Managed Care
The Medical Manager provides many standard features to help you work
with managed care plans, maintaining such vital information as insurance
deductibles and coverage dates. The system tracks the patient co-payment
amounts and/or non-covered services, insuring that payments which may otherwise
go uncollected are received. It also handles different co-payment amounts
for special procedures and automatically calculates the total co-payment
due for a visit.
If a certain service is not covered, the system will alert you at the
time the charge is posted. The optional Managed Care module provides even
greater capabilities, including issuing and receiving referrals; maintaining
member lists; posting capitation payments received from managed care organizations;
and maintaining insurance policy limits. The optional module allows for
you to check for treatment pre-authorization and patient eligibility approval
before services are rendered. It tracks the amount of money and/or number
of visits authorized by a patient's plan, and warns you when the stop/loss
amount or maximum number of visits have been exceeded.
Numerous reports are available from the system to help you work with
managed care plans. For example, a report can be produced to help you analyze
such services as laboratories or x-ray facilities used for a specific patient
or patient group. Another report can show you the profitability of your
relationship with each managed care organization.
Feature Overview
Analyzes, tracks, records, manages and reports on a wide variety of
managed care programs within the practice
Handles multiple insurance providers for a single patient
Manages both incoming and outgoing referrals
Posts capitation payments received from managed care organizations
Prints report on patient utilization vs. reimbursement to determine
profitability of an individual plan
Prints reports for analysis or referrals
Go to Top
Voice Dictation:
The Medical Manager's interface to the Kurzweil voice-activated clinical reporting system enables the physician to save time and money in transcription costs, reduce errors, and provide for risk management.
Physicians dictate patient reports into a telephone-like microphone, connected to the computer, and their words automatically appear on the screen. The system features trigger words and phrases, which means physicians "fill in the blanks" of the reports by choosing from a 50,000 word vocabulary, including 15,000 medical terms and 25,000 common English language words. An additional 10,000 words can be defined by the user.
The interface with The Medical Manager allows the physician to import patient demographic data from The Medical Manager into the patient's report by simply stating the patient ID number. This eliminates errors in demographic information since it is entered into the system only once and then stored as a permanent medical record file associated with the patient.
Voice Dictation features:
Saves money in transcription costs.
Offers a quick payback time.
Interfaces with The Medical Manager so that demographic information is pulled into the patient report by simply stating the patient ID number; the information is then stored with the patient medical record.
Can recognize your voice upon first input.
Has a high level of noise immunity.
Go to Top
Automated Collections:
The Medical Manager Automated Collections Module gives you easy access to non-paying accounts that require collection attention. It also provides a tickler system to determine which accounts require action, such as promise-to-pay dates, return calls, and collection letters.
Accounts can be selected based on claim center, insurance class, status, collector, time in collections, account aging, aging of collection items, provider, and location.
The system lets you access financial detail and enter comments with date and collector information. It will also track promise-to-pay and/or litigation settlement dates and amounts.
Automated Collections features:
Reviews patient accounts for collection needs.
Maintains collection history on accounts.
Allows setup of budget payments.
Tracks patient and insurance-due items.
Prints reports that facilitate the collection process.
Maintains notes on each account.
Generates and documents correspondence to support collection efforts.
Allows all qualifying patients to be flagged for follow-up.
Go to Top
UB Billing / First Report of Injury:
The special UB (Universal Billing) module handles sophisticated billing needs, including the necessary collapsing and sorting of UB revenue codes for billing purposes. The specialized UB ailment screen makes it easy to complete a UB billing form correctly. This option can also be used for electronically transmitting "Medicare Part A" claims. It is also used for specialized reporting needs, such as the Worker's Compensation First Report of Injury.
UB features:
Supports the collapsing of charge items into revenue code groups.
Handles all outpatient facilities.
Allows charges to be monitored as a claim.
Allows Worker's Compensation forms to be customized.
Go to Top
Data Merge:
Data Merge gives new meaning to the term "customization." With this option, data within The Medical Manager can be accessed and manipulated to meet almost any need you have. Data Merge can be used to create all kinds of specialized features for your practice.
It can create user-defined data fields and screens that interact seamlessly with The Medical Manger. This powerful module also functions as a data import/export utility, allowing information to be transferred between your Medical Manger and outside facilities, such as hospitals, laboratories, and other organizations.
Data Merge features:
Can send and receive data from a hospital or other outside facility's computer to The Medical Manager installation.
Can create user-defined data fields and screens.
Go to Top
Image Management:
Computerize the storage of patient photographs, X-rays, and documents with The Medical Manager's Medical Records System Image Management component.
Photos, X-rays, and documents are converted to image data for storage and future retrieval with the use of scanners. The Imaging System allows the clinic to clearly identify the contents of each image, such as the date, type, and ID of the original image, as well as the date of the scan.
