APA Convention in Orlando: Customers, colleagues, and more

From Thursday August 2 through Sunday August 5, 2012, Synergistic Office Solutions exhibited at the American Psychological Association (APA) convention in Orlando. The last time we exhibited at APA was in New Orleans in 2006. As a New Orleanian, it was my way of thanking APA for holding the convention there so soon post-Katrina.

This time, the meeting was held in Orlando. Since the SOS headquarters is located in Clermont, FL, a mere 30 miles west of Orlando, we felt we should attend. We had a few other outstanding reasons to be there.

Three SOS customers also exhibited this year, and we definitely wanted to see and support them.

University of Missouri Community Psychological Service received a large grant that will allow them to expand their services. Dr. Rob Harris was at APA interviewing for their open positions for psychologists.

Alliant University - CSPP booth

Alliant International University – California School of Professional Psychology (CSPP) attends every year. According to Michael Newman, the Assistant Director of Alumni Relations, many CSPP alums attend the convention. For them, it is a great opportunity to reconnect with alumni and to talk with potential new students.

Southeast Psych is a private group psychology practice in Charlotte, NC. Though we had spoken with Dr. Frank Gaskill and Dr. Jonathan Feather many times since 2000 when they started using our software, we had never met. We do receive their monthly newsletter, so we knew that their approach to the practice of psychology is unique. How many practices do you know that have as one of their goals the pursuit of fun?

Dr. Feather and Dr. Verhaagen of Southeast Psych playing at APA









Southeast Psych has begun to do some consulting with others who also want to develop their Dream Practice. I was glad to join in some of the fun while there.

Kathy with Darth Vader and Storm Trooper








I had a few other pleasant tasks while at the convention. I got to visit with and then hear the presentation of my long-time colleague and friend, Dr. Ellyn Kaschak, this year’s Carolyn Wood Sherif Award recipient. I attended a University of Florida reception for alumnae of the program in Clinical and Health Psychology (of which I am a graduate).

Trish and I hosted other visitors/friends at our booth.

Fred Coolidge, Ph.D.

Dr. Fred Coolidge is Seth’s cross-country riding buddy, Professor at University of Colorado – Colorado Springs, author and rock guitarist. Dr. Bob Neimeyer was Seth’s student while at University of Florida. He is Professor at University of Memphis, prolific author and frequent Continuing Education speaker.

Robert Neimeyer, Ph.D.

Finally, I attended a panel on women presidents of APA and the APA Presidential reception hosted by Dr. Suzanne Bennett Johnson, 2012 President of the American Psychological Association.

Suzanne Bennett Johnson, Ph.D. President, APA

Suzanne was an intern and then a post-doctoral fellow when I was a graduate student at University of Florida. We have worked together on the Board of Directors of the Florida Psychological Association over the years. She has had a distinguished career in Health Psychology practice and research, spending many years at U of F and then moving to the Florida State University College of Medicine. It was a special pleasure to attend the APA convention when a career-long colleague and friend was presiding. I’ll bet she had even more fun than we did!

Were you at APA? Do you have memorable convention moments you would like to share? Please do so below.





Electronic Claim Filing for Secondary Insurance

Our technical support and customer service staff regularly discuss questions our customers commonly ask. They often answers these questions in emails—repeatedly. For a long time, we have tried to answer some of these questions in documents to make it easier for our customers to succeed in their jobs. The Document Library page on our web site has always aimed to achieve that goal. This year, we implemented new and additional documents in a blog format on our web site as another way for our customers to get answers to their questions quickly.

Electronic claims filing is one of those areas where questions abound. No matter how many times we answer the same questions, we always need to come up with new and different ways to communicate information that is very familiar to us but not so apparent to our customers. This is the same kind of task psychotherapists and others who work with people in any capacity have to accomplish—coming up with different language and presentation of an idea so it can be heard and understood by the person being addressed.

