By Jerry Sobelman, CPA
The hottest topic for most practices today is: “Will my computer system take me through the next few years?” With the merger and sale of so many vendors, many practices have been left out in the cold and are frantically searching for a new system. Don’t let this happen to you.
The key issues you need to review when you are evaluating the decision whether to replace your current system are as follows:
• Will your system be HIPAA compliant? When?
• Does your current system meet your needs?
• Has your practice made investments to keep your system up to date?
• Is your system “Old Technology”?
• What technologies do you need to improve efficiency and patient service?
• Are you changing or expanding your practice?
• Will your legacy system be difficult to convert and replace?
• Will your current system soon be obsolete?
• Is your system too “slow”?
Many practices are dealing with vendors that have contacted them with confusing correspondence about whether or not they will be HIPAA compliant. Some of these letters leave doubts as to the future of the companies sending them. Some practices have noticed a decrease in service and training classes over the past year or so, a failure to provide updates needed to stay current with insurance company regulations, as well as a lack of new sales in the area and increased support fees.
Even if your vendor has provided satisfactory service and your only concern is whether they will be HIPAA compliant by the extended due date of October 2003, it may be prudent to begin looking at systems. A little homework in this area will not hurt, and may prevent a crisis in the future.
Start your search by:
• Asking other practices in your area which system they are using and if they like their system.
• Attend seminars about choosing new systems, including trade shows where many vendors exhibit, to look at several systems at one time.
• Talk to a couple of the major vendors in your area about their products and set up some demos to see the full system.
• Contact your local MGMA, PAHCOM and Medical Societies to see if they have recommendations or seminars on the subject.
When looking at a system, make sure you look at all the capabilities you will need:
Scheduling Package. Can it work for multi-physician, multi-site practices? Can you schedule different blocks of time for different providers? Can the system track cancellations, no-shows and recalls?
Billing System. Will the system work with your current patient policies? Is the system easy to use for daily functions charge and payment posting? Does the system have a mass rebill module to allow you to resubmit claims by aging and by payor? Can the system do cycle billing for patient collections? Can patient statements be sent electronically? Can a payment or charge trigger a statement? Is the dunning system affected by payments? Can the office staff tell if a patient owes money so they can collect at the time of service for past due balances? Does the vendor offer electronic payment posting? Does the vendor offer electronic claims submission and if so is this a direct submission or is a clearinghouse used? What is the per-claim or monthly charge for this? Can the system accept entering the allowables by carrier so the payment posters can verify accuracy of payments? Is the system password protected to limit staff access to just the parts of the system they need to use? Can multiple responsible parties be tracked at the same time (i.e. patient balance versus insurance balance versus secondary coverage)? Is there a sufficient notes system to allow the staff to track progress on a bill? Is there a tickler file that can be activated with these notes?
Reports. Are the standard billing reports sufficient? (Aging by Date of Service, and by Date of Submission, Charges, Collections, and Adjustments by Payor and/or by Providers, etc.) Are reports not included as “standard” reports written by your staff or the vendor? What is the charge for these “custom” reports?
Electronic Medical Records. Is an electronic medical records package available? If not, will it be able to interface with one?
HIPAA Compliance. There are numerous issues with the vendors in order for them to say they are compliant. The most important issue for your practice is that your vendor is willing to give you a statement in writing, stating that their system has been independently certified to be HIPAA compliant and will remain in compliance for the duration of your ownership.
Regardless of which system you decide to go with, you need to recognize that it will be a difficult transition. With the number of practices buying new systems right now, the vendors are overwhelmed. As a result, they are selling their products without being able to meet their promised deadlines. Make sure that you have contingency plans for stalled start dates. If you choose to go with a new system, we recommend the following:
• Work down the A/R on your old system if at all possible and start your new system with fresh data and tables.
• Do not convert bad data into your new system.
• Most importantly, make sure that you and your staff receive proper training. Our recommendation is to have your initial training to teach the staff how to use the system and then schedule follow-up training at two weeks, one month, three months and possibly six months. The more the staff uses the system, the more questions they will have. Make sure they get the proper training to allow them to utilize the system in the most efficient and effective way possible.
Jerry Sobelman is Principal-in-Charge of the Margolis & Company P.C. Healthcare Services Group.