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REPORT OF THE COUNCIL ON MEDICAL SERVICE

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					                             REPORT OF THE COUNCIL ON MEDICAL SERVICE


                                                                                               CMS Report 14 - A-99
                                                                                                       (June 1999)

     Subject:           Computerized Programs that Retrieve Incidence and Prevalence Data about
                        Billing Codes by Payor

     Presented by:      Kay K. Hanley, MD, Chair

     ----------------------------------------------------------------------------------------------------------------------

 1   At the 1998 Interim Meeting, the House of Delegates adopted Substitute Resolution 805. This
 2   resolution, in part, calls for the American Medical Association (AMA), in collaboration with
 3   medical specialty societies, to evaluate the availability of user-friendly, computerized programs
 4   that retrieve incidence and prevalence data about billing codes by payor in the physician‟s office.
 5   The Board of Trustees assigned the requested evaluation to the Council on Medical Service, with a
 6   report back to the House of Delegates at the 1999 Annual Meeting.
 7
 8   The following report, which is presented for the information of the House, describes a number of
 9   computerized programs identified by the Council that retrieve incidence and prevalence data about
10   billing codes by payor and are currently available to physicians. The Council hopes that this
11   information may be of assistance to physicians in identifying and ultimately selecting those
12   programs that meet their specific needs and are user-friendly. It also recognizes, however, that
13   “user-friendly” is ultimately determined by the user.
14
15   The specific vendor promotional information contained in the Appendix to this report was
16   obtained from the following sources:
17
18      American College of Physicians – American Society of Internal Medicine – Medical Software
19       Directory (www.acponline.org);
20
21      Electronic Vendors Response for Medical Vendors (www.computertalk.com);
22
23      Healthcare Information Systems Directory (www.health-infosys-dir.com); and
24
25      The Healthcare Computing Publications, Inc. (HCP Directory of Medical Office Management
26       Computer System Vendors with Satisfaction Ratings 1997-1998).
27
28   The Council notes, however, that there may be other sources, software, and systems available that
29   retrieve incidence and prevalence data about billing codes by payor. It also should be noted that
30   the product information contained in the Appendix was supplied by the manufacturers. Citations
31   from the HCP directory were based on product ratings that were determined by questionnaire
32   responses from vendors‟ medical office customers, phone and personal responses from vendors‟
33   customers, and information in the author‟s databases. Finally, it must be emphasized that the
34   AMA makes no endorsement or recommendation regarding any of the sources, software, and
35   systems listed.
                                 CMS Rep. 14 - A-99 -- page 2
                                       (June 1999)

                                          APPENDIX

       Computerized Programs that Retrieve Incidence and Prevalence Data about
                               Billing Codes by Payor


SOFTWARE COMPANY                                 VENDOR PROMOTIONAL
                                                 INFORMATION**
ChartWare, Inc.                                  “ChartWare meets existing standards for paper
101 Golf Course Drive, Suite A220                systems, anticipates future electronic data
Rohnert Park, CA 94928                           interchange compatibility… Enhancements
800/642-4278                                     include Physicians‟ Current Procedural
                                                 Terminology (CPT) and ICD-9-CM for
                                                 ChartWare and interfaces to widely used
                                                 practice management products.” (ACPOnline)
CompuSense, Inc                                  “MediSense can show the variance from
Kellym@COMPUSENSEINC.com                         expected reimbursement and how many times
                                                 this occurred – for example our Reimbursement
                                                 Exception report shows you procedures by
                                                 carrier, provider or location and totals the
                                                 number of times you received less than
                                                 anticipated. We also have procedure analysis
                                                 reports that show units within a certain time
                                                 period and allow you to compare the same
                                                 period from year to year (how many 99213
                                                 were done for Medicare patients from April-
                                                 June 1998 compared to the same data for April-
                                                 June 1999). In addition, many of our reports
                                                 are set up for automatic export to MS Excel –
                                                 allowing for graphical depiction of data.”
                                                 (CompuSense, Inc.)


CYMA Systems, Inc.                               “The system includes… payment information,
2330 W. University Dr., Ste. 7                   analyses, diagnoses, test results, lab work or
Tempe, AZ 85281                                  other information in the data base; practice
602/831-2607                                     analysis; and management reports.” (HCP)
Geographical coverage: Nat‟l through dealers.

** The information in this Appendix was supplied directly by either the manufacturers or from
actual customer reviews of the software‟s functionality.

The AMA makes no endorsement or recommendation regarding any of the sources, software or
systems listed. In addition, there may be other sources, software, and systems available that
retrieve incidence and prevalence data about billing codes by payor.
                                 CMS Rep. 14 - A-99 -- page 3
                                       (June 1999)


