T.I.M.E.

Ascent Integrated Medical Solutions T.I.M.E.™ system enables physician practices to be more efficient in clinical, diagnostic, insurance, and billing. With better utilization of time and faster turnaround of cash flow, T.I.M.E. can improve the flow of information in a totally integrated system for a true return on investment. The features of T.I.M.E. include: Electronic Medical Records (EMR), Laboratory Information Systems (LIS) and Practice Management Systems (PMS).

Electronic Medical Records

Features of Electronic Medical Records include:

• Templates
• Vital Signs
• Injection Management
• Writing Prescriptions
• Preventative Maintenance
• Navigation and Reuse
• Evaluation and Management (E&M)
• Medical Necessity Management and Coding
• Messaging

Any piece of information that is required for a complete patient record can be placed in the Electronic Medical Record: complaint, histories, physical, review of systems, plan, vitals, prescription, etc. In addition to documenting a patient's encounter, EMR has the ability to run reports identifying complete but un-reviewed labs; allows the physician to consult schedules to check expected patient loads, and many other features described below. The key to entering all of this information into a patient's record in a timely manner is the use of templates.

Templates

Ascent Integrated Medical Solutions T.I.M.E.™ makes use of "templates" to simplify data entry in the EMR. A template is a framework of the information that a physician uses most often. The information is entered into the computer and is stored so that it can be quickly retrieved for future use. Another important factor is that, by giving the users multiple ways to enter information into the system, clinicians with little or no computer skills can quickly adapt to the new technology. T.I.M.E.™ can be as easily adapted for an ENT (Ear, Nose and Throat) practice as for an Ob/Gyn or any specialty. Clinicians can tailor the templates themselves to meet their more specific needs.

Vital Signs

All vital signs (weight, pulse, height, blood pressure, etc.) are displayed as a line graph relative to dates of previous encounters. This makes it easy to identify unhealthy trends or patterns in vital sign data. Our complete line of Vital Sign Monitors is wirelessly interfaced into the system.

Injection Management

T.I.M.E.™ provides a means for specifying injection dosages, units, location, lot numbers, and more; as well as the ability to run reports and print other information related to these injections.

Writing Prescriptions

The T.I.M.E.™ EMR has the ability to check past and current medications, drug allergies, etc. The physician in just a few point and clicks can prescribe the medication, dosage, frequency, number of refills and instructions, then print it out for the patient.

Advantages to Writing Prescriptions in T.I.M.E.™:

  1. Ability to set default dosages, frequencies, refills, etc. for medications
  2. Ability to bring an old prescription forward into the current encounter, whether modified or just re-prescribed, much faster than by traditional paper methods
  3. Ability for physicians to securely transmit electronically prescriptions to pharmacies
  4. Ability for physicians to fax prescription information to pharmacies in conjunction with commercially available products that can be purchased separately

Preventative Maintenance

In order to keep track and manage routinely administered medical procedures and services (flu shots, prostrate screening, etc.), T.I.M.E.™ integrates built-in maintenance schedules developed from data obtained by the U.S. Preventive Services Task Force. The users of T.I.M.E.™ can also add or modify the services and procedures within schedules and set new services that are used based on a patient's sex, age, service frequency, etc.

Navigation and Reuse

The information required in patient medical records is stored in the system in chronological order. The user can navigate to previous categories of information within the medical record. In cases where patients have chronic ailments, conditions that do not change much with respect to T.I.M.E.™, the physician can quickly pull portions of previous medical records forward into the current patient encounter and speed the process of documenting the medical record.

Evaluation and Management (E&M)

Periodically, the government performs audits where they check charges for 'E & M' services rendered and compare those charges to the supporting medical record documentation to insure compliance with these regulations. By using templates and reusing portions of the past medical records, the physician can quickly build the necessary documentation to justify his services. Also, since much of the information needed to estimate the level of care is available in an electronic format and many of the guidelines can be 'automated', T.I.M.E.™ can offer the feature of estimating the level of care and provide documentation recommendations for moving to a higher level of care.

