[2012 Holidays Reminder]

2012 Holidays Reminder
Remember to update your 2012 holidays in the appointment book schedules screen.

Clean those systems, check those UPS’s, and check for computer software updates
Have you had your computer systems cleaned out?  The fans located inside your computer are 
constantly running and pull in debris from anywhere.  Check with your ITSP 
(information technology service provider) for recommendations on how or when to 
clean out your computer to keep the air flowing throughout your system.
 
Have you tested your battery backup lately?  Your uninterruptable power supply (aka Battery 
Backup or UPS) keeps battery power flowing to your computer system temporarily during 
a power outage allowing you to shutdown your computer safely to avoid hard drive 
corruption.  We recommend checking your UPS devices on a bi‐annual basis.  Please check 
with your ITSP to find out more information on testing your UPS's. 
 
Have you updated your Windows operating system and Anti‐Virus software lately?
 
Do you lock your doors at night?  Do you lock your car doors when you’re at the mall?  If so, you
know the potential danger of miscreants invading your personal property and privacy.  With the
increasing amount of hackers and viruses being spread over the Internet and social 
networking usage at an all time high, your business computer is in grave danger and ripe for
potential private data loss.  Just like locking the door on your home or car, the simplest 
and easiest form of protection is to keep your Windows OS and Anti‐Virus software up to 
date.  While nothing is completely 100% secure, you will increase your PC security by keeping 
your computer current.  Start by verifying that both software packages have their Automatic Updates 
feature enabled.  This procedure may be different depending upon the software and version installed
on your computer.  For further information on how to turn on or install updates/patches please
contact your ITSP.

EMR Exit Strategy
When looking at EMR’s, we recommend you ask the vendor “What is my exit strategy?”  What if you
decide to leave your EMR for another?  What if your practice joins another and has to move the charts
over, what is your process to get my data out of the EMR?  We recommend you get this in writing to
protect your data and your investment (your time, your employee time, etc.).

RSL EMR Interfaces
Our HL7 interfaces work with our Medical Billing, Medical Office, and Appointment Scheduling systems. 
This provides you the ability to interface your billing and scheduling (or billing service if using Medical
Office) with your EMR should you choose a third party EMR.  HL7 has long been the standard for
exchanging information between applications.  Interfaces are not something new in the application
world.  RSL has been providing EMR interfaces for years.

Why will they not interface?
It does not make sense if the EMR will not interface with your existing appointment scheduling and
billing or billing service.  You have an investment in that system or billing service.  Why would they want
you to throw away your investment?  If the EMR will be receiving lab results with an interface, this is thesame interface language in which the EMR will talk with the billing / scheduling system.
We have a flexible, customizable interface application to link to any EMR using HL7.  We can make the
changes on the inbound or outbound if changes are necessary.  We have been down this road and
understand what it takes to deliver the necessary requirements for effective data communications.  We
have the ability to use other interface types (i.e. XML) to exchange information.

Document and Imaging
Our document and imaging library provides the ability to scan and import documents against patients,
providers, payers, facilities, and many other records in the RSL applications.  This application can load
the document against the patient or allow you to load the document into a cabinet and create a link to
the patient (one document, many links).  You can load documents in cabinets (i.e. EOB’s).  For more
information please let us know.
The EMR uses document and imaging to store any inbound document from any source (i.e. scans, lab
results, faxes, device information).

This child board was created to keep clients informed of all the problems being encountered by payers, not BILLPro, due to the migration to 5010 electronic specifications as of 1-1-12.  BILLPro is and has been 5010 compliant.

Please see the following attachment from Ohio Medicaid.

We have created CGS and moved all of the documentation that was originally located in the Cigna child board to the CGS board.  It is still located under the Ohio Medicare Category. 

Thank you

[RSL Fall 2010 Newsletter]

BILLPRO ANNOUNCES NEW EMR APPLICATION

Below is an update from our software developer, RSL Inc., related to new and exciting information
concerning the roll out of the customizable EMR system.  This can be integrated with the current
medical billing and appointment book systems.