Physicians will especially like the free-form comments feature attached to each image, for professional interpretations of X-rays, commentary on photos received from other practices, remarks in response to letters from referring physicians, etc.
Image Management features:
Enables clinics to organize, store, and retrieve photos, X-rays, and documents.
Allows for multiple scanning stations.
Includes a cataloguing feature for entering information about each scan and for free-form notes about each image.
Permits the designation of access levels for image viewing, to ensure document security
Go to Top
Quality Care Guidelines:
Physicians are moving toward a pro-active and preventative approach to patient care and away from the traditional reactive approach of only treating sick patients. Monitoring high-risk patients before a condition warrants more extensive care can reduce the number of costly surgeries and hospital stays. Routine chest X-rays, immunization schedules, and mammograms have all proven to be valuable additions to a cost-effective health care system.
The Quality Care Guidelines component of the Medical Records System is a powerful tool that automates the process of tracking such preventative services. A patient's age, sex, and key health factors, such as previous illnesses or family histories, are used to set up a preventative care routine.
Standards of care, such as intervals for exams, lab tests, or immunizations, specific to each patient age group, sex, and health status, are user-defined. The patient's health factors, age, sex and the physician's standards of care combine to produce the patient care guidelines.
The Quality Care Guidelines System monitors each patient's past and current health condition and changing age, then aids the physician in performing the desired list of services needed at the proper time. Both preventative care recommendations and treatment plans can be monitored for the entire patient base simultaneously and automatically.
Quality Care features:
Integrates fully with The Medical Manager to allow automated recording of patient health factors and clinical history, based on procedures performed.
Interfaces with the Prescription System, allowing the doctor to view current patient medications and set stop dates for prescriptions, based on guidelines.
Enhances encounter forms to include guideline, patient health factors, and current medications.
Generates patient recall notices based on specific guidelines
.
Includes a wide range of reports on the practice's compliance with recommendations, based on the patient's clinical history.
Go to Top
Laboratory Interface:
The Laboratory Interface makes it easy for you to order tests, get results back quickly, and share patient demographic information with laboratory companies. It does this by sending test requests electronically to a laboratory, then allowing the laboratory to download the test results directly into the patient file.
This not only saves time but also eliminates data entry errors, as the results are entered electronically, rather than manually. The information is then readily accessible on-line to speed results to the patient. It is also made available for cumulative reporting.
Laboratory Interface features:
Provides faster, more accurate test results.
Downloads results directly into The Medical Manager.
Allows results to be reviewed onscreen and printed.
Allows cumulative analysis of results.
Can be customized for each laboratory.
Prints labels and bar codes for specimen tubes.
Results can be viewed as part of Medical Record with the View Patient Chart module
Allows results to be graphed through Lotus 1-2-3 export utility.
Go to Top
Prescriptions:
The Medical Manager's Prescription System provides the physician with efficient tools to handle prescriptions from start to finish. Together with Medi-Span database products, it allows the physician to screen for drug allergies, interactions and proper dosages; print patient drug education data; enter prescriptions, refills, and instructions; and optionally send electronic prescriptions to pharmacies.
The Prescription System includes the Prescription Writer screen, which resembles a typical prescription pad. From this screen, physicians quickly select the drugs, pharmacy, SIG code, and enter patient instructions. Full security is provided to ensure that only authorized persons are writing and issuing prescriptions. It also allows standard prescriptions to be easily stored and quickly recalled. The Prescription System can work in conjunction with The Medical Manager's Quality Care Module, automatically transferring drug information to update patients' key health factors.
The module utilizes the optional Medi-Span MED-FILE(tm) drug database, which enables physicians to access a drug file that includes drug names and dosages for more than 20,000 different pharmaceutical products. In addition, when using the optional interface for the Medi-Span Solution, the practice can screen prescriptions for drug-drug interactions, drug-food reactions, drug-allergy reactions, drug-ethanol reactions, disease of health state contraindications to medication use, daily dose ranges and duration of therapy, and therapeutic duplications. It also includes a comprehensive database of patient-oriented drug education information.
After the prescription is written, it can be printed, faxed, or electronically transmitted to the pharmacy of the patient's choice. The system stores information on each pharmacy the practice utilizes. In addition to basic information, it also stores the preferred issue method for each pharmacy: voice, print, fax, or EDI.
Prescription System features:
Available with a drug database for physicians to use right in their offices as a reference for drug code names and for checking drug interactions and allergies.
Allows physicians to quickly enter the drug, pharmacy, SIG code, and instructions.
Includes a security system to ensure that only authorized personnel are writing and issuing prescriptions.
Interfaces with the Quality Care Module so patients' key health factors are automatically updated.