Medical Necessity Management and Coding

T.I.M.E.™ has a built-in Coding System. As health insurers revise policies and the coding changes, the physician's practice has the ability to make those changes in the T.I.M.E.™ system. When the physician, nurse, or other employee orders a procedure or service, the software can provide hints as to what diagnoses is considered necessary for a given procedure, patient and insurer. And equally, by selecting a diagnosis, T.I.M.E.™ will hint at what procedure or service a health insurer considers medically necessary. This is made possible because the Electronic Medical Records and the Laboratory Information System are integrated with the Practice Management System

Messaging

T.I.M.E.™ provides a messaging system, which works in unison with the EMR. Users of T.I.M.E.™ are able to send electronic messages back and forth to each other regarding patients. All correspondence can be saved as a part of the patient's permanent medical record.

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Laboratory Information System

A laboratory information system is designed to manage the details of running a lab and managing clinical lab information. Depending on the size and complexity of the lab, the following are a few of the task the lab manager performs:

  1. Collection and management of specimens and information associated with 'internal' lab tests. The Laboratory Information System (LIS) within the Ascent Integrated Medical Solutions T.I.M.E.™ software is built to exchange information with the majority of the medical industry's 'Lab Analyzers', and after obtaining information (results or element measurements) from these lab analyzers, the LIS stores the information in a manner that allows ALL users within the T.I.M.E.™ software to obtain the information. The LIS can be integrated with over 300 different lab analyzers.

  2. Collection and management of specimens and information associated with 'external' lab tests. In some cases, it is simply not cost effective to perform lab tests internally. The T.I.M.E.™ LIS is equipped to handle information whether lab work is routed to a reference lab or to local hospitals.

    • Discrete-data-exchange: The most common data standard used to exchange this type of medical information is Health Level Seven, or HL7. The LIS is integrated into a common architecture with the T.I.M.E.™ software's Electronic Medical Record (EMR) and Practice Management System (PMS). Therefore, the information used to generate a requisition is pulled from the same source that the PMS uses to file patient insurance claims and generate patient statements. This helps to ensure the accuracy of the data used by the reference lab to perform the analysis and collect payment. Once the reference lab identifies the specimen(s), test(s) to be performed (orders) from the request, and has completed its analysis, the resulting information is then placed in a format, in accordance with HL7 specifications, and made available to the originator of the request. The LIS retrieves this information and stores it as discrete elements. These discrete elements are then stored in a manner that allows ALL users within the T.I.M.E.™ software to access the information.

    • Non-discrete-data-exchange: Used in situations where interoperability or 'bi-directional' data exchanges are not possible. The LIS allows you to manage that data by providing the capability of the 'paper' or 'non-discrete-data' results. Requests (or orders) can still be printed and sent along with the specimen. The results then come back from the reference lab as a 'paper' report and scanned images may be stored in the system in relation to the original order.

  3. Management of the quality assurance (QA) issues within the lab:

      1. The LIS also provides reports to identify inefficiencies in the lab process (i.e., turn-around-time for internal and external lab test)
      2. LIS provides reports that help the user identify any incomplete, un-resulted, or un-reviewed lab work for both internal and external lab tests
      3. LIS provides reporting capabilities to analyze data trends, for instance, you may generate reports to show all the patients with critically high white blood count for the past two weeks.
      4. LIS allows the user to set three types of flags or alert indicators for elements within a lab test.
        1. Boundary Flags: The boundaries at which an element is considered to be Critical Low, Low, Normal, High, Critically High, and Unknown.
        2. Alert Variance or Delta-Check Flags: This type of flag identifies sudden shifts of lab element values relative to the last time that element was sampled for the patient.
        3. Expected Value Flags: Expected values are generally used on element values of a non-numeric nature (positive and negative, or blue, yellow, green, orange). Expected values are the most common (or normal states) of non-numeric data (i.e., Negative).
          All flags are used in conjunction with colors to quickly draw the user's attention to abnormalities in lab test results. High and low values are highlighted in yellow, critical high and low are in red, etc.

  4. Manage and track quality control (QC) measures in accordance with Clinical Laboratory Improvement Amendments [CLIA]. The LIS module provides the capabilities to manage controls and lot numbers, performs statistical analysis of the data resulting from those controls, and graphs this information in accordance with Clinical Laboratory Improvement Amendments.