If you have any questions or would like to schedule a free demonstration, please contact Wendy
at 440-854-0213 or email her at wxb@billpro.net

RSL Fall 2010 Newsletter

Fall 2010
The ICD 2011 update has kicked off a series of rollouts over the next 15 months. We are moving our
clients over to our new clearinghouse, certifying the electronic prescribing, linking to Emdeon Vision,
ANSI 5010 testing and rollout, EMR certification, and more.

Electronic Prescribing Certification
We have begun the process to get formal certification of our electronic prescribing application with
SureScripts. This application and feature will allow our clients to deliver the electronic scripts directly
into SureScripts. We are not using a third party to pass on your scripts. We will have more updates on
this new application and feature as the formal certification process develops.

Electronic Prescribing Eligibility and Prescription History
We want to let you know about two new features SureScripts is providing: prescription benefit /
formulary and prescription history. We will have more information on these two new features in the
upcoming months.

RSL EMR Certification
Once we have completed the electronic prescribing certification with SureScripts, we will begin to
evaluate the three certification entities to determine which entity we will choose.
There is at least one component of our EMR that may require additional certification before we can
certify. The requirement will not be clear until more information is provided from the vendor and
clarification from ONC(Office of the Nation Co-ordinator) comes out. This component is not a module
and has been integrated into our EMR. From what we have read, more information will continue to
come out on the certification processes and components of this nature.
We have a software‐for‐life (SFL) model. We are proud to deliver productive, efficient, compliant, and
extensible applications. We continue to provide the updates to the application on that SFL model. In
2007 we began to design the next release of our application for release in 2012. This was a five year
plan. This was before EMR certification. We are attempting to see if it is possible to cut one year off
this application and release it in 2011. This will allow us to certify the next release. We do not want to
certify two versions which would cost twice as much. We want to continue to provide our applications
with the SFL model and do not want to change this model due to certification.

EMR Exit Strategy
When looking at EMR’s, we recommend you ask the vendor “What is my exit strategy?” What if you
decide to leave your EMR for another? What if your practice joins another and has to move the charts
over, what is your process to get my data out of the EMR? We recommend you get this in writing to
protect your data and your investment (your time, your employee time, etc.).

RSL EMR Interfaces[/color]
We have an HL7 interface that works with our Medical Billing, Medical Office, and Appointment
Scheduling systems. This provides you the ability to interface your billing and schedule (or billing service
if using Medical Office) with your EMR should you choose a third party EMR. HL7 has long been the
standard for exchanging information between applications. Interfaces are not something new in the
application world. RSL has been providing EMR interfaces for years.

Why will they not interface?
It does not make sense if the EMR will not interface with your existing appointment scheduling and
billing or billing service. You have an investment in that system or billing service. Why would they want
you to throw away your investment? If the EMR will be receiving lab results with an interface, this is the
same interface language in which the EMR will talk with the billing / scheduling system.
We have a flexible, customizable interface application to link to any EMR using HL7. We can make the
changes on the inbound or outbound if changes are necessary. We have been down this road and
understand what it takes to deliver the necessary requirements for effective data communications. We
have the ability to use other interface types (i.e. XML) to exchange information.

Indirect Interfacing for Billing
When you have access to your EMR data but you do not have an interface, we can create an indirect
interface that will go into the EMR to get the data that is needed on the billing side.

Document and Imaging[/color]
Our document and imaging library provides the ability to scan and import documents against patients,
providers, payers, facilities, and many other records in the RSL applications. This application can load
the document against the patient or allow you to load the document into a cabinet and create a link to
the patient (one document, many links). You can load documents in cabinets (i.e. EOB’s).
The EMR uses document and imaging to store any inbound document from any source (i.e. scans, lab
results, faxes, device information).

