By Deborah Conn

While not impossible, it is difficult to find an O&P facility that is completely computer-free, relying solely on paper for patient schedules, clinical notes, purchasing, billing and collections.
 
Yet many practices limit their computer use to one or two functions or try to adapt software designed for the general business or physician medical market to their O&P organization.

Software designed specifically for O&P has been around for more than a decade, but recent years have seen an increase in the number of companies producing O&P-specific software–not to mention a far greater sophistication and range of capabilities in these programs.

Such software recognizes the unique clinical and financial aspects of the orthotists/prosthetists’ practice, from measurement forms to work-in-progress features to support for L and K codes.

Over the next two months, the O&P Almanac is taking a brief look at nine software products developed for the O&P market. These overviews are just that—an introduction to programs that are far more complex and have many more features than can be covered in these pages.

If you are considering implementing new software in your own facility, be sure to delve deeply and talk to more than one supplier (see “Top Questions to Ask a Software Vendor,” sidebar).

Editor’s note: AOPA does not recommend or endorse any of the following products. This article provides an overview, not a comprehensive analysis. AOPA encourages you to decide what software is best for your office based on your particular needs after a thorough review of all available products.

MedFlex

MedFlex, based in Lafayette, Ind., was started for the patient care division of Becker Orthopedic in 1988. “This system was written for O&P from the very start,” said MedFlex President John Mason.

According to Mason, MedFlex’s biggest advantage is that it is a completely integrated system. The single application encompasses the complete spectrum of O&P functions, including patient management, billing/receivables/collections, inventory, purchasing, monitoring work in process, marketing, keeping a general ledger, accounts payable and monitoring staff productivity. As a result, information never has to be entered more than once.

Jessica Sager is the office administrator for McCalls Orthotic and Prosthetic Laboratory in St. Petersburg, Fla., a single-practitioner facility. She has been using MedFlex for about a year. She is responsible for all office functions “from the time the phone rings till payment is collected,” and found it easy to transition into the program.

“Because of our size, cost was a major factor when we were searching for software,” she said. “MedFlex is geared for us but it will allow us to expand infinitely.” Although Sager used online and telephone-based training to learn the software, on-site training is also an option.

Some of the highlights of MedFlex include:

Patient registration. “This is a subtle, but very important feature,” said Mason. “It allows us to create separate records when a patient comes to us for different reasons, such as a work-related incident and then a car accident.

“Each event might have a different referral source, insurance carrier and diagnosis code, which can create a tracking nightmare. Normally, you would have to create additional entries for a patient or replace prior information.

“But with MedFlex, each patient has a single master record with a unique and permanent identification number. Then we create a registration for each event, and multiple registrations all point back to the primary patient record.”

Financial reports. MedFlex’s integration of the general ledger allows users to answer simple questions such as “What is my profit and loss?” All reports are immediately available with no batch processing. “We don’t need to archive anything. We have clients with more than 15 years of information available for reporting,” said Mason.

Flexibility of data entry and retrieval. Practitioners and staff members can type in information, cut and paste, or scan documents, photos, or videos into the patient record. Practitioners can also use Internet-enabled cell phones or PDAs to check their schedules and make new appointments.

Work in progress. In this section of the software, practitioners can set up steps for each job. The system keeps track of what parts should be ordered and when billing should occur.

Mason noted, “You can assign the parts you want for the job, and the system will print parts lists to pull for inventory in stock and consolidated purchase orders for parts you don’t keep in stock.” Money paid toward open jobs goes to refundable deposits, not sales, until the job is delivered.

Auto-post. MedFlex is beta-testing a new feature that automatically posts payments to the general ledger. Monica Ferguson, billing office manager at Orthotic and Prosthetic Lab in St. Louis, has been testing the system in her office.

“When I came here, we had to hand post every payment,” she said. “With this system, we use a local clearinghouse, which works with the insurance carriers.”

The clearinghouse pulls the electronic remittance advices (ERAs) or electronic remittance notices (ERNs)—two names for the electronic form of insurance carriers’ explanation of benefits (EOB).

