NOTE: Before sending claims, you will need to finalize your practice and provider setup information on the IDs grids. If you are upgrading to Medisoft 16, you will also need to finalize your IDs grid information. To provide the highest level of data integrity and accuracy, the conversion process for Medisoft 16 provider/practice setup, does not delete information while creating grid entries that might still be needed, such as legacy information (Blue Cross provider numbers, Medicare provider numbers, etc.) but converts this data to a grid entry in Medisoft 16. Before filing claims, you will also need to finalize your grid entries making sure to remove unnecessary data such as out-of-date legacy numbers.
Medisoft 16 introduces new user interface windows to better address different insurance filing requirements. This new layout gives you the flexibility to easily configure your setup to address various requirements when generating both print and electronic claims.
The new implementation provides a flexible environment that you can quickly customizeto reflect your claim processing needs by setting up different grid entries for insurancecarriers, providers, your practice, or your data requirements (NPI, legacy, etc.) that youcan apply and, if needed, quickly modify. These changes support creating as many custom scenarios that you need to successfully file claims.
This new method streamlines and consolidates tabs on key windows such as theInsurance Carrier, Provider, and Referring Provider and moves labs and facilities from the Address tab to the Facility tab. Also, the Practice Information window features a newtab, Statement Pay-To, which is used for Bill Flash reports.
The key element of this improvement is the implementation of Practice, Provider,Referring Provider, and Facility IDs grids. The settings and selections that you make onthese grids, along with settings on the Insurance Carrier window, are used for claim generation. These settings are highly flexible, providing greater breadth and depth toaddress your particular officeʼs billing needs. The inherent flexibility in this implementation means that you can enter limitless scenarios for any combination ofinsurance carriers, insurance classes, facilities, referring providers, providers, and your practice to address different carrier filing requirements.
Another important change for electronic claims involves the logic of group and individualfiling moving from the EDI Receivers window to the Provider window. You now bundleclaims by creating provider filing rules using the Group or Individual buttons on theProvider IDs grid instead of sending via a group EDI receiver or an individual EDIreceiver; however, if a carrier requires further refinement, you can create/use multiplesubmitter IDs to separately batch by submitter ID.
NOTE: Any custom report, either created or modified, in a version of Medisoft prior to 16, such as the CMS 1500, will not pull some data if the field in question was impacted by the new fields on the various IDs grids. The level of customization that went into creating the original report will determine if you should modify the report to reflect the new fields in Medisoft 16 or re-create your custom CMS 1500 form using the CMS 1500 form included with Medisoft 16. For more information on where fields now pull for printed claims using the CMS 1500 form, see Clickable CMS 1500. For more information on the new logic for the changed fields in the CMS 1500reports, see the topic CMS 1500 Report Changes with Medisoft 16. The UB-04 form was also modified. For more information on where fields now pull for printed claims using the CMS 1500, see Clickable UB-04 Form.
NOTE: Statements in Medisoft 16 do not pull data from the EDI PINS table. If you customizethese reports, you cannot add this data to a statement. This data, however, is available when customizing claims, such as the CMS 1500 form, and all other reports. If you have statements from pre-Medisoft 16 that you added these fields to, the statements when used in Medisoft 16 will leave the fields blank.
For more information on the rules engine, data conversion when upgrading to Medisoft16, and settings on the Practice, Provider, Referring Providers, Insurance Carriers, andFacilities window, see Medisoft Claims Generation FAQs in the Medisoft Help File.
Medisoft 16 introduces a new, integrated electronic claims solution, the RevenueManagement feature. This solution is offered in two forms: Revenue ManagementAdvanced and Revenue Management Direct.
Revenue Management Advanced uses the RelayHealth clearinghouse for electronic claims processing and eligibility verification. With Medisoft 16, there is no cost for this software option though there are clearinghouse charges. For more information onpricing, contact your local value added reseller or Medisoft sales at 800-333-4747.
Revenue Management Direct provides pre-configured connectivity to the most popular direct payers and also supports adding connections to other payers or clearinghouses.This solution is available as an annual subscription with additional fees per directconnection. For more information on pricing, contact your local value added reseller or Medisoft sales at 800-333-4747.
With either option, Revenue Management provides a flexible tool that lets you manageyour claims processing environment and, if necessary, make changes withoutcompletely replacing your EDI software.