2011 Holidays Reminder
Remember to update your 2011 holidays in the appointment book schedules screen.

Clean those systems, check those UPS’s, and check for computer software updates
Have you had your computer systems cleaned out? The fans located inside your computer are
constantly running and pull in debris from anywhere. Check with your ITSP
(information technology service provider) for recommendations on how or when to
clean out your computer to keep the air flowing throughout your system.
Have you tested your battery backup lately? Your uninterruptable power supply (aka Battery
Backup or UPS) keeps battery power flowing to your computer system temporarily during
a power outage allowing you to shutdown your computer safely to avoid hard drive
corruption. We recommend checking your UPS devices on a bi‐annual basis. Please check
with your ITSP to find out more information on testing your UPS's.
Have you updated your Windows operating system and Anti‐Virus software lately?
Do you lock your doors at night? Do you lock your car doors when you’re at the mall? If so, you
know the potential danger of miscreants invading your personal property and privacy. With the
increasing amount of hackers and viruses being spread over the Internet and social
networking usage at an all time high, your business computer is in grave danger and ripe for
potential private data loss. Just like locking the door on your home or car, the simplest
and easiest form of protection is to keep your Windows OS and Anti‐Virus software up to
date. While nothing is completely 100% secure, you will increase your PC security by keeping
your computer current. Start by verifying that both software packages have their Automatic Updates
feature enabled. This procedure may be different depending upon the software and version installed
on your computer. For further information on how to turn on or install updates/patches please
contact your ITSP.

A child board is a topic that is listed under a main topic.  It is a separate topic and needs to be looked at separately you will not be able to access the information held under this topic from the main topic.  I have included a current listing of the child boards below along with the main boards that host them.  If you have any questions please feel free to call me at 440-854-0213.

General Medicare Information
    Behavioral Health
    DMEPOS Competitive Billing
Ohio Medicaid Information
    Behavioral Health

please see attachment

please see the attachment

please see the attachment

please see the attachment

Report: CRA-PHPD-R
RA#   : 12345678 
               
OHIO JOB AND FAMILY SERVICES
Medicaid Information Technology System
PROVIDER REMITTANCE ADVICE
CMS 1500 CLAIMS PAID
DATE:   08/11/10
  PAGE:          1
                   
PROFESSIONAL PRACTITIONER 
2010 NEW MITS RD
ANYWHERE, OH 43221
 
 
 
 
 
 PROVIDER ID:    123456789012345
NPI:                99999999999
TAX ID:    LAST 4 DIGITS   1234
ISSUE DATE:          08/11/2010
 
ICN         SERVICE DATES    BILLED  ALLOWED      TPL  SPENDDOWN    CO-PAY          PAID 
PATIENT NUMBER    FROM     THRU   AMOUNT    AMOUNT  AMOUNT           AMOUNT        AMOUNT
RECIPIENT ID: 0000001   RECIPIENT NAME: CONSUMER, JOHN   COUNTY: 01 FRANKLIN   MED REC NUM: 12345678987 
2010220234001      070710 070710     310.00    245.00   0.00       0.00    0.00      245.00
1234567
 
HEADER EOBS:  9365 9366
 
SERVICE DATES:                  BILLED   ALLOWED   TPL  PAID   RENDERING
FROM    THRU    PL SERV PROC  CD   MODIFIERS UNITS AMOUNT   AMOUNT   AMOUNT AMOUNT    PROVIDER    DETAILED EOB
070710   070710   12    78122       1.00   175.00   175.00    0.00 175.00   123 7654321   
070710  070710   12      27625       1.00    65.00     0.00    0.00   0.00  123 7654321  6254   9992   
DUPLICATE ICN: 2010210200001   DET:  05   PREV PD DATE:  07/31/10
070710  070710   12      99217             1.00    50.00    50.00    0.00  50.00   123 7654321 
070710  070710   12      54725       1.00     20.00   20.00    0.00  20.00   123 7654321
 