Our lead technical support rep, Manon Faucher, recently wrote an article about how to file claims for secondary insurance carriers electronically. I have borrowed heavily from her article to address the issues that are crucial in successfully filing electronic claims for secondary insurance payers, assuming that the clearinghouse or site through which you send your electronic claims allows submission of secondaries and the payer to whom you are sending can receive secondary claims electronically.

In order to successfully submit secondary insurance claims, it is essential that you include the information about how the claim was adjudicated by the primary insurer. Doing so requires specific data in certain loops and segments of the 837P. If you are an SOS Software user, you should read Manon’s document. She created detailed instructions with screen shots for our product. If you use a different software product, you will need to find out from your vendor whether you can enter and they can report the necessary information to file the secondary claims.

  • Primary payer– You must be able to indicate the order of liability for payers. Make sure you have the Primary set as such for this claim.
  • Secondary payer– You must be able to designate this payer as Secondary for this claim. You must also be able to enter the “Amount received from other insurance”, information that would go in box 29 on the CMS 1500. This should go into the 2320 loop, segment AMT 02.
  • Verify the Claim Adjustment Reason (CAR) amount– If you have received an Electronic Remittance Advice (ERA) that automatically posted your payment from the Primary payer, you will need to determine that the total of the CARs matches the amount of the date of service Fee minus the payment from the primary insurance. Examples:

Denial – no payment by Primary

Fee for service $200
– Primary insurance did not pay for the service so $0 payment is entered for a Denial
CARs must equal the entire fee, $200.00

Partial Payment and Adjustment

Fee for service $200.00
– Primary insurance paid $120.00 and an adjustment of $30.00 was required from the payer
Amount of your CARs will have to equal to $80.00 ($200-$120)

The information from the CARs must be entered in the appropriate segment in the 2430 loop.

  • Adjudication or payment date: Make sure you have entered the payment date in the appropriate place so it will show up in loop 2330B segment DTP 03.
  • Generate and submit the secondary claim.

If your organization is not yet filing insurance claims electronically, it is certainly a service you should investigate. At some point in the future, it will certainly be required that all claims are filed electronically. In the meantime, it is a major convenience and financial savings for providers and organizations.

Maybe it is time for you to get rid of the paper!

Got any observations, opinions, reservations, cheers about filing claims electronically? Please share in the Comments section below. Thanks for reading!




Mental Health Parity Toolkit

On October 7 the National Council announced the release by The Parity Implementation Coalition of a toolkit aimed at helping consumers of mental health services deal with their insurance companies. The National Council, a member of the Coalition, has made the 60-page booklet available on their web site. This toolkit is aimed at providers, consumers, and their advocates.

I believe many people expected that the implementation of the Wellstone-Domenici Parity Law would be resisted by payers. Now that the final rule for how to implement the law is in place, there are clear procedures to follow…for the insurers, for providers and for the consumers of care.

This new toolkit includes background information on the law, a detailed outline of the claims appeal process, sample requests for medical necessity determination, templates for letters and detailed instructions about how to use everything in the kit. This looks like a tool that every behavioral health organization . . . community-based and private practice . . . should have on hand to share with clients.

Parity Implementation Coalition members include the American Academy of Child and Adolescent Psychiatry (www.aacap.org), the American Psychiatric Association (www.psych.org), the American Society of Addiction Medicine: (http://www.asam.org), the Betty Ford Center: (http://www.bettyfordcenter.org), Hazelden Foundation (http://www.hazelden.org/web/public/publicpolicy.page), Faces and Voices of Recovery (http://www.facesandvoicesofrecovery.org/about/campaigns/equity_main_page.php), Mental Health America (http://takeaction.mentalhealthamerica.net/site/PageServer?pagename=Equity_Campaign_parity_legislation), National Alliance on Mental Illness (http://www.nami.org/Template.cfm?Section=Issue_Spotlights&Template=/TaggedPage/Tag), National Association of Psychiatric Health Systems (http://www.naphs.org/), National Council for Community Behavioral Healthcare (http://www.thenationalcouncil.org/cs/public_policy/resources_and_issues/parity), and Watershed Addiction Treatment Centers (www.thewatershed.com).