A lab information system of this caliber becomes extremely important when you move to larger practices or large 'Healthcare Maintenance Organizations' [HMOs]. These organizations generate patient loads large enough to justify the initial and down stream investment on the lab equipment. By including the LIS within the T.I.M.E.™ product line, we have the three most essential aspects of Medical Information Management (PMS, EMR and LIS) within all midsize and large healthcare organizations, or to put it simply, 'one-stop-shopping' for all your medical information software needs. All of it operating on the same 'sheet of music' and built on a software/hardware platform (Microsoft/Dell and others) that will be around for at least the next 20 years.

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Practice Management System

PMS allows you to have a more resourceful office and staff, meaning you can focus on what truly matters the most…your patients. The PMS module is the practice management segment of the Ascent Integrated Medical Solutions T.I.M.E.™ software.

Full features:

• Front Office - Physician Schedules
• Patient Demographics
• Built-in Checks
• Business Office
• Transcription

The Front Office - Physician Schedules

Our Practice Management System gives the receptionist the ability to manage multiple physicians' schedules.

Patient Demographics
    1. Personal patient information
    2. Patient insurance information
    3. Electronic version of the insurance card via scanning
    4. The insurance validation feature is used to confirm the validity of a patient's Blue Cross/Blue Shield insurance, check co-payment amount, and whether or not a patient has met their deductible.
    5. PMS offers a streamlined check-in system. Once the patient is checked in electronically, the system notifies the nurse that the patient is ready to be seen and the record transitions to what is known as Electronics Medical Records [EMR].
    6. PMS also helps make the patient check-out more efficient. Once the nurse and physician have completed their part in the patient's encounter, the receptionist is alerted that the patient is approaching the check out window. At this point, the receptionist is ready to begin the check out process.
      1. The receptionist can review the patient's demographics, insurance records, and the electronic super bill.
      2. The receptionist collects the co-pay and posts the payment to the system.
      3. Next, the receptionist checks the patient's assessment and plan created by the physician earlier. If the physician has indicated a follow-up visit, the receptionist schedules the appointment, gathers any prescriptions printed by the physician, clicks to print the patient a receipt and details of the next appointment, and hands that documentation to the patient. The patient's encounter is complete.
      4. As the patient leaves the office the receptionist indicates to the system that the encounter is complete. This will give the billing specialist notice that a patient's insurance claim is ready to be reviewed and filed.
      5. PMS electronically notifies the billing specialist that check out is complete.

Built-in Checks

When the receptionist indicates that the patient is finished, and before that information is sent to the billing department, the system evokes a billing validation engine. It checks completeness of the patient's demographics record (name, data of birth, etc.) and insurance record (insured, policy and group number). It also checks correctness for things like primary insurer's age (> 18 years), relationship to insurer, and more.

The Business Office

Once the billing specialist is notified when a patient has been checked out, PMS creates a complete insurance claim with all the diagnosis, procedures and services (including codes) for review. After reviewing and editing the claim it is ready to be filed either by mail or electronically.

The billing department can be broken down into 6 categories:

  1. The creation and preparation of insurance claims. Claims are created in two ways:
    • Automatic: Claims are created and completed during the course of the patient's encounter. The billing specialist simply needs to review the claim and set it up to filed.
    • Manual: There are cases when a claim needs to be created where the patient's encounter is at a different location (Hospital Visits, Nursing Homes, etc.). This is partially automated. When you open a new claim you are required to select the patient, physician, and date of service. When the claim opens, the demographic and insurer information is already filled in. The billing specialist uses the same coding system that the physician uses to help guide in the selection and linkage of the diagnosis, procedure, service, etc. Once completed, the claim is ready to be filed.

  2. Transmission of claims. Insurance claims can fall into two general categories;
    • Government: Direct-transmission to Medicare, TennCare, Blue Cross for Tennessee and Medicare, Medicaid and Blue Cross, for Alabama, etc.
    • Commercial: (Aetna, United Healthcare, Cigna, etc). Most commercial insurance claims can be transmitted electronically through a clearinghouse. For those that can't, the clearinghouse will 'paper-claim' in exchange for a per claim charge. To avoid the charge for the paper claims, some offices create paper claims locally. Since we are fully integrated with the insurance processors, the process of sending a batch is, in most cases, only one to three 'clicks' of a button away.

