PM Billing

Was developed for Medi-Comm of Texas as a product update to their existing character based medical billing application. This system is an advanced state-of-art web based billing system.

Web-based medical billing software is smarter, faster, and proven choice of physicians and health centre administrators. EMD Systems Billing applications are developed by industry experts who understand medical billing and the challenges of running a profitable practice in today’s economy. The recent changes in health care reimbursement means your medical practice cannot rely on antiquated billing methods and obsolete technology.

The Medical Group Management Association reported that the rejection rate of billing claims is 30%. Out of that only 50% are resubmitted. That leaves a lot of potential revenue left unclaimed.

The medical billing solutions developed by EMD Systems are designed to help you overcome high billing claim rejections. We focus on developing web-based medical billing software that includes special tools such as Claim Revenue so that you are assured only complete, up-to-date claims are submitted. The claims review process alerts you of potential errors prior to submission, resulting in a higher first-pass acceptance rate.

• 5010: EMD provides a single integrated healthcare and payments platform, our applications are ready to support the transition from ASC X12 Version 4010 to ASC X12 5010. Our objective is to minimize the impact during this transition period.
• CPT Codes: The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association through the CPT Editorial Panel.

 

The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.

New editions are released each October by the AMA. The current version is the CPT 2012. CPT coding is similar to ICD-9 and ICD-10 coding, except that it identifies the ser rendered rather than the diagnosis on the claim.

• EMD supports both Level I and Level II codes
• Through the intelligence of the application, our software has the ability to create pseudo procedure names that can be mapped to a single CPT code or to a grouping of CPT codes. This allows for rapid order entry and helps ensure that secondary codes are not overlooked at order entry.
• The ICD 9/10 codes can be mapped to the CPT and insurance provider to facilitate exam appropriateness
• Electronic Insurance Verification: Electronic Insurance Verification helps to solve the problem of missing or invalid insurance information that can cost a practice time and money. By utilizing state of the art technology the application can automatically retrieve insurance and benefit information in just seconds. This process can also be manually triggered at any time. The results of the inquiry are automatically stored – no typing required. This provides an immediately recognizable productivity booster, EMD makes checking insurance eligibility so fast, there’s no reason not to do it for every patient. This information is posted in the application dashboard for all appropriate staff to see at a glance.

 

This feature can be support via connections to Insurance clearing houses such as Emdeon or Availity. If clearing house is not feasible, connections to individual insurance carriers can be established.

Features Include:

• Accurate determination of patient co-pay and deductible
• Minimizes claim denials, reducing accounts receivable problems, and improving cash flow
• Easy to use, no additional learning curve, improvement in productivity
• Facilitates the patient enrollment process
• Real-time processing with immediate response within the application
• Saves administrative time and reduces labor costs
• Meets all HIPAA/CMS criteria for identification, authentication, and encryption
• Rules-based for client flexibility and customization
• EDI (5010)
• 270 Transaction Eligibility/Benefit Inquiry
• 271 Transaction Eligibility or Benefit Information (response to 270)
• 276 Transaction Claim Status Request
• 277 Transaction Claim Status Notification (response to 276)
• 837 Transaction Professional healthcare Claim
• 835 Transaction Claim Payment/Advice (Electronic Remittance)
• 277A Transaction Claim Acknowledgement (Replaces Submission Summary Report)
• 999 Transaction Functional Group Acknowledgement

 

The insurance benefits information returned will be stored as part of the patient record and an automatic notice that the eligibility checking has been done will be made on the patient’s appointment record. Additionally, a print-out of the benefits information for the patient can be produced.

This feature is an integrated into the EMD products and is also available as an SKD

Fee Schedules: EMD knows that a practice has multiple fee schedules that are used on a daily basis. Our applications are built with this fact in mind. To facilitate that fact we include the following features in our applications:

• The ability to designate the default Technical, Professional, and Global fee for a charge item
• The ability to designate a “Contract” fee schedule based on the ordering physician
• The ability to designate a “Contract” fee based on the ordering physician group
• The ability to designate a “Contract” fee based on the insurance carrier
• Contracts can be copied to new contracts to facilitate the rapid deployment of new contracts
• Contracts can have an expiration date assigned
• Contracts can be flagged as active or inactive

 

ICD9 and ICD10 Code Support

• EMD products fully supports the use of ICD9 and ICD10 codes
• There are two related classifications of diseases with similar titles, and a third classification on functioning and disability.
• The International Classification of Diseases, Clinical Modification is used to code and classify morbidity data from the inpatient and outpatient records, physician offices, and the National Center for Health Statistics (NCHS) surveys.
• EMD goes a step further by allowing the ICD codes to be mapped to CPT codes to help ensure that non-appropriate exams are scheduled. This helps to ensure proper patient care and medical reimbursement.

 

Insurance Authorization

• Processing insurance pre-authorizations can be tricky business without a sophisticated management system. Our applications records all the staff member who obtained the authorization, authorization number, referral number, effective date, expiration date, issue date, and notes. Authorizations are tied directly to the patient and the exam. The authorization status is updated to the application dashboard to inform front desk staff of a patient’s authorization status.
• The requirement for pre-authorization can be configured based on the CPT code ordered and the insurance carrier entered for the patient.

 

Medical Report Systems
EMD can provide Medical Reporting Systems (MRS) in a variety of manners. We offer full medical report workflow in our products or we can offer components of that workflow as SDKs.

The MRS is a full reporting and distribution subsystem. It facilitates the major tasks that I include dictation, transcription, review and approval, and finally distribution. In supporting these major tasks, we provide the following features:

• Audio recorder / player
• PDF converter
• Word processor
• Report templates by modality type and/or procedure
• Addendum dictation
• Addendum reports
• Electronic signature
• Automated and manual email
• Automated and manual fax
• Automated and manual e-Fax
• Automated and manual printing
• Automatic distribution via HL7 ORU Interface
• Automatic distribution via B2B interface