I think all these organizations deserve our thanks for working together to create the toolkit. Please see page 4 of the brochure for their acknowledgements of sources and people who were involved in the project.

What experiences have you been having relative to parity in your organization? Does your state have additional requirements that must be followed? Do you see a use for this toolkit by your consumers?

Please share your experiences and other comments below.

Spring Fever Has Always Been Real for Me

Spring has finally arrived in central Florida. It has become warm enough not to need to wear cool weather clothing but cool enough to keep windows and doors open for most of the day. This is the time of year when I want to be outdoors even though the air is full of pollens. I experience a strong need to get my hands in the soil and new plants into the ground or into my hydroponic gardening units…or out riding a bicycle.

The biggest difficulty Spring provides for me is that it is hard for me to stay task-focused. This has been the case since I was a child. I just don’t much feel like being indoors, so working on indoor responsibilities comes much harder. As an adult, work is no exception. It is hard for me to focus on tasks that need to be accomplished. I would much rather be playing….or at least doing different work.

As a result of this year’s Spring fever, it was not difficult to decide that the celebration of Synergistic Office Solutions‘ 25th anniversary should happen at home rather than in a restaurant. It may cost me a bit more work, but it is not my usual work. I get to have a party instead of focusing on the changes I need to make to our web site or some other such task.

Yes, our software company has now been around for 25 years. Seth started doing consulting to other psychologists in 1985. Our billing software for mental health and medical practitioners followed in the next year. Florida psychologists were our first customers, but we started selling nationally in 1988 or 1989. Our electronic clinical record product was released in 1990. We made the transition from full-time practice of psychology to full-time software business in 1992-1993. Sometimes I am sure we jumped from the frying pan into the fire!

The primary benefit of the change from providing services to mental health clients to providing products and services to mental health providers has been that we have met so many wonderful folks who embody in their work their mission to care for others. Behavioral health providers and service organizations are the BEST! We are grateful for the opportunity we have had over the past 25 years to work with so many talented and caring people. Thanks to each and every one of you!

As you can see, my Spring Fever is so bad this year that I could not even write a blog article that would have the usual links to information you could use. It contains nothing about behavioral health electronic medical records or HIPAA or HITECH. Oh well, maybe next week will allow a return to those serious issues.

How do you respond to the appearance of Spring? Are you one of those wonderfully responsible people who can just put your head down and keep on taking care of business? Will you share with me how you do that? Or maybe you are just like me and want to have a party!

Please enter your comment in the box at the bottom of this article. If you don’t see one, double click on the title of the article, then scroll down to the box to make your comment.

Workflow and EMR: How do you do it?

During the past two weeks, I have spent several hours creating process diagrams or flow charts for a customer. After using our billing software and a custom attendance/reporting module we created for them in 2003 but maintaining paper clinical records, they are now implementing a custom Forms module and preparing to implement our behavioral health electronic medical record (EMR) product.

Clearly, understanding their current work flow is essential to assure that the steps we follow to implement the electronic record will cause minimal disruption of their productivity and maintain their confidence in their billing and cash flow. The goal of the CEO and CFO is to seamlessly provide and document services so payment audits do not result in lowered funding; the goal of the clinical staff is to help addicted people recover from their addictions and become productive citizens; and the goal of the billing staff is to assure that services are accurately reported and billed so the agency is paid for services provided.

The end point we plan to reach is that billing will not occur until documentation of the treatment is in place, but getting to this point will be a gradual process. Helping clinical and business office staff understand the job responsibilities, work flow and the anxieties of their colleagues will allow them to work more effectively as part of a team. The team, of course, shares the goals of providing the best clinical services as efficiently as possible and assuring that payment is obtained for those services so they all can continue doing their respective jobs.