Revenue Management differs from other EDI solutions by virtue of its design; it is anintegrated component of Medisoft which means that the company that produces your practice management solution also produces your EDI solution—a complete revenuemanagement solution that seamlessly updates claim status and date sent while alsoproviding ERA (electronic remittance advice) posting and eligibility verification.
Revenue Management provides value and robust support by offering claims submissions for many types of providers and facilities including physicians, therapists,surgery centers, rural health, imaging centers, DME providers, dialysis centers, etc. Youcan send Part B claims to virtually any payer via the RelayHealth clearinghouse or direct connections. It even supports Part A along with ERA and eligibility verification.
Additional System Requirements
The Revenue Management feature is engineered to run on the same platform as Medisoft and does not require additional memory or a different CPU. Depending on thetypes of payers/clearinghouses that you connect to, you will need a modem and phoneline, an internet connection, broadband, a web browser, etc. Review your clearinghouse/payerʼs requirements.
What Does Revenue Management Replace
When you complete the Medisoft 16 installation, Revenue Management will replaceseveral Medisoft components including the Claims Manager EDI module, all other existing EDI direct modules (can be converted to Revenue Management), the ERAapplication, and the Eligibility Verification engine. After installation, you will complete anonline registration before your 30 day trial expires and, if necessary, complete any annual subscription agreements.
If you currently use a direct module
Convert to Revenue Management Advanced with enrollment in RelayHealth.
--OR-
Convert to Revenue Management Direct to continue to connect directly to payer(s).
If you currently use Claims Manager
Convert to Revenue Management Advanced with enrollment in RelayHealth.
If you currently use a competitive clearinghouse such as Phoenix
Convert to Revenue Management Advanced with enrollment in RelayHealth.
--OR-
Work with your value added reseller to create direct connection to competitiveclearinghouse.
If you currently use RelayHealth
Convert to Revenue Management Advanced—easy choice since you are already enrolled with RelayHealth.
Installing Revenue Management is simple and is part of the Medisoft 16 installation. Itdoes not require any separate installation activities.
How do I Launch Revenue Management
Launch Revenue Management from the Activities menu, Revenue Management menu,Revenue Management command. Launch Revenue Management reports from thesame menu. You can verify eligibility using mostly the same process as earlier releases (you will need to apply security to your practice and create at least one user)—theverification engine now uses Revenue Management.
Menu items for obsolete features available in Medisoft 15, such as options on theServices menu (Claims Manager and Eligibility Verification) and on the Activities or Tools menu (Electronic Remittance and Claims Manager), no longer appear on themenus. Electronic Claims are now generated from the Revenue Management menu onthe Activities menu.
Both versions of Revenue Management provide (on an additional yearly subscriptionbasis) claim editing and ANSI validation. Reducing your rejections before they are sentby checking for pre-existing errors means that your business will be paid faster for theservices it renders, and your claims processing staff will save time not having to rework and re-file rejected claims.
Before sending and receiving notice of a rejected claim, validate the claimʼs data formatting and validity using system rules. These rules include Medicare requirements along with common billing scenarios. You can also, based on your own business environment, define and apply your own claim check rules using a drag-and-drop rules editor.
An important part of the claim editing feature is the speed and ease in which claims arecorrected in Medisoft. The claims analysis quickly guides you in correcting claim issues,and with a few simple steps you can avoid having a claim rejected.
Depending on your practice needs, you can add several other features to RevenueManagement including additional software plug-ins that add custom data fields for:
Revenue Management seamlessly fits your established workflow. After you enter charges and create claims, the Revenue Management feature retrieves the claim datathat you plan on submitting from the Medisoft database and creates electronic claim files and transmits the files to the payers. You can also receive and view reports andcomplete ERA activities such as posting primary, secondary, or tertiary payments alongwith updating claim status for crossover claims.
An important feature of Revenue Management is claim tracking and history. The featuresupports sending and receiving claim status transactions which gives you insight intoyour claim processing payment timeline. Revenue Management also saves claim information including when it was edited or sent and acknowledgments/payments received.
You can also quickly view and print reports associated with the claim and, if needed,quickly send a claim status inquiry.
When the Revenue Management feature receives an ERA 835 file, you have severaloptions. The application translates the file before posting it, allowing you to review thereport and print or export it. Then you can quickly post the file and select a posting datealong with a payment code. And if needed at a later date, you can review the postingreport that details the specific posting data.
