reference. The good news is you don't have to... Quadax has done it for you!

Quadax has developed the tools you need to make sense of LMRP so that it offers the assistance it's meant to provide. The Medical Necessity Database is an ASCII file containing all the rules, all the codes, all the start and end dates - everything you need to plug into your information system to be sure you're in compliance when you prepare your Medicare billing.

Going one step further, the Medical Necessity Checker puts the policy at your fingertips for use at the point of service, so you can insure compliance before services are rendered. Call up the Checker whenever you see a Medicare patient, choose the Intermediary you'll be billing, then enter the procedure and diagnosis codes and you can see, immediately, if any policies exist regarding this combination of codes. Should the combination be considered not medically necessary due to a LMRP by that intermediary, you can, with a click of your mouse, prepare an Advance Beneficiary Notice for the patient to sign, which will allow you to bill the patient for the service you're recommending. Without a signed ABN, if Medicare denies payment of the service as not medically necessary, your only option is to write off those charges.

You can't afford denials - but you can use LMRP as your ally when you use the Medical Necessity products prepared by Quadax! Both the Medical Necessity Database and the Medical Necessity Checker are available on CD-ROM at an annual subscription rate that includes regular updates as policies change.

Systems Bits & Bytes:

The HP e3000 - Your HARP Application Server

by , VP of Information Systems, Partner

The HP e3000 is a computer that was designed and built to do transaction processing. Transaction processing refers to entering, storing and processing many common data fields. Most business applications like HARP are transaction processing systems. The combination of the HP e3000, Image/SQL Database Management System and Speedware 4GL programming environment have created a very stable, efficient and flexible platform for HARP.

With the media continuing to bombard everyone with information about the Internet and other technologies, I would like to inform you as to how your HP e3000 HARP Server can take advantage of all this new technology.

Do not use your Application Server as a Web Server

First of all, I would like to begin with one basic statement. You should not use your application server as your web server. Your HP e3000 is your application server. You do not want to attach it directly to the Internet. There are two main reasons for this. This will increase the amount of TCP/IP processing that your 3000 has to handle. Thus using up some of your processing power. Then there are security issues. Connecting an application server directly to the Internet is not safe. With that said, there are secure ways to allow your users to connect to your HP e3000 that we consider safe. If you want to get connected to the Internet at your office, your best bet is to use a separate web server.

Fully Networkable

Did you know that your HP e3000 can be connected to your office network? All new 3000s and most older 3000s have integrated 10Base-T or 10/100Base-T network cards. So if you have a network in your office, your HP e3000 can be configured and connected to your network. This connectivity can open your 3000 up to many interesting technologies.

Connectivity at Network Speeds

If you are currently accessing your HP e3000 with a DTC the fastest the data can move between the 3000 and your PC or terminal is 38KB per second. If you have a network with 10Base-T cards in your 3000 and PC, they can communicate at up to 10MB per second. This is a huge difference.

Samba for File and Printer Sharing

According to www.samba.org, Samba is an Open Source/Free Software suite that provides seamless file and print services to SMB/CIFS clients. This means that if your 3000 is connected to your network, your PCs can have access to files and directories on your 3000 by using Samba.

ODBC for PC data access

ODBC is the acronym for Open Database Connectivity. This standard is a way to have PC programs access databases on the HP e3000. So with a program like Microsoft Excel^® or Access^® you could access data from your HARP database.

Autobahn^®

Speedware Autobahn^® is a programming environment that will allow you to put HP e3000 applications, such as HARP on the Internet. Quadax has recently purchased a license to use Autobahn. We are now looking into ways to use it to allow users to access HARP via the Internet from a web browser.

Summary

These are just a few of the technologies available on the HP e3000. Most useful technologies that provide additional business functionality are available on the HP e3000.

Tech Talk:

HP Discontinues Support of 9x7 Models

by , HARP Tech Support Manager, Partner

In September 1999, I sent letters along with brochures of Hewlett Packard's new servers to our Standalone clients. I am printing a copy of this letter again in this forum as a reminder not only of the new systems available, but also as a reminder that as of April 2002, Hewlett Packard is discontinuing support of the 9x7 model systems. Additionally, the 9x7 machines cannot run the 7.0 version of the operating system.

I recently had the opportunity to conduct some testing on the A500-100-14, which is the second tier of the A Class system. The processing ran 5 times faster than it did on an HP 918LX. Depending on the size of the database, this can significantly reduce the downtime of a database for processing.

In February 1999, Hewlett Packard made an exciting announcement that it was introducing two new classes of HP e3000 servers, the A-class and N-class. These new computers take advantage of new technologies to improve performance, while still providing the same security, affordability, scalability, and dependability, which we have come to expect from the HP e3000.