 
TOTAL CMS 1500 CLAIMS PAID: 245.00
 
•  Claim types are separated by sections and are indicated in the title:  CMS 1500, Dental,
Inpatient, Outpatient, Medicare Crossovers Part A, Medicare Crossovers Part B, and
Medicare Crossovers Part C.
•  Each detail page has a title:  Paid, Denied, and Adjustments. 
•  Issue Date is the effective date of the Electronic Funds Transfer or the date printed on
a paper check.
•  Address is the “Pay To” provider address.
•  Individual claims are divided into two parts, the header and detail, and have
corresponding EOBs. Report: CRA-PHAD-R
RA#   : 12345678 
               
OHIO JOB AND FAMILY SERVICES
Medicaid Information Technology System
PROVIDER REMITTANCE ADVICE
CMS 1500 ADJUSTMENTS
DATE:   08/11/10
PAGE:          2
                   
PROFESSIONAL PRACTITIONER 
2010 NEW MITS RD
ANYWHERE, OH 43221
 
 
 
 
 
PROVIDER ID:    123456789012345
NPI:                99999999999
TAX ID:    LAST 4 DIGITS   1234
ISSUE DATE:          08/11/2010
 
ICN       SERVICE DATES     BILLED   ALLOWED       TPL   SPENDDOWN  CO-PAY     PAID              
PATIENT NUMBER  FROM     THRU    AMOUNT     AMOUNT   AMOUNT          AMOUNT    AMOUNT   
RECIPIENT ID: 0000001   RECIPIENT NAME: CONSUMER, JOHN   COUNTY: 01 FRANKLIN    MED REC NUM: 12345678987 
2010220234001    070710   070710  (310.00)  (245.00)    0.00     0.00      0.00    (245.00)
1234567           
5010274127250  070710  070710     310.00    195.00     0.00     0.00      0.00     195.00       
1234567 ADJ RSN:  B13
 
HEADER EOBS:  9365 9366
 
SERVICE DATES:                                    BILLED  ALLOWED  TPL  PAID    RENDERING
FROM     THRU   PL SERV PROC CD MODIFIERS UNITS AMOUNT   AMOUNT   AMOUNT  AMOUNT   PROVIDER   DETAILED EOB
070710    070710   12       78122          1.0 125.00   125.00   0.00   125.00   123 7654321 
070710    070710   12       99215       1.0  65.00   0        0.00    0.00   123 7654321 6254 9992   
DUPLICATE ICN: 2010210200001  DET: 05  PREV PD DATE: 07/31/10
070710 070710   12       82805               1.0  50.00    50.00   0.00    50.00   123 7654321 
070710    070710   12       86945       1.0  20.00    20.00   0.00    20.00   123 7654321 
 
               ADDITIONAL PAYMENT:    0.00
               NET AMOUNT OWED TO STATE: (50.00)
Total CMS Claim Adjustments: (50.00) 
 
•  Original or active claim appears first and is reversed with negative dollar amounts.
•  Claim is reprocessed and given a 50 series ICN beneath the original or active claim.
•  50 series ICN is now the current active claim. 
•  New ICN processes for payment or denial.
•  If the new claim processes for more than the original claim, the difference between the
original payment and the new payment will result in an additional payment.
•  If the new claim processes for less than the original claim, the difference becomes an
Accounts Receivable. 
 Report: CRA-TRAN-R
RA#   : 12345678 
               
OHIO JOB AND FAMILY SERVICES
Medicaid Information Technology System
PROVIDER REMITTANCE ADVICE
FINANCIAL TRANSACTIONS
DATE:   08/11/10
PAGE:          3
                   
PROFESSIONAL PRACTITIONER 
2010 NEW MITS RD
ANYWHERE, OH 43221
 
 
 
 
 