Optionally transmits electronic prescriptions to pharmacies.
Available with interface that allows a host of electronic screening options
Go to Top
Electronic Medical Records
The new age of health care automation demands that you access accurate information in seconds and minutes instead of hours and days. The developers of The Medical Manager software are aware of your pressing demands. We have created a completely integrated electronic chart to assist you as you step up to this new "time table" and totally automate your health care delivery system.
The Medical Manager Electronic Chart: Designed With You In Mind
Feature Overview
Comprehensive Knowledge Base: You have access to a complete library of clinical codes, diagnosis and procedure codes, anatomical and physiological terms, and over 10,000 additiona elements you can use to create a patient's medical record.
Customization: You can tailor Medical Records to fit your practice's individual needs. An unlimited variety of user-defined data can be displayed from View Patient Chart screen in a summary format. You can select The Medical Manager medical record element that best fits what you want to see in your practice.
Security Options: You can control who may read, write, sign, and purge patient medical records. Once a medical record has been "signed" electronically, it is sealed as a permanent record that cannot be modified or deleted.
Information Sharing: Items coded as clinical history are available to any module of The Medical Manager accessing clinical history. In addition, reports are provided allowing the user to query the patient's medical records data.
Team Analysis: You can sit at the screen with a colleague and do side-by-side analysis of the patient's chart data.
Time Savings: Diverse pieces of the patient's medical record are at your fingertips, thus no more wasted time trying to locate misplaced records.
View Patient Chart Screen
Patient :10.0 VIEW PATIENT CHART [Carlson, Steven W]
Health Factors
Neurotic Depression 03/01/93
Essential Hypertension 06/01/92
Congestive Heart Failure (CH 02/06/93
Captopril 03/01/93
Vital Signs
Resp. 24 Temp.F 97.9 04/14/93
Pulse 59 BP 120/70
Wt.lb 176 Ht.in 70
Lab Tests
GENERAL HEALTH SCREEN 06/22/93
GLUCOSE PLASMA AND OTHER S 06/22/93
POTASSIUM 06/22/93
GENERAL HEALTH SCREEN 06/22/93
Allergies
V-Cillin K OR TABS 125 MG 03/27/93
Penicillins 01/21/93
Medications
Imuran 50 MG TABS OR 20 04/10/93
Keflex 250 MG CAPS OR 25 04/01/93
Codeine Sulfate 60 MG TABS O 03/27/93
Carbamazepine 200 MG TABS OR 03/21/93
Procedure History
Electrocardiogram 02/08/93
Office Estb:Detailed Hx-Exam 02/08/93
Injection - Intramuscular 01/31/93
X-Ray Interpretation & Consu 01/31/93
Health Factors Procedure History Progress Notes
Lab Tests Diagnosis History Guidelines
Medications Referrals Imaging
Vital Signs Blood Pressure Immunizations
Allergies Weight History
You can view up to 12 screens of your patient's medical record. Each section on the screen contains up to four of the most recent medical encounters. With the simple touch of a button you can access unlimited background detail of any of the 20 medical record elements, all of which are held in history files.
Go to Top
Chart and X-Ray Locator
Lost patient charts are a thing of the past with the new Chart and X-Ray Locator System. This module provides a secure and convenient method for clinics to track patient medical charts and X-rays.
By simply looking at the central screen, the user can view the last known location of any chart or X-ray in the system as well as an audit trail of their three most recent locations.
Pulling patient charts for the day becomes extremely easy, as The Medical Manager contains an automatic batching program. The system tells the clinic which patients have appointments on a selected date and prints a list of charts that need to be pulled for each doctor group. Batching routines are used to automatically check out and check in the charts to the appropriate locations. Chart out-guides and flash cards may be printed to mark the correct location of each chart or X-ray for easy re-filing.
Chart and X-Ray Locator features:
Tracks last known location of any medical chart or X-ray chart in the system.
Shows an audit trail of the three most recent locations.
Includes an automatic batching program for easy chart check-in and check-out.
Designed to be fully bar code compatible, if desired.
Go to Top
Claims Adjudication System
Primary care providers (PCPs) as well as specialists are taking on full risk responsibility in the managed care arena. How do these groups make sure that the payments made to health care providers are indeed for authorized services'? How can an IPA automate payments to the providers plus rebill those services to the insurance company? Staying on top of these accounting details sounds like an administrative nightmare that can be costly and confusing. Not so with The Medical Manager's new automated Claims Adjudication System - ProClaim for full-risk PCPs and ProClaim Plus for large IPAs and MSOs.
These options adjudicate claims for payments, maintaining a complete audit trail that begins with issuing a referral within The Medical Manager's Managed Care Module. The referral information is fully integrated into the Claims Adjudication System, which will automatically adjudicate the claim, determine the payment, generate the checks, and produce an explanation of benefits (EOBs) for the specialists.
