zymed aps · 2013. 4. 3. · maintained and automatically updated on a statis-tic screen. there is...

ZyMedPractice Management Solutions

Featuring

ZyMed APS

The Automated Posting System

&

Managed Care Control

Referral and Encounter Tracking System

© 2001 Auditron Electronics Corp � All rights reserved

ZyMed: Base Package OverviewOverview of some of the programs included with the base package such as data entry, electronic patientcharts, electronic data interchange, managed care control, code management, recalls and reports.

Claim Management TechniquesAccount Receivable management centers around good claim management. Patient and insurance carrierbilling, payment posting, tracking and reporting are just some of the functions included in the ZyMed BasePackage.

Managed Care ControlEliminate manual tracking of referrals. Enter encounter information with ease. Referral information integrateswith service entry and the appointment scheduler. Managed care control is included in the ZyMed BasePackage.

ReportsA major part of a software system's strength is the reporting functions. Report generating capabilities are in-cluded in the ZyMed Base Package.

Electronic Data InterchangeElectronic Data Interchange (EDI) modules offer the ability to transmit claims electronically, perform direct in-quiries, connect to hospital databases, and transfer/retrieve data for communications and updating. EDI isthe future of healthcare and is included in the ZyMed Base Package.

Automated Posting SystemThe dream of office personnel and Providers alike, the Automated Posting System (APS) is offered as an op-tion to the ZyMed Base Package. Using ZyMed APS, a 10 page EOB can post accurately in a few seconds!

Appointment CalendarFast, flexible and efficient, the electronic Appointment Calendar integrates into the ZyMed Base Package.

Auditron Electronics Corporate ProfileThe history and operating philosophies of Auditron, committed and dedicated to the ongoing developmentand support of an outstanding software product.

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Contents

The primary reason for purchasing a practicemanagement system is to control cash flow.For maximum impact: 1) increase the incom-ing revenue with accurate and fast claim filingand patient billing, and 2) decrease the ex-penses by making staff more efficient and pro-ductive and using fewer supplies, such aspostage, envelopes etc. ZyMed does both andmore.

ZyMed's comprehensive base package in-cludes patient database management, patientrecalls, third party billing, accounts receivablemanagement/tracking, referral tracking, capi-tated encounter tracking, Electronic Data In-terchange (EDI) with insurance companies,comprehensive reports program, word proc-essing, on-line help, lookup and much, muchmore. The system also includes utilities forsystem configuration, code management andhardware setups.

Available options include the ZyMed Appoint-ment Calendar, the ZyMed Automated PostingSystem (APS), and Electronic Submissionand Retrieval of Referrals from such compa-nies as Aetna/U.S. Healthcare, Cigna andothers.

Data Entry80% of the usage of a medical office computer is fordata entry. An important feature of ZyMed's designis fast, easy and accurate data entry and retrieval.That is why ZyMed is written by and for medicalpractice personnel.

ZyMed has simple, concise, easy to read screenswhich focus on moving data in and out of the sys-tem quickly. Screens are designed with knowledgeof medical office operations. ZyMed's design en-ables Users to be “on-line” after only two, half daytraining sessions. It is a system that people enjoyusing.

Data SecurityUser ID’s are used for tracking and protection. Lev-els are assigned to the Users to limit access todata, functions and programs. Practices have com-plete control over the security of their data and rec-ords.

NOTE: Auditron does not require access to yourrecords as part of the Licensing Agreement.

EDI: Electronic Data InterchangeIncluded in the ZyMed Base Package are numer-ous EDI tools, such as electronic claim submissionto Medicare, Blue Shield carriers and Envoy Clear-inghouse. Inquiry and support functions are avail-able such as DAS CareConnect, and access toAuditron's 24-hour electronic bulletin board andautomated update system.

Using ZyMed ECS (Electronic Claim Submission),claims are submitted to insurance carriers for accu-rate processing and faster payment with NO PERCLAIM CHARGE! Other EDI products are used forinquiries, data transfer/retrieval, communicationand updating.

ReceivablesZyMed uses a cash basis accounting method.Charges, payments, and adjustments are postedto individual service lines. Account balances aretracked and reported based on service, posting,last payment and billing dates. Insurance submis-sion history and patient billing are also tracked foreach service line.

One of ZyMed's strengths include the ability to gen-erate professional quality patient bills, statementsand receipts on-demand all without the use of pre-printed forms. Automatic patient cycle billing canbe done in minutes and offers complete flexibility inselecting billing cycles, adding individual mes-sages, payment plans, due dates and financecharges.