PROVIDER ID:    123456789012345
NPI:                99999999999
TAX ID:    LAST 4 DIGITS   1234
ISSUE DATE:          08/11/2010
---------------NON-CLAIM SPECIFIC PAYOUTS TO PROVIDERS---------------  
TRANSACTION                   PAYOUT   REASON  SERVICE DATE     
     NUMBER    CCN            AMOUNT   CODE     FROM    THRU    RECIPIENT ID    RECIPIENT NAME        
 
NO NON-CLAIM SPECIFIC PAYOUTS TO PROVIDERS
TOTAL PAYOUTS:                   0.00 
  
---------------REFUNDS FROM PROVIDERS--------------- 
             CHECK             REFUND          CHECK   CHECK   REASON 
CCN          NUMBER            AMOUNT         AMOUNT   DATE    CODE                                
 
NO REFUNDS FROM PROVIDERS
TOTAL REFUNDS:                  0.00 
 
-----------------------------ACCOUNTS RECEIVABLE------------------------ 
AR NUMBER/   SETUP      RECOUPED  ORIGINAL    TOTAL    REASON SERVICE DATES  
ICN       DATE   THIS CYCLE    AMOUNT RECOUPED  BALANCE CODE FROM     THRU RECIPIENT ID  RECIPIENT NAME
5010274127250 081110       50.00    50.00   50.00     0.00    75   070710 070710 0000001     Consumer, John
 
TOTAL BALANCE:                                  0.00
 
•  Non-Claim Specific Payout to Providers: Lump sum not related to a single claim.
•  Refunds From the Providers:  Provider submits a check back to the OHP. 
•  Accounts Receivable
•  A/R number: Is the Adjustment ICN if the Accounts Receivable is claim related. 
•  Recouped this Cycle: Is the amount subtracted from current warrant amount and
decreased the amount of AR.
•  Original Amount: Is the dollar amount at the time the Accounts Receivable was set up.
•  Total Recouped: Is how much has been satisfied to date.
•  If a balance remains, the Accounts Receivable will carry over to the next week’s
financial cycle. Report: CRA-SUMM-R
RA#   : 12345678 
               
OHIO JOB AND FAMILY SERVICES
Medicaid Information Technology System
PROVIDER REMITTANCE ADVICE
REMITTANCE ADVICE SUMMARY
DATE:   08/11/10
PAGE:          4
                   
PROFESSIONAL PRACTITIONER 
2010 NEW MITS RD
ANYWHERE, OH 43221
 
 
 
 
 
PROVIDER ID:    123456789012345
NPI:                99999999999
TAX ID:    LAST 4 DIGITS   1234
ISSUE DATE:          08/11/2010
              --------------------CLAIMS DATA----------------------------
                     CURRENT CURRENT MONTH-TO-DATE   MONTH-TO-DATE   YEAR-TO-DATE  YEAR-TO-DATE
               NUMBER   AMOUNT       NUMBER         AMOUNT      NUMBER           AMOUNT
 
CLAIMS PAID:        1    245.00       1     245.00      1      245.00
CLAIM ADJUSTMENTS:     1    (50.00)     1     (50.00)     1      (50.00)
  TOTAL CLAIMS PAYMENTS   1    195.00       1        195.00      1      195.00
CLAIMS DENIED:       0            0                       
                                                     
                                  --------------------EARNINGS DATA---------------------------
PAYMENT: 
 
CLAIMS PAYMENT:              245.00                245.00
 SYSTEM PAYOUTS (NON- SPECIFIC)           0.00                       0.00   
 ACCOUNTS RECEIVABLE (OFFSETS):           0.00                      0.00
      CLAIM SPECIFIC                                                 
          CURRENT CYCLE           (50.00)                          (50.00)   
          OUTSTANDING FROM PREVIOUS CYCLES  (0.00)               (0.00)                     
 
NON-CLAIM SPECIFIC OFFSETS        (0.00)               (0.00) 
 
NET PAYMENT** 
             
REFUNDS:
 CLAIM SPECIFIC ADJUSTMENT REFUNDS      (0.00)               (0.00)     
 NON-CLAIM SPECIFIC REFUNDS           (0.00)                                 (0.00)   
           
OTHER FINANCIAL: 
MANUAL PAYOUTS (NON-CLAIM SPECIFIC)         0.00                             (0.00) 
  WARRANT VOIDS                              (0.00)                              (0.00) 
     
NET EARNINGS                 195.00                  195.00
 
•  Year to Date is running total of what the provider’s 1099 will be at the end of the
calendar year.