In the past, an electronic payment would arrive, but the explanation of benefits for that payment might take several weeks to appear, and then the billing manager would have to enter the payment manually.

“Now I download a file from the clearinghouse and load it onto our MedFlex server. I tell it where to find the file and where I want it posted, and it does it,” explained Ferguson. “We can apply $40,000 worth of EOBs in 10 minutes—a job that used to take a couple of hours.”

Mason expects auto-post to be generally available within three months.

Integration with outside entities. MedFlex has integrated its programs with a number of companies to create additional services. For example, working with Televox in Mobile, Ala., MedFlex can use the data in its patient scheduler to produce automated telephone reminders for patients.

MedFlex has recently integrated catalogs from PEL Supply Co., Cleveland, and Cascade Orthopedic Supply Inc, Chico, Calif., for electronic ordering. MedFlex will be working with other distributors as well.

“We consider MedFlex a total solution for O&P offices,” said Mason. “From patient and clinical management to back-end office functions, to marketing and reporting, MedFlex is a powerful, completely integrated system.”

OPIE

OPIE, or the Orthotic and Prosthetic Information Expert, is practice management software produced by oandp.com, Gainesville, Fla. The company’s founder, Paul Prusakowski, CPO, developed OPIE because he wanted software that was “practitioner-centered, that followed the workflow of the practitioner throughout the day.”

According to Prusakowski, the system is “at its core an electronic medical records system. But at a higher level, it is a workflow management system that incorporates patient notes as one small piece of the practitioner’s extensive work processes and documentation requirements.”

For Barry Jones, CPO, president and co-owner of Brownfield’s Prosthetic and Orthotic Technologies in Boise, Idaho, OPIE ensures that procedures occur in an orderly and timely manner.

“I like how it enforces responsibility,” he says. “It establishes a clear line of communication and ensures that each step happens in the proper order. Since we started using OPIE a year and a half ago, we have become more productive.”

“When a patient comes in, the receptionist enters all the appropriate information and scans in ID cards, prescriptions, signatures, [and] HIPAA authorizations,” explains Prusakowski.

OPIE creates all the documents required for each patient, like authorization forms and patient education sheets. Once patients sign the forms, the administrator scans the documents back in to the computer so that everything is stored in the system.

The practitioner uses the software’s evaluation and measurement forms and can select and order components using an integrated purchasing management system called OPIE Lite (below).

“After that, the practitioner initiates the fabrication work order and assigns it to the appropriate technician, who will enter updates on the status of fabrication as it occurs,” says Prusakowski.
O&P1 in Waterloo, Iowa, is a central fabrication facility integrated into OPIE. Practitioners can send all information from a patient’s chart directly to O&P1 to have a device fabricated. Integration with other central fabrication facilities is planned.

Seeking a paperless office
“With this software, the practitioner never needs to touch patient charts,” says Prusakowski. “He or she types or dictates patient notes into the system or uses templates, and then can digitally sign them. The system completely integrates all aspects of clinical documentation.

“And while the practitioner is seeing the patient, the administrative staff can simultaneously begin the process of getting insurance authorizations and generating all Medicare-required documentation, including detailed prescriptions, delivery forms, estimates—and doing it all electronically.

“The key point is that there is never double entry of codes. Once the practitioner selects the appropriate
L-codes, the rest is automated. And while all this is going on, the technical staff is initiating fabrication.”

OPIE Lite

This Web-based purchasing management tool can be used alone or incorporated into the full OPIE Software Suite.

“OPIE Lite eliminates the paper process from managing ordering, receiving and tracking of supplies,” notes Prusakowski. “Practitioners can build ‘favorites’ lists and track what is bought.

“Reports can show purchases by orthotics vs. prosthetics, by office, by patient [or] by shipping method. It allows a multi-office practice to centralize purchasing processes and reduces duplication of staff.”

OPIE Lite is integrated with a number of O&P suppliers, allowing practitioners to place orders directly from the software.

