Creating the Electronic Office:
An Overview of O&P Business Software, Part 2

By Deborah Conn

Last month, the O&P Almanac began a two-part look at business software intended for the O&P market. Designed for such functions as scheduling, inventory, billing, claims submission and reporting, these programs aim to replace the paper in your office with electronic files, saving time and money.

This issue features practice-management software from four companies, along with CodingPro, an electronic reference program that can be used on its own or as an adjunct to a more comprehensive system.

These programs run the gamut. There are those designed specifically and solely for the O&P market (The O&P Hub and CodingPro), those developed by companies that specialize in another area of health care (eCeno/ MedEvolve and OrthoPro Complete), and a program designed for physicians that is nevertheless used by a number of O&P practices (Medical Office Software).

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.

The O&P Hub

The O&P Hub was developed by Gez Bowman, CO, in 2000. “I started it because there didn’t seem to be anything else out there that covered the needs of the O&P office, particularly the paperwork needs of the practitioner,” he said. “Before I entered O&P I was a programmer, so I decided to design an application that would address the unique needs of the O&P office.”

The Hub’s name, explained Bowman, reflects its intended purpose: to be the center of the O&P practice. “Everything is done on the computer through the Hub,” he said.

“Most medical software is built for a physician’s practice. O&P has very specific requirements, so in addition to patient registration, scheduling, reporting, purchasing and accounting, we include functions such as product design and manufacturing and product and service tracking that are unique to O&P.”

Suzanne Eckhardt, CP, is the owner and president of Action Orthopedic Co. in Los Angeles. Her practice has been using The O&P Hub for the past three years. “Before we got the Hub, I used to have a desk piled high with patient files,” she said. “Even though we used an electronic billing program, I spent half my time writing prescriptions, evaluation letters, doing all kinds of paperwork.

“Now, once I’ve coded a procedure, I can shoot off a prescription, send the code to insurance for approval, create estimates, invoices—with the push of one button, I can use that same information a dozen different ways without having to enter it over and over again. Now I can spend 80 to 90 percent of my time with patients, instead of 50 percent.”

The Hub is a completely integrated program, although a less comprehensive version, O&P Hub Lite, is available. “The Lite version is actually the full program with the EDI invoicing and electronic medical recordkeeping functions disabled,” said Bowman. “When clients decide they want to add features, it’s easy to upgrade the system.”

According to Bowman, The O&P Hub can be used in single- or multiple-office settings. It can be set up to accommodate central-office billing and collections or administration by separate branches.

Bowman highlighted several features of The O&P Hub:

Electronic charts. All notes are done electronically, either by direct entry or by attaching documents, pictures, or video. The system supports digital signatures, and insurance cards and patient-signed permission and authorization forms can be scanned in. Users can access the Hub remotely from laptop computers. 

Purchasing. The O&P Hub has a database of approximately 2,000 products, with a feature that enables vendors to add items. Users can send their orders online, and the system generates an electronic or faxed purchase order for the vendor. The purchasing system is fully integrated with an inventory control function. 

“While I am in the patient’s file, I can order something just by going to that menu,” said Eckhardt. “I can create work orders internally for our central fabrication facility or send them off to vendors.

“You can easily group the vendor orders for any particular service, so you automatically know what you spent for prosthesis components. That has helped a lot with product selection. We always know what we spent on a patient and if there is a profit.”

Data acquisition. The O&P Hub is about to release a proprietary patent-pending data acquisition program for the LA scoliosis brace. The company is also developing similar programs for the TLSO spinal brace and AK and BK prostheses.

Integrated manufacturing workflow. This work-in-progress function creates an internal fabrication order and assigns it to technicians. Each step is logged until the device is completed and ready to be fitted on the patient.

“Every day techs enter their progress, so I know the status of the device and if it’s going to be ready when I need it,” said Eckhardt.

Accounting. The O&P Hub uses integrated, proprietary accounting software. “The data has to be entered just once,” said Bowman. The full-featured program includes accounts receivable, cash management, bookkeeping, and financial reports.

“We pull financial reports about every three months,” said Eckhardt. “If our accounts receivable are behind, we can ask for different aging reports to get the information we need.”

Bowman estimated that, while the program can be up and running very quickly, it would take a month or more to familiarize everyone in a practice with the system. Training is done over the telephone, although Bowman expects an interactive online demo to be completed by early summer.

OrthoPro Complete

OrthoPro Complete is a product of Artsco Inc. (Assistive and Rehabilitative Technologies Solutions Co.), based in Turtle Creek, Pa. Artsco, which produces software for the rehabilitation field, recently expanded into the O&P market.