When you receive an 835 remittance payment file from a payer or clearinghouse, theRevenue Management feature interprets the file and prepares it for posting in Medisoft.A preview of the remittance is displayed so you can review the payment information andprint or export a copy. When you are ready to post the payment, just choose the postingdate and payment code (use the payerʼs code or assign your own), and the payments and adjustments are posted in seconds. After posting is complete, a posting report is generated to show exactly what was entered in your system.
Eligibility verification is a simple process and uses mostly the same establishedmethods in Medisoft to check a patientʼs status. The Revenue Management feature then checks with the payerʼs records to check the patientʼs coverage.
The Revenue Management feature manages the connection to payers by selecting theappropriate connection method to a clearinghouse/payer. Most require claims to besubmitted using a defined method such as a broadband connection, a dial-upconnection, a web site, ftp, etc., and the feature calls the needed tool such as hyperterminal, web browser, ftp application, etc.) for each payer. In some cases, you would still login to your payerʼs web site and perform the file transfer. But in some casesfor certain payers, Revenue Management can completely automate the claims submittalprocess. For each claim file, the Revenue Management feature creates an ANSI4010A1 native format file, configured to the payerʼs specifications.
Along with sending claims, the feature also processes all received reports. You canquickly preview, print, and post to Medisoft.
What Do I Need to Complete Before Sending Claims
Before using the Revenue Management feature for new connections, you must enrollwith the clearinghouse or direct payer and receive submitter numbers for theRelayHealth clearinghouse (Revenue Management Advanced) or direct payers (Revenue Management Direct). You will also need to set up the RelayHealthclearinghouse or direct payers in Revenue Management; the software includes preconfigured support for many popular clearinghouses and direct payers.
You will also need to register your software and, if necessary, complete your annualsubscription once your trial period ends.
NOTE: Revenue Management supports payers that accept a HIPAA-compliant ANSI 837 claim file.
For More Information
After installing Revenue Management, view the online help located in the Program Files\Medisoft\Bin\RCM folder. Double-click help.exe to launch the system and view the helpvideos.
Medisoft 16 provides enhanced data flow to Medisoft Clinical. Key updates are nowupdated in Medisoft Clinical from the patient message including data fields like phonenumber, email address, new insurance carriers, and new referring providers.
The enhanced communication is mostly transparent to users and takes place inbackground. You will be able to use new controls on Communications Manager todetermine if you transmit and receive appointment status updates.
Communications Manager also deploys new controls for sending enhanced library resources to Medisoft Clinical including provider, facility, procedures, and diagnosis updates.
Medisoft 16 now transfers more data to Medisoft Clinical via the Communications Manager in an updated A04 and A08 patient message. The updated message nowsends (one-way from Medisoft 16) the cell phone and email address fields.
New insurance address data and one telephone number is also sent. When a newinsurance record is created in Medisoft 16, the Communications Manager will send thedata to Medisoft Clinical in an updated appointment or patient message. Theinformation maps to the Insurance Maintenance table in Medisoft Clinical with the newinsurance telephone number mapping to Medisoft Clinical in the Work Phone field.
NOTE: This feature only sends new insurance information from Medisoft 16. You will need to manually add any updates to the insurance records in both systems. Also, the insurance fax number and contact fields are not supported in Medisoft Clinical.
When a referring providerʼs information is added or updated on a patientʼs record,Communications Manager will send the data to Medisoft Clinical. The data is added inMedisoft Clinical to the Referring Sources Maintenance table and to the Patient table.
WARNING: When referring provider data is received in Medisoft Clinical, the Type field is set to Physician. However, the next time an appointment message is sent with the referring providerʼs information, the Type field is cleared (blanked out). If the Type field value is not manually reset to Physician in Medisoft Clinical, reports that use this field (for instance the AS/PR Referrals report) would not report accurate data.
Medisoft 16 also introduces a new library interface system for transmitting facility,diagnosis, and procedure codes to Medisoft Clinical. This feature lets you synchronizeyour data after initial setup of Medisoft 16 or after receiving updated ICD-9 or CPTcodes.
TIP: The initial transfer of CPT and diagnosis codes can take several hours or more.Consider completing this activity when the system is not in high demand or utilized, forinstance at the close of business.
You can also use this feature in conjunction with the automatic provider mapping featureto send provider updates depending on the structure of your existing provider IDmappings between Medisoft and Medisoft Clinical.