Integrated suppliers include College Park Industries Inc., Fraser, Mich.; Kingsley Manufacturing Co., Costa Mesa, Calif.; Prosthetic Research Specialists Inc., Bushnell, Fla.; Ohio Willow Wood, Sterling, Ohio; Endolite, Centerville, Ohio; and O&P1, Waterloo, Iowa, with others to be added soon.

Barry Jones feels, “The beauty of OPIE Lite is that you have rapid access to catalogs and ordering information. We place many orders with the patient in the room with us.

“You can create a purchase order and have your central ordering office purchase that item and verify the order.

“Or if you are ordering from a supplier that is integrated with OPIE Lite, you can configure the products from their catalog and submit directly to their purchasing system.

“Then the process is seamless—the order goes from your PC to their inventory. The order is then permanently stored in the patient’s OPIE file for easy access and repeatability.”

Billing and collections
OPIE is beta-testing a new billing and collections module of the suite, which, when it is released later this year, will be a free upgrade to existing OPIE Suite users and incorporated into the suite for new users.

This program uses data already available in the practice management suite to automatically fill out claim information and track collections. Like the suite itself, the billing program relies on a task-driven system to minimize delays and provide accountability.

“The process of getting paid for your services has become far more cumbersome in recent years,” says Prusakowski. “OPIE Billing & Collections is designed to create maximum efficiency in today’s reimbursement environment, and we are very excited about the innovations that we have made in this area.”

Practitioner-centric software
Prusakowski believes that what differentiates OPIE from other O&P software is that it was designed with the practitioner as the driving force and primary beneficiary of the software.

“The practitioner is the most expensive resource a practice has,” he says. “We needed to streamline the process, minimize paperwork and provide tools to make the practitioner’s job less burdensome.”

MedePresence

MedePresence practice management software was first developed for M&M Orthotics & Prosthetics Centers in Las Vegas. Paul Laria, director of orthotics for M&M, and Jenefer Edelen, M&M’s billing specialist, were instrumental in developing clinical and financial systems for the program.

Kris Madsen is the owner of M&M, and her husband, David Dugan, founded MedePresence in 2002 and have since expanded the software to encompass other medical specialties.

What sets MedePresence apart, according to Mark McNeill, vice president of marketing and sales, is that “MedePresence is the only solutions provider that not only offers a customized EMR and practice management system for the O&P market, but also one that offers value-added business services. We offer a total package, a soup-to-nuts solution for the O&P practitioner.”

Additional offerings include billing and collections, insurance authorizations, verification and explanation of benefits and chart editing and transcription. MedePresence also provides marketing creative services, including Web site development, and the ability to create brochures and business cards.

MedePresence consists of a full complement of patient, clinical and administrative management tools, including patient scheduling and registration, electronic medical records, billing and financial management.

Roy Riding, CO, is owner of Red River Orthotic Specialists in Shreveport, La. Riding recently established his business after 10 years as director of O&P at the Shriners Hospital for Children in Shreveport.

He has been using MedePresence software and billing services since August 2005. “We had used electronic recordkeeping at Shriners, so I found the transition fairly easy,” he notes.

“And once the initial setup is done, it’s much less expensive than hiring billing personnel. I like that everything is electronic; it makes us automatically HIPAA compliant.” Riding has used MedePresence marketing services as well, both for creating brochures and developing a Web site.

McNeill highlighted several features of the MedePresence system:
Expedited billing. According to McNeill, many practices are able to bill patients for their share of the cost before they even leave the office, as a result of MedePresence’s insurance authorization service and Quick Bill, its proprietary billing program built into the software.

As the practitioner works with the patient, he or she enters information into the system, which is automatically sent to the front office or billing manager for processing.

The software calculates what percentage of the bill will be assigned to the insurer and how much is the patient’s personal responsibility, generates an invoice and, once paid, a receipt.

Digital tablets. MedePresence generates authorization and compliance forms for patients, who can digitally sign the documents using an electronic tablet. Not only does this eliminate the need for paper, it stores the information securely and makes it easily accessible in the event of an audit.