The performance of these new servers provides approximately a 65% increase on the low-end servers, and approximately 35% at the high end. In addition to the increased processor performance, the I/O system, which transfers data between the processor, disc drives, and tape drives, uses new technologies to improve throughput as much as tenfold. The A and N-class systems also have the capacity to hold more memory than previous generations.

These two new models of the HP e3000 also provide a reduced cost of ownership. A key reason for the lower cost is a reduction in the cost of support. In addition to lower support costs, these new servers come with a one-year warranty for next day support. If your business were not 24x7 critical, you would not need to purchase hardware support on the processor itself (note that there are still costs for software support and for devices such as disc drives, tape drives, and printers). In some cases, you may even be able to fund a new server with your savings in support costs.

The A and N-class systems are all being shipped with unlimited user licenses. In the past, purchase price and support costs were based on the power of the system and a license for a set or unlimited number of users. These costs are now based on the power of the server, allowing you to add users at no additional cost. These systems are also being shipped with the IMAGE/SQL database management system bundled into the operating system. HARP uses this database management software for nearly all of its data storage. Depending when you originally purchased your HP e3000, you may have had to pay for this option with your system.

The A-class server provides an affordable entry-level system, which can grow with your company. It is capable of housing two processors, meaning that you could purchase a single processor system and add another one later. The A-class servers come in a small enclosure, which is about the size of a desktop PC, and can be rack mounted with other devices if desired. The N-class server provides a scalable mid-range to high-end solution. The N-class uses faster processors, and can currently support up to four processors. The N-class servers are rack mounted.

So, you may be asking yourself "Do I need to upgrade?" or "Why should I upgrade if my current system is functional?" In the world of information technology, applications become more sophisticated, businesses grow, and hardware eventually becomes obsolete.

Today's computer applications can do far more for you, and therefore require more powerful computers to run, no matter what the type of computer. HARP is no exception. The functionality of HARP 2000 is far beyond that of HARP4GL, which was far beyond that of its predecessor, MED. Quadax will continue to improve upon the HARP product, adding functionality, which may be necessitated by billing standards or requested by you, the customer.

We at Quadax hope that your business has grown since you have chosen us as your billing software vendor. Along with an increase in business comes an increase in the number of users using your system and an increase in the number of transactions processed by HARP. Eventually the activity can become more than your system was meant to handle, and it is time to upgrade your system. Because there is some lead-time for HP e3000 orders, it is best to be proactive and upgrade your system before implementing a large amount of new business.

Many of you are currently using a 9x7 model HP e3000, i.e. 917, 927, 937, or 957. These models were first built ten years ago, when 386's were the latest personal computer available. This illustrates the longevity and durability of the HP e3000. However, the 9x7 is very near the end of its support life. As noted in documentation 9x7 users have received from Hewlett Packard, HP as of April 2002 will no longer support these systems. There are third parties that would be more than willing to support your system, possibly even for less than the cost for HP support. However, it has been our experience, at Quadax, that these companies cannot provide the same high level of support provided by HP.

For more information, point your web browser to http://www.hp.com/products1/mpeixservers/index.html. If you are interested in upgrading your HP e3000, please contact me. I will be able to start a process in which Quadax can recommend the proper system configuration for your needs and obtain that system for you.

To 'Q' You In:

ICD-10-CM Coding Changes

by , Quality Assurance

Quadax personnel recently participated in an audio seminar presented by Medicode and St. Anthony Publishing regarding the projected changes needed for ICD-10-CM diagnosis coding. ICD-10-CM will be the replacement for the current ICD-9-CM coding.

The change will occur no earlier than October 2004. The government must give 24 months notice prior to implementing the new coding system. The ICD-10-CM version is currently being used in more than 35 countries, including Canada.

The format of the code is one alpha followed by 2 to 5 numerics (A11.111). Valid codes can have anywhere from three to six characters. These codes are much more detailed and will require more documentation in order to code correctly. There are triple the number of codes used for ICD-9-CM. Some codes will remain the same (prefixed by an alpha character), and others will change completely. Note: The letters "I" and "O" will be used as the first character, which could cause some confusion with numeric values of 1 and 0.

The transition issues are predicted to have as much impact on resources in the healthcare industries as the Y2K effort. Beyond the technical issues, there will be a significant impact on the coding staff in regards to education. It is expected that for the first six months, coding will take approximately 25% longer.

Implementation of the new coding system will be date of service driven, causing systems to be able to accommodate both versions of coding for a period of time. All payers will be required to make the switch at the same time.

Quadax continues to monitor new developments in this area, and will allocate needed resources to accomplish the transition for all of our products.