  3. Follow-up of claims and patient accounts
    • Insurance claims: The follow up on electronic claims is simple, requiring only a 'click' or two. The audit report will provide information regarding total claims transmitted, accepted, rejected and then a detailed report for rejected claims. There is also the capability to produce an aging report that identifies outstanding payments in categories of 0-30, 30-60, 60-90, 90-120 and >120 day intervals. Once identified the user has the option to re-print or re-submit electronically these outstanding claims.
    • Patient Accounts: T.I.M.E.™ has the ability to follow up on patient accounts by providing reports identifying patients who have neglected to pay their bills. Once patients are identified on the report, users have various options available to help manage the accounts such as to send final statement, collection agency report, account write-off, and other options.

  4. Posting and balancing of claim and patient payments
    a. Electronic Posting

    • Large volume providers, such as Blue Cross and Medicare, offer electronic posting of explanation of benefits [EOB] or remittances. A click of a button usually downloads and posts most payments from the electronic EOBs.
b. Manual Posting
  • Patient payments, co-pays and mail, offers a 'distribute' functionality that allows the users to distribute large patient payments over several encounters, oldest to newest
  • Payments from insurers who do not provide electronic EOBs are quickly manually posted

c. Balancing

    • The T.I.M.E.™ software offers several reports to balance both daily patient payments and daily insurance payments, so the user can make sure that the cash drawers and computer totals match. These reports can also be used for end-of-month balancing and end-of-year balancing when reconciling bank statements.

  1. Patient Statements

The user selects some initial criteria, clicks a button, and the system generates a list of patients whose insurance has reconciled and who have a balance greater than a specified amount. No more need to send a statement for a 10¢ bill when a stamp costs more than three times as much. Statements can also be transmitted electronically to bulk mailing houses.

  1. Accounting Management

PMS also provides hundreds of reports to manage accounting details associated with practice, charge, payments disallowed, write off, patient payment, etc, and can be broken down by Facility, Insurer, Physician, and Procedure Code, etc. These reports offer date range options for date of service, file date and post dates. T.I.M.E.™ has other features that include auto re-file so you can set dates to automatically re-file insurance that has not paid. All reports have a unique feature allowing the user, with the click of a mouse, to go directly from a follow-up report into the claim needing attention, correct the claim, resubmit and then, with another click, quickly start back at the last place in the report. All reports can be sorted by column heading. For example, quickly sort patients with the largest account balances to the top of the report.

Transcription

The EMR eliminates transcription costs. The medical record is completed during the encounter. When the patient leaves the office, the entire medical record is complete.

Account Receivables and Reporting Management

  • Comprehensive patient information including demographics, insurance, appointments, contacts, referrals, notes, case management details fully integrated with TIME EMR
  • Fast patient registration with alert messages including duplication warnings
  • Case specific records: insurance plans, hospital stays, A/R classes
  • Patient and guarantor account retrieval by numerous search criteria including patient and/or guarantor name, date of birth, social security number, account number, transaction number, medical record number, and user-definable fields
  • Procedure and diagnosis code tracking specifically designed for oncology care plan, etc.
  • Patient and insurance company balances displayed in every patient-related view
  • Custom fields available for user-defined information
  • Automatic computation of all managed care data
  • Easy viewing of managed care issues such as referral tracking, copayments, number of allowable visits, utilization and outcomes
  • User-defined reports generated by procedure, A/R class, location, referring doctor, date range, service or posting date, insurance, department, provider, credit type
  • Patient referral tracking warns when patients approach referral service limits
  • Next post-procedure date for reimbursement

Financial Ledger

  • Comprehensive transaction information with easy mouse click drill-down capabilities
  • Accounts receivable and collection activity: complete computation, tracking, and reporting
  • Insurance and HCFA forms: automatic generation and recreation
  • Recording of check numbers with the associated procedures for easy posting reconciliation
  • Dynamic formats and flexible customization features
  • Full audit trail
  • Open item posting: automatic disallowance, withhold calculation, automatic write-off
  • Multiple statement formats