While this flow charting was a time-consuming process, it was most instructive. One thing we have learned in almost 25 years in business is that our customers rarely use our products in the way we designed them. . . .and each organization does things differently. This customer was no exception. For us to make assumptions about how the counselors and business specialists in this or any of our customer organizations do their work would be foolish, at best.

A couple of months ago, our business development manager indicated that she gets frequent questions from prospective users wondering how they will integrate an EMR into their current work flow. Should they enter the progress note into the program while the consumer is in their office? If they wait until the client leaves, won’t it take too much time? Trish suggested that we write a blog article on how clinicians utilize our EMR in the course of their work. We decided to ask a couple of our customers to describe their work process so we could get a more accurate idea of how they work.

The answers to our inquiry were very interesting, and different from one another. As could be expected, the work flow of a psychiatrist/psychopharmacologist and that of a psychologist/psychotherapist were quite different. We are grateful to Scott P. Hoopes, M.D. of Meridian, ID and Scott Gale, Ed.D. of Franklin, TN for their input.

We were interested to find that neither Dr. Hoopes nor Dr. Gale enter a progress note while the patient is in the room; that happens after the patient has left. We also learned that neither provider relies upon a staff assistant to enter clinical information; they are both comfortable with a keyboard and prefer typing their own note to the more involved process of dictating, reviewing and correcting transcription, copying the note to the patient file and signing it. Dr. Hoopes does manage prescriptions while the patient is present, including reviewing, creating and sending the prescription to the pharmacy.

We learned that Dr. Gale, in spite of his use of our electronic clinical record since 1992, still scribbles notes and thoughts on paper while the patient is in his office. He scans these notes into electronic storage and shreds the paper. (As a solo provider without support staff, he does everything in his practice.) While he could attach these scanned documents to the patient’s file in the EMR, it is my impression that he considers this brief process note to be his work product. . .the psychotherapy note that HIPAA allows a psychotherapist to keep and store separately and not to release to an insurer. His note in the EMR is the formal record of the service provided. While some recommend against maintaining a separate set of psychotherapy notes, we have found that many of our customers do so. For some, this is the main reason not to move to an EMR. . .they are not sure how they would continue to maintain these psychotherapy notes while also using an electronic record.

Dr. Hoopes’ work flow was developed after time working in a community mental health setting where he was expected to see five patients in an hour. In 1995, not very long after starting his private practice and struggling for a while with paper records, he started using our software for billing, electronic claims filing and clinical records. Eventually, he also added scheduling.

His current work flow allows him to see his schedule at all times. Prior to the arrival of his patient, he brings their record onto the screen and makes a quick review. He duplicates the last progress note into one with today’s date for editing after the patient leaves. In the fifteen minutes he spends with each patient for a medication check, he is able to be engaged with them to determine their progress or lack thereof. Based on the information obtained, he decides to continue or alter their current medication, making any needed adjustments and sending the prescriptions to the pharmacy. He walks the patient out to the receptionist, who electronically schedules their next appointment. He returns to his desk, edits the progress note with today’s status, signs the note, and calls up the record of the next scheduled patient, repeating the process between 20 and 32 times a day.

My guess is that other users of our EMR product and of other products in the marketplace follow both very similar and very different work processes in their organizations. After all, while most of our customers provide behavioral health services, each is different, with varying clinical and business cultures. In every case, to most effectively implement a behavioral health EMR, it is essential to have a clear picture of your pre-EMR work flow and your goal for use of an EMR. Both of these will make it easier to choose and to implement the EMR of your choice.

Please share your experiences with the work flow in your business. Is work flow analysis something you have ever done? If so, what was your motivation? We would also love for you to share your work process experiences with implementing an EMR, if you have done so. What changes were necessary in your work flow to fully utilize the EMR? How successful have you been in that process?

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