Practitioners can also use electronic pen tablets for making clinical notes, as well as the traditional keyboard. Some practitioners dictate notes to create audio files, which are then transcribed and entered into the patient record.

Patient registration options. MedePresence offers several ways for patients to register. In addition
to traditional paper registration, patients can use a wireless pen tablet, which electronically captures the information for immediate input into the system.

Riding says, “If you do clinics or hospital visits, it’s really convenient to register patients with the pen tablet and you don’t have to carry around a lot of paperwork.”

Patients can also register from home using the Internet, which saves time and inconvenience on the initial visit. McNeill says, “We focus on obtaining accurate demographic and insurance information so that claims can be processed more quickly and with fewer denials.”

Auto Notes. This feature, exclusive to MedePresence, helps practitioners construct various sections of progress notes by creating full sentences and paragraphs based on information entered by the patient and from the physical exam. This both saves time and ensures that documentation is complete.

MedePresence also offers the Progress Notes Composer Tool. With a single click, practitioners can compose a patient’s entire progress note in a format that can be used for clinical correspondence and insurance claims. Notes can be e-mailed or printed as needed.

Exam templates. Based on the patient’s diagnosis, MedePresence
displays templates for orthotists and prosthetists to record measurements and other data. A screen for work in progress displays the status of each task, showing what has been completed and what remains to be done.

Financial Dashboard. This screen allows practice managers to access and analyze financial information, from the status of a single payment to total revenues by insurance company, referring physician or other sources.

A modular system
MedePresence offers a number of options for the O&P practice, including an introductory package that includes scheduling, registration and Quick Bill financials.

“We can always add the exam templates when the practitioner is ready for them,” explains McNeill. “It streamlines the process without forcing practitioners to learn a whole new system.”

Practitioners can also buy software separately from such additional services as billing and financial management, insurance authorizations and verification and explanation of benefits, although McNeill believes that practices will realize the greatest benefit from a more inclusive package.

He says, “By providing billing services and doing insurance authorizations for our customers, we can remove a heavy administrative burden from them, help them reduce their costs and allow practitioners to focus more on their patients.”

O.P.S.

O.P.S., or Orthotic Prosthetic Software, is a product of Futura International Inc., developed in 1994 by Futura’s president, Terry Long. Long had been a consultant for other software companies and noted the need for a product to serve the O&P industry.

She describes O.P.S. as a “robust program” that provides detailed management of an O&P practice from basic billing needs to detailed job cost tracking and work-in-progress functions. It is an integrated application that, says Long, “truly takes the client into a paperless environment.”

Gregg Fischer, an information technology consultant for C.H. Martin Co. Orthotics and Prosthetics, Atlanta, Ga., selected and helped implement their new software system.

After some research, he selected O.P.S. because, he says, “it was the only package at the price level we could afford that was completely Microsoft Windows-based and -driven.” That was important to
Fischer because it meant the system could interface easily with other programs and companies.

One of O.P.S.’s most important features for Fischer is its upcoming release of a Microsoft SQL version. SQL is a database platform that is standard throughout the corporate world.

“This is hugely important from the IT perspective,” explains Fischer. “It will allow anyone who uses the program to manipulate data and integrate with other systems and products.”

New England Brace Co., based in Hooksett, N.H., has been using O.P.S. since January 2005. “One reason we chose O.P.S. was for compliance,” says General Manager Karen Acton, PT, CO.

“Now we have the ability to make sure all of our documentation is per Medicare standards and everything is compliant before we bill it out. It has been a huge help. We also make extensive use of its reporting capabilities, and we’ve developed a number of custom reports with Futura’s help.”

Long outlined several additional important features of O.P.S.:

Integration with Microsoft products and Intuit’s QuickBooks. O.P.S. integrates with Windows programs such as Microsoft Word and Excel. And rather than using a proprietary accounting system, O.P.S. integrates with Microsoft QuickBooks Pro, Premier and Enterprise.