Reporting

  • Robust set of system reports:
  • Transaction listing
  • Aged trial balance (user-defined patient/insurance aging categories by date range for itemized charges).
  • Recall report (selected by patient name, account number, birth date, provider, recall reason, last service date, or procedure selection)
  • Demographics reports
  • New patient listing
  • Reports may be sorted/filtered by any combination of A/R class, department, insurance, provider, plus date range (daily, weekly, monthly, quarterly, annually, and for any date or date range)
  • Screen-preview and printing of all reports, statements, receipts, immunization record, insurance forms, encounter forms, and letters
  • Laser Forms Software (optional module) for patient statements and receipts, encounter forms, HCFA 1500 forms

Word Processing

  • Built-in word processing, seamlessly integrated with other system modules
  • Mail-merge for automation of single letters or letters to groups of patients, providers, insurance companies, attorneys, etc.
  • Letter creation based on: date of service range, diagnoses, procedures, birthday letters, operative reports, dunning and pre-collection letters, request for insurance information, patient labels, referring physician labels
  • Free-form letters and documents supported, both stand-alone or generated by merging information from the system database
  • Mail-merge label printing
  • Integrated spell-checker

Customization, Personalization, Security

  • Choice of ledger column headings and their sequence
  • On-screen patient summary
  • Insurance plan billing order
  • Procedure and diagnosis code linking
  • Linked procedure code posting
  • Customized billing cycles
  • Aging categories
  • Dunning messages
  • Administrator-defined access permissions and customizations
  • Multiple security levels: read-only, add, modify, delete; access assigned per user, per group, per module

Appointment Scheduler Module

  • Numerous views and reports available including schedule printouts by provider/room, daily/weekly schedule report, no-shows
  • Effortless modifications to existing appointments in one or two mouse clicks
  • Extensive customization: customized screen settings, user-defined appointment types, appointment durations, overbooking features, time slot intervals by provider/room, etc.
  • Separate office and surgical schedules
  • Wave scheduling
  • Charge slip and label printing for chart preparation

Patient and Insurance Billing

  • Detailed insurance plan information screen
  • On-screen insurance claim status (insurance claims pre-submission report, insurance unpaid claims report, automatic claims re-submission and claims tracking)
  • Procedure-diagnosis code linkage: helps ensure claim acceptance by automatically verifying that an accurate and appropriate diagnosis code is attached
  • Automatic cascading: sequential billing of an unlimited number of carriers per patient
  • Automatic claims resubmission (user definable by insurance carrier)
  • Unlimited insurance-specific fee schedules
  • Multiple insurance holders per patient
  • Multiple insurance coverage and effective dates

EDI - Electronic Billing & Reconciliation

  • Fast and flexible electronic claims submission and Electronic Data Interchange (EDI) can handle the most sophisticated billing requirements
  • Quick reimbursement on electronically submitted claims
  • Eliminate the need for paper forms, HCFA and other forms
  • Dramatically reduced insurance company rejections due to error-free electronically submitted claims
  • Electronic reconciliation for automatic posting of payments, eliminating the need for manual keyboard entry

Medical Practice Management Reports Module

  • User-defined reports including:
  • Practice analysis report
  • Procedure analysis report
  • Referral analysis report
  • Insurance aging report
  • Diagnosis analysis report
  • Transaction summary report
  • Reports may be sorted/filtered by any combination of A/R class, department, insurance, place-of-service, provider, referring doctor, plus date range (daily, weekly, monthly, quarterly, annually, and for any date or date range)
  • All reports are fully customizable
  • Customized report parameters can be saved for easy reuse
  • On-screen preview available for all reports
  • Reports are produced without interrupting other system operations

 

Regulatory and Compliance Planning

Four risk areas identified by the OIG are:

    1. Coding and billing
    2. Reasonable and necessary services
    3. Documentation
    4. Improper inducements (referrals, anti-kickback violations)

Ascent services include:

    • Comprehensive Practice Assessments
    • Operational Audits
    • Reimbursement Review and AR clean-up
    • Interim Management
    • Practice Oversight
    • Coding Education
    • Compliance Review
    • Policies and Procedures

 

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