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A Successful Operation

Using the iSeries system as its primary computing platform, MedAmerica Billing Services has been able to move toward an image-based billing environment.

It's a fact that more and more U.S. residents are uninsured or underinsured when it comes to medical care. As a result, many people are increasingly using hospital emergency rooms - "where they can't be turned away for an examination," notes Nancy Templeton, IS director with MedAmerica Billing Services, Inc. (MBSI) - as their point of primary medical care.

Hence the need for organizations such as California Emergency Physicians Medical Group (CEP). CEP is a partnership of emergency-medicine physicians that contract with more than 50 hospitals in California, as well as three outside the state, to staff the emergency room. There's also a growing group of what are called "hospitalists," who are physicians acting as specialists and primary-care providers for patients who are admitted to the hospital.

As one might expect, their billing, which is independent of hospital billing, can become quite complex. To help streamline the process, MBSI handles billing for several such groups, including CEP and Galen Inpatient Physicians. Unfortunately, the resulting avalanche of paperwork was threatening to overwhelm MBSI, with government mandates dictating that the documents be stored for at least seven years.

To streamline this process, MBSI is currently implementing LaserFiche document imaging and LYNX E-Code computerized coding applications to be integrated with their billing application, which runs on an IBM* eServer iSeries* system. Once completely up and running (parts already are), it will allow the organization to significantly reduce paper-based data entry and vastly improve medical-chart handling. In a related move, the organization has developed an electronic chart-tracking system that will help it account for and track missing and incomplete charts. And so far, according to Dennis Harsh, IT manager with MBSI, "We've had a very successful operation." No pun intended.

Image is Everything

MBSI has around 400 employees at its Modesto, Calif., site. Although CEP is the organization's primary customer, MBSI also provides management and reimbursement services for organizations such as Galen and several other similar and smaller groups. In fact, it processes some 140,000 claims a month for more than 1,000 physicians in more than 60 hospitals located in California, Georgia and Hawaii, the latter of which is where many of the "hospitalists" MBSI deals with are located.

According to Harsh, the organization has a volume of some "1.7 million patients a year." This growth is due to CEP being awarded more contracts and MBSI expanding to provide services to several other physician groups. MBSI can take on more clients because of its value-add services, including education related to medical billing, coding and documentation; coding-compliance auditing by in-house professionals; and custom data analysis and reporting.

"When an insurance company calls requesting a missing document, we can fax the image directly to them while they're on the phone." -Nancy Templeton, IS director, MedAmerica Billing Services, Inc.

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