You can send updates as often as needed or on an annual basis; when you decide tosend these type of updates, will most likely depend on the frequency of updates received and whether it is more convenient to send the updates via Communications Manager or by modifying the records in both systems. To send the updates from Communications Manager, you will need to click the Configuration button and on the Medisoft Clinical connection line, click Edit. Then, depending on the type of updates youwant to send, you will select a combination of the Send Providers box, Send Facilities box, Send Procedure Codes box, or Send Diagnosis Codes box. When the data is sentto Medisoft Clinical, the boxes you selected are cleared, and the system displays whenthe update occurred.
TIP: Before using this feature to send updates to Medisoft Clinical, verify that the Medisoft Clinical Inbound DemShed feature is not running. On the desktop, click the Exit button onthe Connect-DemSch In window if it is open. Also, verify that the Medisoft ClinicalOutbound BillCode feature is not running. On the desktop, click the Exit button on theConnect-BillCode and Sch Out window if it is open.
When facility records are added or updated in Medisoft 16 (only records with the Type ofFacility or Lab) and these changes are sent via the Communications Manager toMedisoft Clinical, the data is added in the Medisoft Clinical Facilities Maintenance table.
NOTE: When a facility is marked as Inactive in Medisoft 16, this status is not transferred to Medisoft Clinical. If you change the status of the facility in Medisoft Clinical and then at a later date, update the status in Medisoft 16, the updated status is not transferred. You will need to update the status in Medisoft Clinical. Also the Phone field does not map to Medisoft Clinical.
Medisoft Clinical accepts initial diagnosis and procedure codes from Medisoft 16 alongwith new codes that are transmitted when you send updates. Medisoft Clinical does notaccept updates to existing codes other than the Inactive setting. If you change a code toInactive, this setting will transfer during an update (no description changes supported forexisting codes). Reactivating a code, however, in Medisoft 16 will not transfer. Alsodeleting a code in Medisoft 16, will not change a code to inactive in Medisoft Clinical.
When using the automatic provider mapping update feature in conjunction with theSend Providers box, provider records are added or updated in Medisoft 16, and thesechanges are sent via Communications Manager to Medisoft Clinical. The data is addedin the Medisoft Clinical Provider Maintenance table, and an Inactive status will transfer.If you mark a provider as inactive in Medisoft 16, this setting transfers to MedisoftClinical.
WARNING: Do not use the automatic provider mapping feature before reviewing appropriate situations for use, which are documented in the Automatic Provider Mapping topic. Your existing provider ID mapping between Medisoft and Medisoft Clinical determines if you should use this feature. Using this feature, if your provider ID mappings do not meet certain conditions, can jeopardize accuracy of appointments sent from Medisoft to Medisoft Clinical, the provider associated with a patient, and possibly the provider assigned to charges coming in from Medisoft Clinical to Medisoft. Also, before using this feature, back up your data.
The automatic provider mapping feature also replaces the DemSch and Billing cross reference file mappings with new logic that converts Medisoft provider codes that aregreater than three characters to a three character code in Medisoft Clinical. This featuremanages provider matching/mapping between the systems.
If you want to use this feature to automatically transmit provider updates, you will needto select the Automatic Provider Mapping box and Send Provider box inCommunications Manager.
NOTE: If you are installing Medisoft Clinical for the first time, the Automatic Provider Mapping box is selected by default. Select the Send Providers box to automatically synchronize your providers in Medisoft and Medisoft Clinical.
When a provider is transferred to Medisoft Clinical, the application applies new logic toconvert Medisoft provider codes that are greater than three characters to a threecharacter code in Medisoft Clinical. The system will also avoid duplication of an existingprovider by creating a new provider code in Medisoft Clinical.
For more information, see Automatic Provider Mapping in the Medisoft Help File.
If you add or update an appointment note in Office Hours, the note is sent to MedisoftClinical. Notes are only sent from Office Hours to Medisoft Clinical (one way transmission). When an updated appointment note is sent, it will replace the previously received note. View the appointment notes in Medisoft Clinical by clicking theDashboard button or in the Clinical schedule.
Along with updating appointments, Medisoft 16 and Medisoft Clinical now supportsending and receiving appointment status updates. This is a bi-directional dataexchange. Changes from Office Hours to Medisoft Clinical appear in the Scheduler andPhysician Dashboard. Changes move from Medisoft Clinical to Medisoft 16 (OfficeHours) when appointment status is changed from the Timing button or from theScheduler. Appointment status updates will transfer via Communications Manager if theSend and Receive appointment status updates box is selected (click the Configurationbutton and on the Medisoft Clinical connection line, click Edit).
