Picis – ED PulseCheck
Jeff Kelly, Online Industry Editor

ED PulseCheck from Picis is a tool to help hospitals maximize revenue, improve quality and realize full clinician potential of emergency departments, or EDs. Among its most critical features are integrated charge capture and medical necessity documentation to help hospitals achieve full ED reimbursements.

Read the full product review

Cash perks plus cost savings: Get paid for adopting electronic medical billing

The most commonly recognized advantages of adopting electronic medical billing programs are postal fee savings, immediate notification in the case of the rejection of a claim, 98% coding and billing accuracy rate, payments received in one to two weeks as opposed to 45 days, streamlined office procedures and guaranteed HIPAA compliance.

However, there are two other financial benefits accruing from conversion from paper to medical practice management (MPM) software systems. The first is that the Health Information Technology for Economic and Clinical Health Act (HITECH Act or "The Act") contains financial incentives designed to accelerate the uptake of electronic health record (EHR) systems by providers, and the second relates to the fact that research organizations are increasingly turning to using only electronic health records because this format enables data management software to quickly perform impressive feats of data manipulation.

“Grant money and incentive programs are available, for example, and they want data in the electronic form,” points out Francine Wheelock, PT, MPA, manager of clinical systems for Maine General Health. Medical data owners who have not gone electronic will miss out on these cash perks as well as the savings associated with reduced labor and supply expenses.

Best-in-Class Medical Billing and Coding Providers:

• Offer one software product with one transmission, one protocol and one support number
• Utilize the ICD-9-CM or HCPCS index medical coding standards
• Employ certified medical billing and coding specialist

Top Considerations Before Selecting Medical Billing and Coding Provider:

While most medical billing programs bring you into compliance with the increased security standards and ANSI billing format sections of the Health Insurance Portability and Accountability Act (HIPAA), some software provides only partial HIPAA compliance. Discuss this aspect of the software solution capability with each vendor.

Key Providers:

1. A-Life Medical Inc.’s computer-assisted coding (CAC) solution, Actus, which assists coders with suggested and traceable reimbursable codes through LifeCode proprietary Natural Language Processing (NLP) technology, was designed to address the difficulties associated with outpatient coding. This system has the capability for remote sign in. Actus has the ability to quickly find‚ review and verify electronic medical records (EMR); improve coder productivity to help compensate for coder shortages which currently exist in the marketplace; reduce turnaround time‚ labor costs and accounts receivable days of sales outstanding; obtain reliable‚ accurate coding of outpatient records; easily integrate with hundreds of billing, hospital and documentation management systems; streamline workflow; and minimize auditing needs. A-Life Medical is the winner of Red Herring's Top 100 North America award in 2010, which is given to startups in North America that pioneer innovation in their industries.

2. Promantra Synergy Solutions' Billing Services improve compliance with Medicare and other Payor requirements, monitor billing collections and recommend how much should to be written off on Payor-regulated timelines. This business processing outsourcing (BPO) company reports that "Our coding services will help our clients to experience an increase in returns and a reduction in the number of denials.” It complies with the ICD-9-CM Official Guidelines for Coding and Reporting, AMA Guidelines from CPT-4 Code Manual, and CMS (HCFA) Guidelines [CCI (Correct Coding Initiatives)] and LMRP(Local Medical Review Policies)." This US-based company, founded in 2003, specializes in services for the Long Term Care (LTC) Industry. Promantra is headquartered in Piscataway, NJ and has regional offices in Idaho and California.

3. AdvantEdge Healthcare Solutions’ (AHS) Hospitalist Billing software solution workflow optimization enables faster and more accurate superbill and other paper-based data entry. AHS reports that “The entire workflow is designed to speed the end-to-end billing cycle.” For clients with either hospital- or office-based electronic medical record or other systems, AHS billing technology captures patient demographics and charge information. Handheld devices enable on-site charge data capture. Updates to insurance coverage automatically trigger updates to all affected claims. Other software solutions include: Anesthesia, Radiology, Virtual Manager, Internal Medicine and Neonatology Billing. This company, founded in 1999 and based in Warren, New Jersey, also offers revenue cycle management services to hospitals and office-based specialty physician practices.

4. Lister Technologies provides medical billing in addition to insurance verification, coding, charge/demographic entry, claims submission, payment posting, denial management, accounts receivables management services and insurance follow-up services to medical groups and companies across the US. This Chennai, India-based company provides medical billing services by remotely connecting to its customers’ practice management software. This end-to-end medical billing outsourcing company reports that "Our stringent quality checks ensure an accuracy level of over 98% in processing the claims. Lister, started in 2001, also builds software solutions for the manufacturing, publishing, internet and ecommerce, telecom and educational industries.

Medical Billing and Coding
Definition: Medical codes are published codes such as HCPCS and ICD-9-CM that are used when submitting a claim to an individual’s insurance company to indicate which services and products the health care provider is seeking payment for. These codes are also used by governments and private healthcare organizations for research purposes to gather statistical data about the treatment of certain conditions.