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Thread: Medical Billing

  1. #1
    Ron Cammack
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    Default Medical Billing

    Does anyone know of any applications written for medical billing? (Specifically, ambulances)

  2. #2
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    Jay Patel
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    Default RE: Medical Billing

    I don't but I am also interested in seeing the medical billing program with A5 database. It would be nice

  3. #3
    Member Mike Konoff's Avatar
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    Mike Konoff
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    Default RE: Medical Billing

    Have you tried building/designing one yourself?

  4. #4
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    Jay Patel
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    Default RE: Medical Billing

    No, but I am thinking to start after new version is out and may even use professional developer to design the program.

  5. #5
    03*/46
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    Default RE: Medical Billing

    I developed a medical billing system for an oncology practice running on 10 Win 95/98 workstations with Linux RedHat 6.0 as a file and print server.
    The system does all billing and business management. Runs under 4.0.

    I you need more info. let me know.


    G.Kovach MD

  6. #6
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    Lowell Wardlow
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    Default RE: Medical Billing

    I have a couple of questions ?

    Does it do electronic billing and 1500's ??
    Will it run on win98 ?

    Lowell

  7. #7
    Ron Cammack
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    Default RE: Medical Billing

    We are interested in your program. How could we contact you to ask more questions?

  8. #8
    Jorge Mir
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    Default RE: Medical Billing

    I am currently working on a revision to previously designed medically billing system (mental health application) which will handle the electronic billing of HCFA 1500.

    If you are interested in final product when completed, send e-mail for future follow-up (jmir@carolina.net)

  9. #9
    Member
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    Lowell Wardlow
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    Default RE: Medical Billing

    Hi. I noticed your entry about a medical billing program.
    Questions: Does ir run on A5v4 :
    Is it applicable, or can it be modified, to
    work in a medical billing service for multiple
    locations, multiple doctors, general practice
    Is it multiple user
    Cost ???

    Any information will be appreciated.

    Lowell
    email res1r9od@verizon.net

  10. #10
    Member
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    Lowell Wardlow
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    Default RE: Medical Billing

    Jorge -

    I am interested in the details of you program
    Please email me at res1r9od@verizon.net

    Thanks
    Lowell

  11. #11
    Thomas Henkel
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    Default RE: Medical Billing

    Be careful of the HFCA 1500 As of October 2003, All Electronic submitters MUST file HIPAA Compliant records. The old 1500 wil not be valid. We do electronic billing for the 1500 professional for case management. I have tried looking at the HIPAA Rules, and they are VERY VERY Confusing.

    Tom

  12. #12
    Ron Cammack
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    Default RE: Medical Billing

    I am interested now. What about the HIPAA compliancy aspect?

    Sincerely, Kathy

  13. #13
    Ron Cammack
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    Default RE: Medical Billing

    Where did you find your information about the HCFA 1500 being "out-dated" by fall of 2003? I want to know because we do medical billing and I have not heard that one yet!

    Sincerely, Kathy

  14. #14
    Thomas Henkel
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    Default RE: Medical Billing

    I have been sporatically trying to weed through the HIPAA documentation. The Document that describes the Electronic biling transactions is only 750 pages long. HIPAA is supposed to simplify and standardize information in all aspects of patient information. All I can say is to go out onto the web and find out what HIPAA is, and then figure out HOW and WHEN you will need to become compliant.

    This is a VERY BIG deal!!

    Tom

  15. #15
    Thomas Henkel
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    Default RE: Medical Billing

    The state of New Jersey pledged HIPAA compliance by Oct 2003. We are a state agency that does Home Healthcare case management and bills Medicaid. Our billing is around $40K per month. Doing it on paper just is NOT practical.

    Tom

  16. #16
    "Certified" Alphaholic forskare's Avatar
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    Ken Nordin
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    Default RE: Medical Billing

    Click on the blue name of the person you wish to contact and send and email.

    kenn

  17. #17
    Thomas Henkel
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    Default RE: Medical Billing

    A follow-up to my statements.