NOTE: Appointment Status is not sent or received in either direction for repeating appointments.
Medisoft 16 introduces new eligibility data entry and processing logic that gives yougreater control and the ability to manage you Payers IDs (the enhanced payer IDmanagement also applies to insurance payer IDs, not just those used for eligibility verification). The flexible implementation lets you define when you check for updates and gives you the ability to update a Payer ID, which reduces potential downtime andincreases your ability to address eligibility verification issues.
A key element of this change is enhanced system performance--eligibility does notautomatically check for updates, avoiding kicking off an unintentional update cycle. Alsowhen you installed Medisoft 16, the application included an initial payer ID data setwhich also avoided a longer delay between the time you install the software and the time you use it. And when you do check for updates, the new logic only pulls updated/changed information, saving you more time.
Adding to the performance enhancement is the new Payer ID lookup window whichdeploys enhanced search filters with the ability to add, edit, and delete a record (user-supplied Payer IDs) with no template editing required.
Payer IDs supplied by initial installation of Medisoft and subsequent updates are nowlabeled as System, which in turns provides a simple way to filter the Payer ID window.Payer IDs that you enter are labeled User which also provides a quick filter option.
System supplied payer IDs are read only—you cannot edit or delete them. You can,however, edit and delete entries you create (user), and the new logic will deploy a user-defined payer ID before a system ID. The new logic does not allow duplication of user-supplied Payer IDs; however, you create a duplicate of a system supplied payer ID as auser-supplied ID, which means you can edit it on the fly and make timely updates ifneeded.
Medisoft 16 also streamlines eligibility security and access by making eligibility security assignments part of insurance—that means that the rights you assign (add, edit, delete)for insurance are the same for eligibility.
With the new security addition, your settings/available records match the logged in user.
For more information on this feature, see Payer ID Lookup Window and Eligibility Verification Overview in the Medisoft Help File.
Medisoft 16 drastically improves the ease of installing Medisoft Clinical. The new, DVD-based installation contains all you need to install Medisoft 16 Client Server and MedisoftClinical--all on one disc. Using the new type of media reduces the amount of applicationdiscs since Medisoft 16 and Medisoft Clinical are on the same disc and reduces the installation time and your involvement by deploying greater automation in the setup ofMedisoft Clinical.
The number of screens that need user intervention (select a path, directory, file, etc.) is greatly reduced. The new installation was re-engineered to enhance the flow and easefor installing Medisoft 16 Client Server, the Medisoft Clinical server and database, andthe Medisoft Clinical client.
The standard Medisoft 16 installation was also re-engineered. Though this install is stillCD-based, the new installation improves the install process and provides a more robustplatform for future enhancements.
New Interface
Medisoft 16 introduces a completely new and updated look. The user interface retains the logic, structure, and order of previous releases, but implements new colors, icons,window controls, etc. to enhance the user experience. The new design, influenced by the user interface changes that Microsoft introduced with Office 11, uses new icons onthe toolbar and menu commands. The updated colors along with the new image andsizing of icons provide improved navigation and movement through the user interface.Importantly, none of the keyboard hotkey shortcuts (for instance in the Transaction Entrywindow press F2 to open the Multilink window) changed or the location of functions.
NOTE: the shortcuts available from the menu in Office Hours have changed. To access a window from the menu, click the ALT key and click the underlined letter in the menu title, for instance clicking ALT + F would display the File menu. To select an option from a displayed menu, press the underlined key, for instance press O to display the Open Practice window.
TIP: If you are running Medisoft on a PC with the Windows 7 operating system, select the Classic Theme; other themes used in Windows 7 have background colors that conflict with the text in various Medisoft windows.
For more information, see Navigating in Medisoft and Medisoft Toolbar in the MedisoftHelp File.
Medisoft Reports and Medisoft Reports Professional now use the standard Medisoftsecurity model. You do not need to create or maintain users specific to the reports feature only (Medisoft Reports user); the application uses your existing or newly createdMedisoft users instead. You can now assign and limit access to the Medisoft reports engine and specific reports (Advanced and Network Professional) using the newMedisoft Reports Permissions window (click File and select Reports Permission) basedon user level. For more information, see the topic Medisoft Reports Permissions Window.
NOTE: Permissions for most statements and other reports using the .MRE format, however, areset in the Medisoft Security Permissions window.