Vigor Billing Interface™ for Medisoft®

[Gavin Walker]

Hello, I would like to announce that we have developed an HL7 interface for Medisoft. You might wonder why another interface for Medisoft when there are already several to choose from.

Well, Vigor Billing Interface™ for Medisoft® has these features that you might not find in other Medisoft interfaces.

1. Vigor reads HL7 messages from the EHR and inserts those messages into Medisoft.
The flow of data goes like this: EHR -> generates Detailed Financial Transaction (DFT/P03) HL7 message files -> Vigor generates records into Medisoft

2. The following data flows from the EHR into Medisoft: Patients, Cases, Transactions, Diagnosis Codes, and Insurance Carriers.

3. Vigor runs as a Windows Service. This means you can run it on the server without an extra task tray on one of your user's desktops. You don't have to run a locked desktop on the server. Running as a service is more secure than running as an application on a locked desktop. If the server is rebooted, the service will automatically start again. No more troubleshooting why data stops transferring whenever the server is rebooted.

4. Transaction updates flow from the EHR. If there is an error with the transaction update, then a task is created in Medisoft's Work Administrator for your billing staff to follow up on.

We currently have this working with Cedaron's EHR and Medisoft v15 or v16.

Vigor Billing Interface is a trademark of Creative Software Solutions. Creative Software Solutions is a wholly owned subsidiary of MedTech Medical Management Systems. Medisoft is a registered trademark of McKesson.

[Gavin Walker]

We have made a few enhancements and fixes to Vigor since we released it:

1. Enhanced error reporting:
a) All interface errors are now also reported in the Medisoft Task
Administrator. (Log entries of type=information or warning do not cause this to
happen, only errors.)
b) All tasks created in the Work Administrator start w/the line: "MESSAGE
FROM BILLING INTERFACE". Added date/time to end of this heading line, since
Work Administrator tasks do not include a time.
2. Enhanced facility support:
a) Facility has been added to case-lookup criteria. This means that if the
facility changes, a new case will be created.
b) Facility is now being populated to charge transactions. Previously,
facility was not populated in charge transactions.
3. Patient update enhancements:
Blank fields do not erase fields that have been populated in Medisoft. So
if you populate the birth date in Medisoft, and a message arrives containing no
birth date, no action is taken, where previously the interface had erased the
birth date in Medisoft in this case. This is still a one-way interface:
populated values will always be overwritten with any non-blank values sent
through the interface.

[Gavin Walker]

Version 1.54 was released:

• Fixes related to mappings for Medisoft case field: patient's relationship to Insured:
• Medisoft follows CMS-1500 locator 6 paradigm of, "Patient's Relationship to Insured". Allow for source systems which follow the opposite paradigm such as found in HL/7 standard, "Subscriber's relationship to patient". Implemented the following mapping:
Source System Value populated to Medisoft
Self = Self
Spouse = Spouse
Parent = Child
Other = Other
• A valid concern was raised that the source system (Connect), with the subscriber relationship of "Other", was sending free form text entered by the user. Any value which does not map to Medisoft's enumerated relationship values will populate to Medisoft as "Other". So, "5thcousin" will result in "Other" in Medisoft. For billing purposes, only self, spouse, parent, and other are important, and billing is Medisoft's mission.

[Gavin Walker]

To All VBI Customers,
We have finished testing and documentation.

Version 1.60
Added support for inserting/updating entries in the Medisoft Referring Provider (RP) List (master table).
1. When an RP is present, but no NPI appears in the message,
- an error message is sent to Work Administrator (WA) indicating that an RP is present, but will be ignored because there is no NPI.
2. When an NPI appears in the message, and a RP EXISTS in Medisoft which has matching NPI:
- New values are updated to Medisoft RP record: Last name, First name, middle initial, phone, address, and other IDs (license, DEA, & UPIN are also supported), etc.
3. When an NPI appears in the message, and a RP does NOT exist in Medisoft which has matching NPI:
IF NPI, Last Name, AND First Name are ALL included in the message:
- A new entry is created in the Referring Providers List in Medisoft and populated from the message
IF any one of NPI, Last Name, or First Name are missing in the message:
- No Medisoft entry is made
- An error message is sent to WA describing this problem.

[Sam]

Are you planning on releasing this for more EHRs in the future (e.g. AmazingCharts)?

[Gavin Walker]

At this time we have no plans, but we do have a phone meeting with AmazingCharts scheduled for next month to discuss Vigor Billing Interface for Medisoft. We'll see what develops. At this point the best we have to offer for AmazingCharts is X-Link.