“We had customers who were in both rehab and O&P and wanted us to offer an O&P version,” explained Mark Malagodi, president.

The program is an integrated system. It is meant to be accessed over the Internet, although clients can temporarily use the system without an Internet connection and synchronize at a later time.

“Whenever the software changes, we can automatically update people through the Web and it will land on their computer,” said Malagodi.

Some of the features of OrthoPro Complete include:

Customized forms. The program offers a number of stock forms, but Artsco can replicate any form electronically, including O&P measurement and evaluation forms, state Medicaid forms and business tracking reports.

Purchasing. Users can select equipment from the CMS code list (including A, K and L codes) directly from manufacturers’ price lists (including such companies as PEL Supply Co., SPS, Otto Bock HealthCare, and Fillauer Inc.), or add their own custom manufacturers. An optional purchase order module tracks stock and orders.

Billing. Once the codes are selected, the system can send bills electronically or print to a Center for Medicare and Medicaid Services 1500 claim form. “This can be tracked on the system,” said Malagodi.

The software can produce financial reports, such as cash received, aging reports, and sales reports. According to Malagodi, an interface with Intuit’s QuickBooks is being developed.

In addition, said Malagodi, “OrthoPro Complete can launch Microsoft Word to create a letter of medical necessity for a patient, and organize patient files, such as pictures, scans of claim forms, etc., under a patient’s folder.

“The system also has the capability of creating ‘SuperCodes’ to quickly prescribe a set of codes to a patient.”

Medical Office Software

Medical Office Software Inc., or MOS, originally Mom and Pop Software, was developed in the mid-1980s. While intended for the physician’s office, the software is used by a number of O&P facilities.

According to John Paull, director of sales and marketing, the company has “experience in configuring the system to meet the needs of the O&P practitioner. We know how to make it run properly in each office.”

MOS is an integrated application that includes scheduling, practice management, billing, insurance claims, custom reporting, certificates of medical necessity and inventory management.

Darlene Baker, practice manager for Bio-Tech Prosthetics and Orthotics of Durham, N.C., has been using MOS for the past five years, and has recently transitioned to an upgraded version.

She noted that her office was not quite ready for paperless record- keeping, and MOS’s features and price made it an attractive choice. “It’s a user-friendly system,” she pointed out. “I was able to train a part-time employee to enter patient demographics in about seven minutes.

“We do all our billing and patient information through the system,” Baker continued. “MOS is really useful for running reports and graphs. We can do searches using different criteria, so I can pull physician referral reports, [Health Care Common Procedure Code] reports, diagnosis reports, and others.

“The program lets me create monthly summary spreadsheets that I send to our accountant. On the accounts receivable side, I can print aging reports and keep up with any problems with payers.”

Paull highlighted these aspects of the program:

Customization and configuration. “We can do conversions from most other software,” he said. “A lot of what we do is tweaking the program to accommodate what each individual office needs.”

Paull emphasized the company’s software support. “The true test of a company is how it deals with problems. This is not an out-of-the-box product where you have to do it one way. We’ll work with clients to determine what they need.”

Scalability. MOS can be adapted for single-practitioner offices or for large, multi-office practices.

Affordability. “MOS is in the low-to-medium price range,” said Paull. “We are definitely cost competitive in the practice management market.”

eCeno/MedEvolve

eCeno practice management software is produced by MedEvolve, based in Little Rock, Ark. The company began as a revenue management and billing service more 20 years ago, and in the late 1980s it moved into creating software for physicians’ offices.

MedEvolve expanded its practice management software into the O&P arena about five years ago when it modified parts of eCeno for Snell Prosthetic & Orthotic Laboratory in Little Rock, Ark.

eCeno includes patient account information, scheduling, transaction processing, electronic claims, financial and billing management, reporting, document management and managed care administration.

It does not have the capability for creating electronic medical records (EMRs), although it can interface with an EMR system. Documents are presented as a series of templates into which office staff enter information.

“Many practices don’t want EMR,” noted Casey Honeycutt, director of professional services for MedEvolve. “It’s very expensive and it needs a sophisticated skill set.”

The system features automated paperless collection. Based on criteria selected by the practice, eCeno will use outstanding amounts, age of accounts, and account type to automatically generate collection letters and a workflow sheet for office staff to manage outstanding accounts.

“Our comprehensive reporting is especially important for O&P practitioners, since so much of their business is funded by Medicare,” said Honeycutt. “Medicare tends to hold claims to do additional research or audits. Practices need the ability to pinpoint which claims are outstanding.”

