ELECTRONIC HEALTH RECORDS (EHR) INTEGRATION – Integrating third-party or custom software with client’s EHR system.
EHR / eRx Integration
Client’s custom EHR was without an electronic prescription component so a third-party solution for this was found. In an effort to eliminate the need to dual enter information into either system, a solution was developed to monitor the EHR’s new patient records and automatically create patient records in the eRx system. Conversely, new medication records created in eRx are automatically downloaded into the EHR’s medications file.
EHR & Service Entry Automation
Client’s EHR presented them with a challenge in that it has no direct relationship between patient documentation and the medical service activity that generated this documentation. The system instead forces staff to record their documentation in real time then at the end of the day record their billable/non-billable activities. This dual entry was costing staff thousands of hours weekly as well as introducing human error as the two entries did not always agree with each other. To combat these issues a customized solution was developed by which the documentation when completed would automatically and seamlessly file the service record. This eliminated the need for dual entry and the errors it produced.
EHR SYSTEM ROLLOUT – Managing client changeover from current to new EHR system.
Custom EHR to Evolv Conversion
Client’s custom developed EHR was showing its age after 15 years of operation and was identified as being more costly in terms of continued maintenance and management than a new system. After evaluating numerous candidates, a product was identified as being the best match for Client’s operations. Throughout the process we assisted in all aspects of conversion including setup of the new hosting platform and hardware, identification and engagement of key participants in the discussions surrounding configurations, implementation of those configurations, and migration of data from the pre-existing record.
EHR ADMINISTRATION – Performing software updates and database maintenance according to best practices.
EHR Database Backup Improvements
The SQL databases originally set up by the vendor were placed on the OS partition of the server, were in various recovery models, and used the default backup plans. The databases were moved from the OS partition to prevent contention and increase performance. Also, the recovery models of the databases were switched to full recovery to provide point-in-time recovery in a disaster scenario. In addition, the databases originally were not configured correctly which would eventually lead to the server running out of space. The backups were reconfigured to correctly take regular backups of the logs to prevent this and enable synced restorations between all databases to protect data integrity.
Client EHR Database Failure
Due to aging hardware, the Client’s primary EHR database server suffered a catastrophic failure. Due to the disaster recovery policies in place, replacement hardware was located and installed, and the system and database restored to functioning status with no loss of data within hours. In the wake of this incident proper funding has been acquired, the processes improved and the servers virtualized reducing the risk of future problems and cutting downtimes even further.
EDI SUPPORT INTEGRATION – Adding support for new EDI standards/requirements
MEDICAL BILLING – Adapting systems to 837/835/277ACK configurations necessary for new payers/trading partners.
Client Third Party Billing
Client was billing non-Medicare or Medicaid insurances via paper claims typed directly onto HCFA-1500 and UB-04 forms fed into an electronic typewriter. We were able to identify a clearing house that was able to handle all of their claims and subsequently configured their system to produce 837 claim files and receive 835 remittance advice files for these transactions.
Client 5010 Conversion
On 01/01/2012, all healthcare providers were required to transition their electronic data exchange formats from the 4010 version to the new 5010 standard. Changes were required to all electronic claims as a part of this, and each trading partner adopted the “standard” in a slightly different fashion than the others. This required extensive configuration changes for each of the insurances our Client filed claims with, as well as exhaustive testing leading up to the implementation date to ensure there was no interruption in billing.
MEDICAL COVERAGE ELIGIBILITY – Adding support for 270/271 transactions to determine insurance coverage for services.
Client Eligibility Lookup
Given the constantly changing coverage of their population and the unreliability of this population with regards to reporting changes in coverage a need was identified for a better source of verification. To accomplish this, new trading partnerships were setup with the insurances they send their claims to. Through this interface, queries are sent directly to the insurances in the days before a scheduled appointment to verify that there has been no interruption in coverage. Patients whose insurance has lapsed appear on the appointment listing with a special note so any changes can be recorded and verified prior to the visit.
CUSTOM EDI SOLUTIONS – “Non-standard” EDI requirements can be met through custom software supplementing existing system capabilities.
Client 837 Scrubber
Due either to limitations in their own billing system or to unusual requirements their primary funding source enforces on electronic claims, the client was unable to send electronic claims to various insurances. To combat these limitations, we developed a custom piece of software to meet their needs. This software is fed an 837 claim file produced by their billing system that does not meet the requirements of the insurance, and then cross references the claim numbers included in the file over to the service data in order to add in the missing information required by the funding source.
ICD10 CONVERSION – Adding ICD10 support for current ICD9 systems.
Client EHR ICD10 Conversion
Client needed a way to be ready for the upcoming mandated ICD10 switchover. Their current EHR only supported ICD9 codes. To solve this issue, enhancements were made to their systems code and database. These enhancements allowed them to continue using ICD9 codes for billing purposes while being able to train their staff in diagnosing under ICD10 codes. They are able to diagnose a patient and see both the ICD9 and ICD10 codes relevant to that diagnosis. In addition, when the switchover happens they will be able to immediately start billing based on ICD10 codes without interruption with trained staff that have had time to learn ICD10 while diagnosing patients for months already.
DATA ANALYSIS – Analyzing client data in various forms to answer business or technical questions.
Client Overlapping Services
Due to improper time recording procedures, the client found that on some level they were likely to have routinely submitted claims for services that had been documented as having occurred at the same time as another service with a different staff. We extracted service data from their EHR into a SQL database to determine a set of services that were recorded at the same time, then examined it to find trends, some of which were determined to be legitimate combinations of services while others might suggest the client was in two different locations simultaneous. Through this analysis we were able to determine a list of services that would need to be voided to avoid fraudulent billing charges.
SQL QUERY TUNING/Optimization – Finding and optimizing queries that cause slow database/application performance.
REPORT WRITING – Creating custom reports for clients.
Client Chart Review Report
Client needed a report allowing them to efficiently print out all documentation for a consumer. The current process involved running reports for each individual document and was a very time consuming task. To streamline this process a new report was created that allowed a clinician to easily select any report or group of reports for a given timeframe and consumer. In addition, they could select templates of commonly needed sets of reports to reduce time spent navigating their EHR. This centralized many disparate reports and greatly reduced the time required to produce a report of all services performed for a consumer.
Client Billing Exception Report
Our client found that there were many services they were delivering that were not being picked up by the billing system and translated into claims due to lack of sufficient information about the patient or service to create a claim. These factors might include a missing or improperly formatted insurance policy #, missing diagnoses relevant to the service, incomplete demographic information or numerous other factors all managed in their discrete portions of the application. In order to get ahead of these missed opportunities a report set was created to show any services that were delivered that were un-billable and how to remedy the situation, as well as to show all patients missing information required to bill future services.