[Gavin Walker]

Release notes:
Version 1.70
• Enhancements
• Added support for 64-bit architecture operating systems (OS).
• Setup programs are now named with either "32" or "64" in the name. Be sure to use the setup program appropriate to your OS. If you have had VBI installed previous to this release, then you are using 32-bit OS.
• Note that 64-bit is only supported on the multi-user version of Medisoft.
• Bug fixes
• Updates to case data updated all cases for a patient instead of the specific case selected. Fixed so that only the selected case is updated. This bug did not affect situations where a new case was being created, only situations where an existing case was being updated.
• Diagnoses descriptions containing an apostrophe caused diagnoses and new case insertion to fail. Fixed to properly handle embedded apostrophes throughout the interface.

[Gavin Walker]

We are distributing this to all VBI customers. This is just an FYI.

Version 1.80
• Authorization Information Enhancements
Authorization information comes to the interface as insurance-specific. In Medisoft, some authorization storage is by case and some is by insurance.
• Authorization # sent from primary insurance:
• Authorization # sent from primary insurance is now part of case selection criteria. So if a case cannot be found for this patient, this combination of insurance 1-3, this facility, and this authorization #, a new case is created.
• Authorization # sent from primary insurance flows to the case "Prior Authorization Number" field on the Miscellaneous tab.
• Authorization # sent from primary insurance also flows to the case "Treatment Authorization" field on the Policy 1 tab. So the primary authorization number flows to two fields on the case. This field is used for UB-04 billing.
• Authorization # sent from secondary insurance flows to the case "Treatment Authorization" field on the Policy 2 tab. This field is used for UB-04 billing.
• Authorization # sent from tertiary insurance flows to the case "Treatment Authorization" field on the Policy 3 tab. This field is used for UB-04 billing.
• Bug fixes
• Transaction deletion/insertion was not updating Medisoft Patient Reference Balance. Fixed.
• The interface was not honoring the Medisoft Program Settings, "Number of Diagnoses" setting. Now, the interface will process the number of diagnoses in this setting. If additional diagnoses are sent, they will be ignored. E.G., if "Number of Diagnoses" is set to 4 and 5 diagnoses are sent, the 5th diagnoses is ignored and only the first 4 are processed. The interface now supports processing for 4 – 8 diagnoses, the valid range for the, "Number of Diagnoses" setting.
• Diagnoses pointers are now set correctly in certain edge cases where they were being set incorrectly:
1. The full set of case diagnoses is copied to each transaction;
2. The pointer corresponding to each case diagnoses is checked if that diagnoses was included in that transaction.
Example: case diagnoses are A,B,C,D,E and this charge has diagnoses B,C. Results: Transaction gets diagnoses A,B,C,D,E and transaction diagnoses pointers 2 and 3 are checked (the rest are unchecked). Note: Without going into details, the previous behavior only caused pointers to be set incorrectly when the # diagnoses sent exceeded the "Number of Diagnoses" setting, so, diagnoses pointers were set incorrectly infrequently.

[Gavin Walker]

In addition to the changes below, we now support gGastro EHR by gMed.

Version 2.0.2
Fixed error "Object reference not set to an instance of an object" when the insured's or guarantor's SSN was omitted.
Version 2.0.1
Pre-release fixes to handling of new fields introduced w/ Medisoft v17.
Version 2.0
• Improved Retrying for Locked Records—This enhancement eliminates the need to resend charges from the EHR to Medisoft when the interface was unable to process charges due to a locking error.
When the interface is unable to bring charges into Medisoft because the patient or case is being edited/viewed in Medisoft, the interface retries 5 times. Previously, after the 5th retry, the message was discarded (moved to an Errors folder) and a message placed in the Task Administrator. It was then necessary to resend the charges from the EHR. This behavior has changed in these ways:

• • All message processing inbound to Medisoft is halted until the lock is resolved (not just the message for the locked patient/case);
  • The message that encounters the locking error is not discarded;
  • Once the lock condition goes away (the patient/case is closed in Medisoft),
  o Normal message processing continues – so the charges that previously would have been discarded are now processed successfully into Medisoft; and
  o The interface resolves (deletes) the locking message from the Task Administrator;

• Multiple Connections—A single install of the interface can now be configured to service multiple connections, each connection can do inbound/outbound between a different practice (database) and file folder, and each connection can be configured with its own behaviors. Each connection must be licensed separately.
• Smarter Matching of New Patients—In cases where two different family members are entered into the EHR with the same SSN, the two different patients in the EHR will correctly come into Medisoft as two different persons. Previously, accidentally using the same SSN for two different persons in the EHR caused the 2nd family member to match the first one in Medisoft.
• Smarter Matching of Physicians—If you have entered physician(s) more than once w/the same NPI, there was a chance that the wrong attending physician would be assigned to a patient/case. The interface now honors the inactive flag on physicians and will only look at the first active physician w/matching NPI to assign a Medisoft physician code to an incoming patient/case.
• Improved Error Messages in Task Administrator:

• • Many message now indicate the specific field which caused a problem;
  • Most messages now indicate the patient's chart # in the header information, so that when you open the task, the patient's chart# and name display in the header area.
  • The interface no longer sets the reminder flag. The reminder flag on a task causes a task to appear in a pop-up list of similarly-flagged tasks when starting Task Administrator. This only caused confusion and added the extra step of having to close this pop-up.
  • Bug fixes
  • Referring Provider phone numbers were not always saved in the correct format. Fixed.
  • Fixed bug in startup message that inserted many periods after the copyright year, "Vigor Billing Interface™ for Medisoft®, version

2.0 ADS90
Copyright Creative Software Solutions, 2010........................................................................ All rights reserved....". You would only have seen this message if you look at the Windows Event Log.
Version 1.81

• • Insurance matching enhancements
  • Insurance company is matched by looking up insurance address in Medisoft to determine the insurance code. As previously, this match ignores dashes and spaces in zip codes and ignores upper/lower case distinctions in all address fields. Address line 2 (street 2) is not considered in the comparison. With this change, periods in address line 1 (street 1), city, and state will now be ignored when making a match. So, previously, if the spelling of address line 1 had changed from "PO Box 123" to "P.O. Box 123", (the same except for the periods after P and O in the 2nd example) the match would fail and the interface would create a (duplicate) insurance in Medisoft, and assign the new insurance to the case. And because insurance is a case-selection criterion, this also means that the interface would create a new case and put the charge transactions on the new case. With this matching enhancement, the matching would have found the original insurance in Medisoft and populated transactions to the same case (so long as other case criteria remained the same: other insurances in the sequence, facility, and authorization number).

[mbpros]

Any update to a possible interface with Amazing Charts? X-Link is terrible...and I know Amazing Charts now offers a basic HL7 interface, but your interface seems like it offers more.

[Gavin Walker]

Hi, we have had a few doctors approach us regarding an interface to AmazingCharts.

Here is what I have found so far:

1. The basic HL7 interface for AmazingCharts is only for the AmazingCharts side of the interface. You will also need an HL7 interface for the Medisoft side of the interface.

2. X-Link is one possible HL7 interface.

3. If you talk to AmazingCharts, they now recommend Communication Manager for the HL7 interface. There are a few issues with Communication Manager a) McKesson will not support the interface for anything besides Practice Partner. b) Demographics will only go from Medisoft to AmazingCharts, not the other way around. Charge transactions can flow from AmazingCharts to Medisoft.

4. Since AmazingCharts already has two interface possibilities for Medisoft, they are not interested in developing yet another interface.

We do have enough information to put together a quote to modify Vigor to work with AmazaingCharts. If you are interested, let me know. Honestly, it will be cheaper for you to go with Communication Manager if you can get past the two major issues I pointed out above.

[mbpros]

Thanks, Gavin. For my situation, Communications Manager is not an option. We host Medisoft for a number of providers and have several Amazing Charts users. These users are hosting AC themselves, but some want us to host it for them. With CM you have to have a separate server per practice. It used to be you could configure multiple practices and multiple EMR connections with CM, but they stopped that with I believe V16 (and I don't want to go the route of Virtual Servers). Plus CM is VERY costly, especially considering you basically have to upgrade each year.

As for X-Link, I think we both know it's only an okay program. I don't have enough clients now to warrant you modifying your Vigor to accomodate AC, but it's good to know it could be a possibility.

Steve

[Gavin Walker]

PS, Vigor billing interface runs as a service and it will process multiple practices at once. Depending on the number of practices you are talking about, it may be cost effective for us to develop the AmazingCharts -> Meidsoft interface for you.

[mbpros]

Right now I only have one practice but that's because we haven't had an interface to offer. If you read the AC Forum, many AC users hate the X-Link interface. I also have to decide if it's cost effective for me for one reason. Unlike many EMRs like E-Z Notes that we offer, AC requires separate servers per practice...which means I will have to go out and get a new server and have VMs configured for each practice and have AC installed on each VM....So, I'm not sure it's worth it or not. If I would go ahead and do it...and I could get at least 4 practices, give me an idea of what it would cost for Vigor.

Steve

[mbpros]

Hey, Gavin: A few questions regarding a possible interface between Vigor and Amazing Charts.

First, some docs have multiple cases in Medisoft (for example, one for office visits and one for hospital visits). How would you handle with the interface the provider determining which case to send claims to? One thing I don't like with X-Link is you don't have that option (I think it's either last open case...or you can choose an option to always create a new case, which is ridiculous).

Second, what is the provider charts a patient in AC, but the patient is not yet in Medisoft? Since we're a billing service, there will be times when a new patient comes in and the doc enters the patient in AC, but the patient is not yet in Medisoft. Is there some type of "holding" option in Vigor so once we set up the patient in Medisoft we could then have the charges go from AC into Medisoft?

Steve