SOFTWARE COMPANY                                 VENDOR PROMOTIONAL
                                                 INFORMATION**
Datamedic Corp.                                  “It uses a business group concept that enables
20 Oser Ave.                                     common files such as patient demographics,
Hauppauge, NY 11788                              procedure and diagnoses codes, and managed
516/435-8880                                     care information to be accessed and
Geographical coverage: National except           manipulated across practices, specialties,
Hawaii.                                          locations, and organizational structures.” (HCP)
Fiscal Information, Inc.                         “Patient billing is guarantor-based with a single
985 Wilson Ave.                                  bill broken out by patient and encounter
Loveland, CO 80537                               provided to the guarantor of the account.
303/669-4340                                     Payment posting applies specific payments to a
Geographical coverage: National.                 specific encounter, thus payment allocations to
                                                 a particular procedure, date of service, or
                                                 insurance invoice number…” (HCP)
InfoSys                                          “Medsys certainly has the ability to report on
Schaumburg, IL                                   CPT and/or the Health Care Financing
888/463-6797                                     Administration Common Procedure Coding
http://www.infosysusa.com                        System data by insurance and/or financial
Medsysusa@aol.com                                class.” (InfoSys)
Machelp Associates, Inc.                         “The system performs 30-, 60-, and 90-day aged
322 Troon Rd.                                    account tracking, as well as financial analysis
Dover, DE 19901                                  procedures performed according to CPT codes,
302/734-7491                                     practitioner, or other parameters.” (HCP)
Geographical coverage: NY, PA, NJ, DE, MD,
DC, VA, NC.
Medical Digital Technologies, Inc.               “Our practice management software provides
Http://www.medoccur.com                          various different types of reporting on billing
Plummer@meddig.com                               and collection by payee.” (Medical Digital
                                                 Technologies, Inc.)

Medical Information Management Systems,          “The program can identify revenue sources by
Inc.                                             payor, patient class, patient diagnosis, patient
511 Union St., Ste. 1800                         medication usage, inventory supply types and
Nashville, TN 37219                              categories across an entire enterprise.” (HCP)
615/259-3400
Geographical coverage: National.

** The information in this Appendix was supplied directly by either the manufacturers or from
actual customer reviews of the software‟s functionality.

The AMA makes no endorsement or recommendation regarding any of the sources, software or
systems listed. In addition, there may be other sources, software, and systems available that
retrieve incidence and prevalence data about billing codes by payor.
                                   CMS Rep. 14 - A-99 -- page 4
                                         (June 1999)

SOFTWARE COMPANY                                  VENDOR PROMOTIONAL
                                                  INFORMATION**
The Medical Manager Corp.                         “Functions of…Version 9 include… procedure,
500 Clyde Avenue                                  diagnosis and financial history… over 170
Mountain View, CA 94043                           detailed management and financial reports...”
415/969-7047                                      (HCP)
Geographical coverage: National.
MicroMed Healthcare Information Systems           “You recently requested information from
404/467-1500                                      ComputerTalk‟s Web site regarding a program
www.micromed.com                                  that „retrieves billing code data by payee for a
mburke@micromed.com                               practice.‟ I would like to provide you with
                                                  some information on MicroMed‟s Enterprise
                                                  Practice Management system, which
                                                  accomplishes your requested task and more.”
                                                  (MicroMed Healthcare Information Systems)
Millbrook Corp.                                   “Many reports inform the practice of its
5151 Beltline Rd., Ste. 1020                      financial status. The open database also allows
Dallas, TX 75240                                  physicians and office staff to query the database
214/663-2000                                      for information and create reports in Microsoft
Geographical coverage: National.                  Excel or letter in Microsoft Word.” (HCP)
Nuesoft Technologies, Inc.                        “ComputerTalk magazine contacted me and
404/351-5052                                      mentioned you were interested in a program
www.nuesoft.com                                   that readily retrieves billing code data by payee
Mkirksey@Nuesoft.com                              within a practice. This is exactly what Medicat
                                                  does.” (Nuesoft Technologies, Inc.)
Patient Analysis and Tracking System (PATS)       “PATS functions to track, analyze, risk stratify
Axis Clinical Software, Inc.                      and predict clinical outcomes of medical
5201 SW Westgate Drive, Suite 216                 procedures. Import/export capabilities allow
Portland, OR 97221                                interfacing with other systems and national
503/292-3022                                      database submission.” (ACPOnline)
Psimed Corp.                                      “The database holds all patient procedures that
1221 E. Dyer Rd., Ste. 260                        may be used for accounting purposes, managed
Santa Ana, CA 92705                               care utilization reporting, medical records, or a
714/979-7653                                      combination of these.” (HCP)
Geographical coverage: CA, MA, AK, GA, DC,
TX, TN, PA, OR, IL, NJ, OH, KY.

** The information in this Appendix was supplied directly by either the manufacturers or from
actual customer reviews of the software‟s functionality.

The AMA makes no endorsement or recommendation regarding any of the sources, software or
systems listed. In addition, there may be other sources, software, and systems available that
retrieve incidence and prevalence data about billing codes by payor.
                                  CMS Rep. 14 - A-99 -- page 5
                                        (June 1999)


SOFTWARE COMPANY                                  VENDOR PROMOTIONAL
                                                  INFORMATION**
Visionary Medical Systems, Inc.                   “Probably the most powerful report in The
1355 Snell Isle Blvd., N.E., Suite 225            Visionary Office is the „Patient Research
St. Petersburg, FL 33704                          Report.‟ With this report, you can find patients
727/895-2466                                      and charges based on almost any criteria. The
bonnie@visionarymed.com                           selection criteria is virtually any information
                                                  about the patient, charge, and policy.”

** The product information in this Appendix was supplied directly by either the manufacturers or
from actual customer reviews of the software‟s functionality.

The AMA makes no endorsement or recommendation regarding any of the sources, software or
systems listed. In addition, there may be other sources, software, and systems available that
retrieve incidence and prevalence data about billing codes by payor.

KEY

ACPOnline – American College of Physicians and American Society of Internal Medicine Medical
            Software Directory
HCP – Healthcare Computing Publications, Inc.

				
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