“Without the Futura software, so many P&O facilities don’t have the capability to integrate with an accounting package,” says Long. “QuickBooks is the preferred, off-the-shelf accounting application.”
“This gives you a full, feature-rich accounting system with standard, open architecture,” says Fischer. “If something happens, you don’t want to be stuck in a company’s proprietary software. QuickBooks is an easy standard that lots of people can get into, and the cost is also excellent.”

Real-time wireless access. Practitioners can use PDAs, including BlackBerrys, to access the system. O.P.S. supports automated phone retrieval and call messages that tie into a feature Futura calls The Navigator, an Outlook-like application that includes schedules and tasks.

In addition, practitioners can use tablets or laptops in the field, and the system supports digital signatures entered on tablets or electronic signature pads. The system also supports scanning, storing images and creating portable document format (PDF) files.

Job tracking and work-in-progress status. “These capabilities are very important for P&O,” says Long. “Work-in-progress is a standard feature for our application.

“The practitioner can deploy account statuses and can have multiple pending items, such as waiting for a prescription or back-ordered components. The system reminds them of these outstanding services to be completed.”

ASP hosting. As an option for its clients, Futura provides application server provider (ASP) hosting services to a number of practices that prefer not to maintain their own computer networks.

All software and data reside on Futura’s servers, and users access the network over the Internet, using a dial-up or broadband connection. Programs appear to be running from the clients’ own computers, but responsibility for the network belongs to Futura.

“I can only say that in the day-to-day craziness of the office, this makes a lot of sense,” says Long. “With us hosting, clients are guaranteed 24/7 access, backups, security and system maintenance.

“It’s a huge cost savings to practitioners, not only for new startups, but for large-scale practices that don’t want to invest in hardware and IT staff.”

Purchasing capabilities. “From within the O.P.S. application, clients can launch a vendor’s Web site or catalog for the purpose of ordering or purchasing inventory and other items,” notes Long. “We also support PDF images from vendors in their product inventory file.”

Dennis Acton, network administrator for New England Brace Company, is a fan of the program. He says, “Our pre-Futura days seem like the dark ages now that we have so much control over our the flow, use and analysis of data.

“Overall, our return on investment with Futura was the fastest I’ve ever seen in my 20 years in the high-tech business.” Karen Acton agrees: “Within a year, the software paid for itself.”

What to Ask Software Vendors Finding the right software for your facility can depend a lot on the kinds of questions you ask the vendor—and who does the asking. Gregg Fischer of C.H. Martin O&P asked everyone in the company–owners, practitioners, billing specialists and technicians—to come up with their own lists of questions, focusing on features that were important to their area of operation. These are some questions you might ask. Of course, “right” answers will depend on your practice’s individual needs. How is your system specific to O&P? Do the developers have O&P experience or credentials? Is the system a single, integrated application, or does it have modules that can be purchased separately? Will it accommodate our needs as we grow? Is the system better for single-office practices, or will it accommodate multiple offices? What does the price include? Updates and upgrades? Training? Maintenance and support? Additional services? If certain services are not included, how much do they cost? How mobile is the system? Can I use laptops or PDAs to access it? What are the system’s capabilities in terms of electronic claims submission; how many payers does it support? Is it HIPAA compliant? Have the DMERCs approved claims submissions from this system? What is the learning curve? If we are changing systems, how will you handle the transition? What kind of technical support and training do you provide? Is it on-site, via telephone, or online? When is technical support available? Once you’ve narrowed down your choices, ask for references. Call other O&P facilities and learn about their experience with the software and services offered by each vendor. Rick Fleetwood, general manager, COO, and CFO of Snell Prosthetic & Orthotic Laboratory in Little Rock, Ark., urges prospective buyers to make an on-site visit to another practice that uses the software to see it in action. Selecting the wrong company can cost your business significant time and money, so it pays to research providers thoroughly.

Next month: The O&P Almanac takes a look at the O&P Hub, OrthoPro Complete, Medical Office Software, MedEvolve and Coding Pro.

Deborah Conn is a freelance writer based in Falls Church, Va.