ProClaim - Basic System Features
Referral System Integration - It transfers referrals from The Medical Manager's Managed Care system directly into the Claims Adjudication System saving as much as 75 percent of adjudication input time. It tracks physicians authorized to provide services and those physicians who provided the service but were not authorized. It maintains and tracks diagnosis changes or secondary diagnoses. If you are using capitation in a managed care environment, use this feature to better understand the profitability of different managed care contracts.
Claims Tracking System - Once the claim is assigned for payment, an internal system assures your claim is paid within the required plan contract time limits. Unique claim tracking numbers allow the adjudicator to follow a claim through the system. From a single screen, you can notify your provider of the date the claim was received, inputted, adjudicated, and paid. It also indicates when the check was generated.
Go to Top
Electronic Media Claims
The Electronic Media Claims (EMC) module gives you the ability to comply
with all of the new federal regulations, in addition to improving payment
turnaround time on insurance claims. This module allows you to send claims
electronically to Medicare, Medicaid, commercial carriers and clearinghouses
nationwide. If your practice deals with Medicare, then you know how important
it is to be able to submit claims electronically to decrease turnaround
time and increase cash flow.
Feature Overview
Checks data prior to transmitting claims for accuracy and reports any
errors detected
Monitors claims that have been transmitted and have been either accepted
or rejected
Complies with all Health Care Financing Administration regulations
Uses audit trails and reports to insure that claims have been processed
properly
Go to Top
Electronic Remittance System
Used in conjunction with the Electronic Media Claims module, the Electronic
Remittance System (ERS) saves hours of data entry time, compared to manually
posting payments from the Explanation of Benefits (EOB). With this module,
payment information can be downloaded from Medicare or other claim centers
and posted directly into a patient's account within The Medical Manager,
complete with writedowns, proper payment allocations and responsibility
transfers. ERS also allows you to determine what is posted and provides
full reports on payments, profiles, over-and-under-payments, etc., with
a full audit trail provided.
Feature Overview
Automatically posts payment information utilizing all approved amounts
and fees that were previously defined
Saves hours of data entry time
Go to Top
Data Merge
The Data Merge option gives new meaning to the term "customization".
With this feature, data within The Medical Manager can be accessed and
manipulated to meet almost any need you have. Data Merge can be used by
your dealer to create all kinds of specialized features for your practice.
It can create user-defined data fields and screens that interact seamlessly
with The Medical Manager. This powerful module also functions as a data
import/export facility, allowing information to be transferred between
your Medical Manager and outside facilities, such as hospitals and laboratories.
Feature Overview
Can send and receive data from a hospital or other outside facility's
computer to The Medical Manager installation
Can transfer prescription information to a pharmacy
Can create a specialized utility needed by the practice
Go to Top
Custom Report Generator
In addition to the more than 150 reports available within The Medical
Manager, this module allows you to access all data files and create your
own custom-designed reports. Examples of reports that can be designed include
practice analysis, specialty-specific analysis, marketing information,
special letters, mailing labels and unique financial analysis.
Feature Overview
Custom Report Generator has access to all data within the system and
can report it in virtually any format desired
Selecting data to be used is easy, as data can be presented in groups
within help windows
Allows reports to be automatically transferred to Lotus 1-2-3 for graphing,
or to a word processing package for mail merge projects
Go to Top
Electronic Data Interchange (EDI) Interface
The Medical Manager provides you with a state-of-art Electronic Data
Interchange (EDI) Interface. This interface makes it possible for you to
have immediate access to various insurance providers, third-party connectivity
networks and other outside facilities directly from The Medical Manager.
Using the EDI Interface, you can electronically check on a patient's pre-authorization
status, confirm benefit eligibility and even obtain credit card or check
approval. You can also file or check on a physician's referral verification.
The EDI Interface can be used to check the status of claims that have already
been filed. It can also be customized to allow you to electronically send
prescription information directly to pharmacies or to share clinical data
with outside sources.
Feature Overview
Reduces time required for eligibility authorization
Obtains payment guarantees through prior authorization
Verifies insurance coverage for a new patient
Based upon the outside facility, customized features may include verification
of co-payment amounts, eligibility, coverage, referring doctor approvals
and credit card and check authorizations; encounter notifications, electronic
claims and prescriptions to pharmacies and other providers; and much more
Go to Top
The Medical Manager is a registered trademark of Personalized Programming, Inc. Systems Plus Incorporated and its logo are trademarks of Systems Plus Inc, 500 Clyde Ave, Mountain View, CA 94043, (800) 222-7701. All other product names mentioned throughout this site are trademarks or registered trademarks of their respective companies.