    The state of New Jersey has committed itself to be HIPAA Compliant. As an electronic biller to NJ Meicaid, we MUST follow the state.

    My previous posts implied that everyone must be compliant by Oct 2003. That is obviously NOT TRUE.

    I am sorry for worrying anyone who read my posts.

    Please understand, however, that HIPAA will become a reality, and that you should be at least thinking about it now if your systems are in any way health care related.

  18. #18
    Member
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    William Schone
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    Default RE: Medical Billing

    We have a small medical billing practice in Topeka Kansas that been designed around A5. We have an input form that looks like a HCFA form. We transmit the data to a division of Kansas BC/BS that acts as a clearing house for all of our electronic claims. Because they sit between us and the actual clearing house, they are responsible for the data set change for HIPPA.

    We track the claim through the insurance company by aging the claims and follow up with insurance if the claim starts getting old.

    Following insurance processing we then send a statement to the patient or responsible party.

    We are currently working with four different provider groups. We've been processing claims since 1998.

  19. #19
    Ron Cammack
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    Default RE: Medical Billing

    Have you sold your program to others to use? We are interested.

    Sincerely, Kathy

  20. #20
    Member
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    William Schone
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    Default RE: Medical Billing

    In my earlier post I had mentioned that Kansas BC/BS was going to take care of coding for the converting of our data into the HIPAA format. We just recently found out that was no longer the case.

    Thus we are currently investigating the data set requirements to create the 837 X12N Professional Health Claim 004010X098A1.

    Should anyone want to tag along with us on this project please let me know and we can share notes.

    I have forwarded a request to Alpha Software to see about establishing a medical billing users group that would possibly allow not only Alpha 5 tech information, but also a forum for medical billing issues as well.

    Bill Schone

  21. #21
    Ron Cammack
    Guest

    Default RE: Medical Billing

    We are interested if you think that your software could be used for our billing company. We bill for ambulances, diagnostic lab, counselors, and a medical doctor.

    Sincerely, Kathy

  22. #22
    Member
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    William Schone
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    Default RE: Medical Billing

    Ron or Kathy,

    Is the email address with your posting a current address? I had sent some info to that address but hadn't heard back and wasn't sure if you had received the emails or if your last post was intended for me or not?

    Bill Schone

  23. #23
    Member
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    Hendrik Krosschell
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    Default RE: Medical Billing

    Bill,

    I am an optometrist who has developed an office management system, EMR, and HCFA 1500 printing. The last piece of my puzzle is the electronic billing. I would be interested in any info you might have with regards to electronic billing Via A5.

    Currently I am using a write file scenario, with write line info to create the spacing for an unformatted print image file with proper spacing. I have not tested this with a clearinghouse yet, but I will be in a few months. The complexity of the new file formats is beyond my scope, unless someone has a routine for it that cuts to the chase.

    Thanks for any help

    Rick

  24. #24
    Thomas Henkel
    Guest

    Default RE: Medical Billing

    Why didn't you just create a report in the format of the HFCA 1500? Before we got into the electronic billing game, we printed directly from Alpha onto the forms. It took a lot of patience to format the report so that it just fits properly, but we were able to do it.

    My big problem now is converting our electronic 1500 to a HIPAA Compliant one.

    Tom

  25. #25
    Member
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    William Schone
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    Default RE: Medical Billing

    Rick,

    As I understand it, there seems to be two primary methods for converting claims from a billing (or claims) system into data ready to be transmitted to a clearing house.

    One of them is to create a "print image" file, which apparently is what you are currently doing or wanting to do. When we started our medical billing practice, this was a completely foreign concept to me, but one that apparently is used quite a bit in the medical billing arena. Once the print image file is created, it than then be converted in the properly formatted data files for processing. In the past, that format was typically NSF(National Standard Format) but now needs to be converted to the HIPAA ANSI format. Conceptually, the new ANSI format can be created from a print image just as the old NSF format could be.