The system is built on a Microsoft SQL database, which means it can easily interface with other systems and products.

Rick Fleetwood, general manager, COO, and CFO of Snell Prosthetic & Orthotic Laboratory, said “I cannot say enough good things about them.” Fleetwood had purchased another software program that turned out to be a poor fit for his business. “I knew after three months that it wasn’t working, but I kept trying for another six. It was an expensive mistake, and I was determined not to repeat it,” he said.

Fleetwood began his in-depth research into alternate software vendors with an attitude. “When I talked with MedEvolve, I was fairly hostile, skeptical, and demanding,” he said. “I was not an easy person to please, but they really did please us.”

Fleetwood gives eCeno high marks for its ease of use. “Information that took my people forever to enter can now be done in one window. Our nine offices across the state have a secure system, but every office can enter updates so that they don’t have to go through headquarters.”

eCeno’s proprietary accounting program was also a positive feature for Fleetwood. “The integrated accounting system is important to me. I can find out right now what we’ve done today or last month or last year. With our old software, if I ran a report two different ways, I’d get two different figures. With MedEvolve, no matter how I run the report, the results are consistent.”

Fleetwood noted that offices can scan insurance cards into the system. MedEvolve recently added photo storage capabilities, a feature he appreciates. “We can take a picture of a leg or a foot and show the insurer why a custom device was necessary,” he explained. “Now we can integrate pictures so insurers can actually see the justification.”

eCeno is not intended to be specifically directed to O&P. “Our product is multi-specialty,” said Honeycutt. “We have carved out a niche and can handle O&P billings, but we are a comprehensive solution for O&P practices as well as other health care specialties.”

Fleetwood said, “The O&P fit was just fine. We were drowning, and MedEvolve literally saved our company.”

CodingPro

Unlike the other software reviewed in this article, CodingPro is not an office management program. It is, rather, a reference program that provides information to help practitioners accurately code and build claims to Medicare and other insurers.

CodingPro was first developed in the mid 1990s by the American Orthotic and Prosthetic Association (AOPA) in response to member requests for an electronic version of AOPA’s illustrated, printed guide to coding.

“The program began with the basic features of the Illustrated Guide,” explained Joe McTernan, AOPA’s assistant director of reimbursement services. “It included all the L codes and official Medicare descriptors, a graphic representation of each one, and an AOPA interpretation of each code. We have added more features, and CodingPro now goes well beyond the scope of the Illustrated Guide.”

Some of these features include:

Fee schedules. The program includes Medicare fee schedules for all 50 states. Users can select and maintain as many as 14 different schedules, including customized schedules that reflect negotiated rates with particular carriers.

“If an insurance company provides you with a file of its fee schedule in Microsoft Excel or another compatible format, you can import that into the program as well,” said McTernan. “You can also import your company’s usual and customary fee schedule, either manually, or electronically if it is a compatible format.”

Medical justification. CodingPro includes pre-loaded medical justification for the 20 most utilized L codes. For other codes, the program provides space for users to enter and save their own information for medical justification.

Search function. The L code database is searchable by code and term, and the search function can be refined for faster results. “Users can tell the system to show only codes that, for example, deal with lower-limb prostheses or AFOs,” said McTernan.

“This allows them to run faster, more efficient searches. Then they can drill down to six or seven levels of detail.”

Split window. This feature allows users to look at two codes side by side. Veronica Norris, administrative assistant in the Pueblo, Colo., office of Orthotic Prosthetic Solutions, said “When the practitioner is trying to determine which code to use, it’s easy to compare two codes at the same time. The illustrations are also very helpful in identifying the right code, since the descriptions often sound similar.”

Prescriptions. CodingPro will print prescriptions based on the codes selected. “This is a new feature in 2006,” said McTernan. “Users have been asking us for years to give them the ability to generate a prescription out of CodingPro.”

Because the prescription can be exported to Microsoft Word, users have an electronic document that they can e-mail to physicians for their signature. The system also creates supporting documents for claims submissions, which can be printed or saved in Microsoft Word.

Many offices use CodingPro alongside their office management software. Dennis Acton, information technology manager for New England Brace Co. in Hooksett, N.H., realized that CodingPro could be integrated into Orthotic Prosthetic Software, or O.P.S. (see the May O&P Almanac for an overview of O.P.S.).

“It’s just another tab,” he said, “so when we are looking at L codes, we can pull up CodingPro directly from the O.P.S. application. It’s very handy having it right there.”

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