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Medisoft Version 16 What's New?
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
customize to reflect your claim processing needs by setting up different grid
entries for insurance carriers, providers, your practice, or your data requirements
(NPI, legacy, etc). that you can 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 the
Insurance Carrier, Provider, and Referring Provider and moves labs and facilities
from the Address tab to Facility tab. Also, the Practice Information window features
a new tab, 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 on these grids, along with settings on the Insurance Carrier window, are
used for claim generation. These settings are highly flexible providing greater
breathe and depth to address your particular office’s billing needs. The inherent
flexibility in this implementation means that you can enter limitless scenarios for
any combination of insurance companies, insurance categories, 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
individual filing moving from EDI receiver settings to the Provider window. You
now bundle claims by creating provider filing rules using the Group or Individual
buttons on the Provider IDs grid instead of sending via a group EDI receiver or an
individual EDI receiver; however, if a carrier requires further refinement, you can
create use multiple submitter 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. 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.
For more information on the rules engine, data conversion when upgrading to
Medisoft 16, and settings on the Practice, Provider, Referring Physicians,
Insurance Companies, and Facilities window, see Medisoft Claims Generation
FAQs.
Management feature. This solution is offered in two forms: Revenue Management
Advanced 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.
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 direct connection.
With either option, Revenue Management provides a flexible tool that lets you
manage your claims processing environment and, if necessary, make changes
without completely replacing your EDI software.
Revenue Management differs from other EDI solutions by virtue of its design; it is
an integrated component of Medisoft which means that the company that
produces your practice management solution also produces your EDI solution—a
complete revenue management solution that seamlessly updates claim status and
date sent while also providing ERA (electronic remittance advice) posting and
eligibility verification.
Revenue Management provides value and robust support by supporting claims
submissions for many types of providers and facilities including physicians,
therapists, surgery centers, rural health, imaging centers, DME providers, dialysis
centers, etc. You can 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 the types of payers/clearinghouses that you connect to, you will need a modem
and phone line, an internet connection, broadband, a web browser, etc. Review
your clearinghouse/payer’s requirements.
What Does Revenue Management Replace
When you complete the Medisoft 16 installation, Revenue Management will
replace several Medisoft components including the Claims Manager EDI module,
all other existing EDI direct modules (can be converted to Revenue Management),
the ERA application, and the Eligibility Verification engine. After installation, you
will complete an online registration before your 30 day trial expires and, if
necessary, complete any annual subscription agreements.
Does Revenue Management Offer Any Additional Features or Solutions
Both versions of Revenue Management provide (on an additional yearly
subscription basis) claim editing and ANSI validation. Reducing your rejections
before they are sent by checking for pre-existing errors means that your business
will be paid faster for the services it renders, and your claims processing staff will
save time not having to rework and refile rejected claims.
Before sending and receiving notice of a rejected claim, validate the claim’s 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 you 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 are corrected 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
Revenue Management including additional software plug-ins that add custom data
fields for:
Part A Rehab (CORF / ORF)
Dialysis
KidMed (Medicaid EPSDT)
Medicare DME with CMN’s
Rural Health
General Purpose UB-04
Medicaid Programs
Ambulance
install is DVD based and places all you need to install Medisoft 16 Client Server
and Medisoft Clinical on one disc. Using the new type of media reduces the
amount of application discs one (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 of Medisoft 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 ease for installing Medisoft 16 Client Server, the Medisoft Clinical server
and database, and the Medisoft Clinical client.
The standard Medisoft 16 installation was also re-engineered. Though this install
is still CD-based, the new installation improves the install process and provides a
more robust platform for future enhancements.
- Medisoft has a new look.
- New Flexible Grids for Claim Generation
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
customize to reflect your claim processing needs by setting up different grid
entries for insurance carriers, providers, your practice, or your data requirements
(NPI, legacy, etc). that you can 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 the
Insurance Carrier, Provider, and Referring Provider and moves labs and facilities
from the Address tab to Facility tab. Also, the Practice Information window features
a new tab, 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 on these grids, along with settings on the Insurance Carrier window, are
used for claim generation. These settings are highly flexible providing greater
breathe and depth to address your particular office’s billing needs. The inherent
flexibility in this implementation means that you can enter limitless scenarios for
any combination of insurance companies, insurance categories, 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
individual filing moving from EDI receiver settings to the Provider window. You
now bundle claims by creating provider filing rules using the Group or Individual
buttons on the Provider IDs grid instead of sending via a group EDI receiver or an
individual EDI receiver; however, if a carrier requires further refinement, you can
create use multiple submitter 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. 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.
For more information on the rules engine, data conversion when upgrading to
Medisoft 16, and settings on the Practice, Provider, Referring Physicians,
Insurance Companies, and Facilities window, see Medisoft Claims Generation
FAQs.
- New Electronic Claims, Eligibility Verification, and ERA Processing
Management feature. This solution is offered in two forms: Revenue Management
Advanced 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.
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 direct connection.
With either option, Revenue Management provides a flexible tool that lets you
manage your claims processing environment and, if necessary, make changes
without completely replacing your EDI software.
Revenue Management differs from other EDI solutions by virtue of its design; it is
an integrated component of Medisoft which means that the company that
produces your practice management solution also produces your EDI solution—a
complete revenue management solution that seamlessly updates claim status and
date sent while also providing ERA (electronic remittance advice) posting and
eligibility verification.
Revenue Management provides value and robust support by supporting claims
submissions for many types of providers and facilities including physicians,
therapists, surgery centers, rural health, imaging centers, DME providers, dialysis
centers, etc. You can 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 the types of payers/clearinghouses that you connect to, you will need a modem
and phone line, an internet connection, broadband, a web browser, etc. Review
your clearinghouse/payer’s requirements.
What Does Revenue Management Replace
When you complete the Medisoft 16 installation, Revenue Management will
replace several Medisoft components including the Claims Manager EDI module,
all other existing EDI direct modules (can be converted to Revenue Management),
the ERA application, and the Eligibility Verification engine. After installation, you
will complete an online registration before your 30 day trial expires and, if
necessary, complete any annual subscription agreements.
Does Revenue Management Offer Any Additional Features or Solutions
Both versions of Revenue Management provide (on an additional yearly
subscription basis) claim editing and ANSI validation. Reducing your rejections
before they are sent by checking for pre-existing errors means that your business
will be paid faster for the services it renders, and your claims processing staff will
save time not having to rework and refile rejected claims.
Before sending and receiving notice of a rejected claim, validate the claim’s 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 you 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 are corrected 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
Revenue Management including additional software plug-ins that add custom data
fields for:
Part A Rehab (CORF / ORF)
Dialysis
KidMed (Medicaid EPSDT)
Medicare DME with CMN’s
Rural Health
General Purpose UB-04
Medicaid Programs
Ambulance
- New Enhanced DVD Install for Medisoft Clinical
install is DVD based and places all you need to install Medisoft 16 Client Server
and Medisoft Clinical on one disc. Using the new type of media reduces the
amount of application discs one (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 of Medisoft 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 ease for installing Medisoft 16 Client Server, the Medisoft Clinical server
and database, and the Medisoft Clinical client.
The standard Medisoft 16 installation was also re-engineered. Though this install
is still CD-based, the new installation improves the install process and provides a
more robust platform for future enhancements.
Contact us at
MedisoftV16@OTMBS.com
MedisoftV16@OTMBS.com