    Thus, one solution would be to find a clearing house that provides the ability to convert your current print image file to the ANSI format.

    In our case, the data exchange between us & the clearinghouse on the print image concept, hasn't work as well as we wanted. Additionally, the fewer parties involved with coding changes, the better as far as I'm concerned (subject to the cost of maintaining the code).

    That leads to the second option. We want to write our own module in Alpha 5 to take our claim data and simply output it to the HIPAA ANSI format for transmission to our clearinghouse. I am to be working on that module as we speak, but haven't been able to start quite yet. Very soon though. Our clearinghouse will provide conversion to ANSI from our print image file until sometime next year. But we hope to be up and running on our project prior to year-end.

    The concepts that we develop should be transportable to any other installation, but keep in mind, our code will start with our data structures and end with the ANSI format (hopefully). Your starting point, ie your data structures are different than ours, or probably anyone else's, thus our code wouldn't work for you without changes in the code or your data structures, either of which could probably be done, if desired.

    In our environment, going directly to the ANSI format makes the most sense. So I'm soon off on that project. Should you like to tag along, help, or simply stay tuned, I'm happy to oblige.

    Bill Schone

  26. #26
    Thomas Henkel
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    Default RE: Medical Billing

    Bill,
    I'm at the point of trying to make heads-or-tails of the loop structure. The transmission structure on the old system was fairly straightforward, but this new HIPAA format... Maybe it is just me blocking, but the documention is confusing. Which loop, how many of each type within a loop, and finally the actual output stream.

    Anyone who has come to grips with the documentation and can explain (Simply, I'm getting older) I would love to hear from.

    Tom

  27. #27
    Member
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    William Schone
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    Default RE: Medical Billing

    Tom,

    At the risk of sounding like Tom Cone, I'll refer you to the implementation guide. (I hope Tom Cone isn't monitoring this thread!) But unlike Tom Cone, who refers us to the guides because he understands it, I'm referring you there, because I don't understand it, at least yet.

    Looking at the ASC X12N Professional Health Care Claim implementation guide, index page A.1 show a schematic for the processing loop. You may already be familar with that schematic. I truly haven't had the time to read enough about this structure to explain it. If you haven't seen that page, or need a copy of it let me know & I'll try to get one to you.

    Sorry for the clinical answer, but maybe that will help and then maybe you can help me.

    Anybody else out there that has some experience with the new format, come on & speak up, if you're willing to help. As I've proven, you don't have to be an expert to join in.

    Lets stay in contact.

    Bill

  28. #28
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    Hendrik Krosschell
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    Default RE: Medical Billing

    Bill,

    Thanks for the encouragement. During my last look at ANSI format I ran across some examples of how the output of a typical claim might look. My impression was that, despite the confusing instructions, the actual output for an ordinary office visit claim, was very simple looking. There will typically be only a few lines of data that get output.

    There must be somebody (and I know there is) who has the knowledge to say, "these are the data elements you really need for 99% of your claims, and this is how they should be ordered". From there Alpha5 data fields can get written directly into a file that actually will look a lot more simplistic that the print image file.


    Rick

  29. #29
    Member
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    William Schone
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    Default RE: Medical Billing

    Rick,

    I think you are absolutely correct. The examples are normally always more confusing to start with, than they are after we get to work with them for awhile.

    Hopefully, we will all be saying this, in the following months.

    I would certainly be willing to share any experience that I get from writing our module, if it's of interest.

    As I said when asked if we could provide medical billing services - "It can't be too tough can it?"

    Let's see what happens.


    Bill

  30. #30
    Member
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    William Schone
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    Default RE: Medical Billing

    Is there anyone monitoring this message thread that has been investigating or coding for the new ANSI standard? I'm looking for any early on ideas to help explain the new transaction sets.

    Any thoughts, experiences or wisdom would be much appreciated.

    Bill Schone

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