Incentive payments totaling as much as $27 billion may be made under the Medicare & Medicaid Electronic Health Record (EHR) Incentive Programs beginning in 2011. Are you eligible for an incentive? How much can an eligible professional earn? What are the key dates for these programs?
Learn more on the Centers for Medicare & Medicaid Services EHR Incentive Programs website!

Tip Sheets for Eligible Professionals:

          UPDATED: Medicare EHR Incentive Programs, PQRI, and E-Prescribing Comparison

Learn what opportunities are available to Medicare Eligible Professionals to receive incentive payments for participating in important Medicare initiatives. This fact sheet provides information on eligibility, timeframes, and maximum payments for each program.

          UPDATED: Flow Chart – Determine Eligibility for Medicare and Medicaid EHR Incentive Programs

Unsure if you are eligible to participate in the Medicare or Medicaid EHR Incentive Programs? Use this handy flow chart to find out!

          Medicare EHR Incentive Payments for Eligible Professionals

Which types of individual practitioners can participate in the Medicare EHR Incentive Program? This easy tip sheet provides information about incentive payment amounts and describes how payments are calculated for fee for service (FFS) and Medicare Advantage providers. It also describes payment adjustments beginning in 2015 for Eligible Professionals who are not meaningful users of certified EHR technology.

For the 3 tip sheets above, go to http://www.cms.gov/EHRIncentivePrograms. Select the “Medicare Eligible Professional” tab on the left, and then scroll to “Downloads.”

          NEW: Medicaid EHR Incentive Payments for Eligible Professionals

Which types of individual practitioners can participate in the Medicaid EHR Incentive Program? Learn about Medicaid patient volume requirements, payment amounts, and the timeframes for the Medicaid EHR Incentive Program.

 Go to http://www.cms.gov/EHRIncentivePrograms. Select the “Medicaid Eligible Professional” tab on the left, and then scroll to “Downloads.”

Important Dates:

NEW: EHR Incentive Program Timeline

Find it at http://www.cms.gov/EHRIncentivePrograms in the “Downloads” section of the “Overview” tab.

Electronic Health Record Incentives – Get the Facts from CMS.   

CLIENTS:

Please see the CMS e-mail below and click on the link provided.  From there, in the article under "Provider Action Needed" the following website is listed which is CMS's "Emergency" website.  Therein lies "the guidance and procedures (in the form of Questions & Answers) previously implemented."  PLEASE DO BOOKMARK THIS SITE FOR FUTURE REFERENCE.

  CMS'S EMERGENCY WEBSITE:    http://www.cms.gov/Emergency/

Debra Farley
Billing Director
BILLPro Management Systems, Inc.
debra@billpro.net
440-854-0205 OR 1-800-736-0587 ext 0205
FAX 440-516-3783

    From: CMS MLNMatters-L [mailto:MedlearnMatters-L@CMS.HHS.GOV]
    To: MLNMATTERS-L@LIST.NIH.GOV
    Sent: Tue, 28 Sep 2010 15:11:54 -0400
    Subject: New Articles Posted to MLN Matters (8/0)

    New:

     

    MM6837 – Medicare Fee-For-Service Emergency Policies and Procedures: Questions and Answers (Qs & As) for All Types of Emergencies and Disasters – Rescission of CRs 5099, 6146, 6164, 6174, 6209, 6256, 6280, 6284, and 6378

    http://www.cms.gov/MLNMattersArticles/downloads/MM6837.pdf