Another major ZyMed feature for managing receiv-ables is a wide range of accounts receivable re-ports, from financial analysis to account balancefollow-up.

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ZyMed: Base Package OverviewZ

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ZyMedPractice Management System

Patient Data

Along with standard patient demographic and in-surance information, ZyMed includes a User de-fined screen. This is designed by the practice andcan include items such as a patient's medical andfamily history, allergies, medications and notes.Patient billing, diagnosis and appointment data aremaintained and automatically updated on a statis-tic screen. There is even a freeform memo screenfor pages of notes. Using ZyMed, the practice canmaintain an electronic patient chart.

Patient data can be researched and integratedwith Microsoft Word or WordPerfect for producingmail merge files.

Chart and Form PrintingLabor and time savings result from eliminatingdouble work!! ZyMed prints information directly topatient charts, files, medical histories, workmen'scompensation reports, lab forms, etc. Variousstandard formats are available to integrate withinthe office. Custom formats are also available.

Encounter forms (AKA “superbills”) are laserprinted on plain paper and include a wealth of infor-mation from the patient file, including aged bal-ances for patient and insurances as well as briefvisit and diagnostic history. Most of the form isUser definable allowing easy changes using astandard word processor!

Code ManagementCode entry is a snap with ZyMed. ZyMed usespop-up lookup windows that contain codes and de-scriptions. New codes can be added “on the fly”during patient and service entry.

Multiple fee tables are available for each CPTcode, provider and location. ZyMed also tracks ap-proved and payment amounts for each CPT code,by provider and by location for each insurance car-rier. Utility programs are included to manage allcode databases.

Word ProcessingZyMed's word processor is a simple, effective toolfor communication, perfect for sending form lettersto patients or referring physicians. The word proc-essor is integrated with the patient and referringProvider database.

Reports

Patient, financial, managed care, insurance carrierprofiles, productivity and accounting reports are allavailable. All ZyMed Reports are highly flexible andcan be tailored by the User to meet specific practiceneeds.

RecallsA successful practice uses recalls to stimulate pa-tient appointments and as patient reminders. Theyare also very helpful tools for practice marketingand financial management. ZyMed recall codescan flag patients for clinical reasons or researchprotocols, collections and recall intervals. Recalltracking provides label printing, mail merge filecreation and other valuable communication toolsthat enhance patient care and help market the prac-tice. Recalls integrate with service entry and ap-pointment scheduling, automatically tracking recallstatus (i.e. pending, appointment made,satisfied).

HELP! and LookUpHELP! is available any time by pressing Fl. HELP! iscontext sensitive and provides an on-screen man-ual. When used in code fields, the LookUp functionis activated, which offers point-and-shoot selectionboxes. Searching for existing codes within theLookUp is done by simply typing in the search string(i.e. name, partial code, etc.)!

Message CenterThe Message Center is a place to leave messagesfor others or as automatic reminders. Messagescan be copied or moved to any day, and even as-signed to appear on specific days of the week.

Multi-User Multi-TaskingAny number of Users can add and update service,appointment and patient information simultane-ously with the ZyMed Multi-User system. PIN num-bers are assigned to each User to further evaluateactivity and for increased security. Multi-tasking canbe performed with Windows computers and othermulti-tasking Operating Systems.

System ConfigurationsEvery practice is unique and has individual needs.That is why many of ZyMed's functions and pa-rameters can be modified to suit each practice.

ZyMed: Base Package Overview

ZyMed's accounting system operates in thebackground as claims are added or updated.The data is immediately analyzed andchecked for completeness by the rule-basedaccounting system.

Adjustments and reversing entries are calcu-lated, confirmed and posted to accounts by thesystem, remarkably reducing complexity andincreasing accuracy.

During data entry, the User is notified of any in-consistencies before continuing to post trans-actions. Charge, payment and adjustmententries are immediately recorded and saved;no waiting until daily closing. The result is acomprehensive accounting system that en-sures accurate patient accounts and providesa broad range of account management tech-niques and financial reports.

Service Oriented AccountingZyMed uses Service Oriented Accounting, ratherthan Patient Balance Forward accounting. TheUser simply posts payment information exactly as itappears on the EOB or bill stub. Simple screensand ease of movement through the billing systempromotes accuracy and fast assessment of ac-count status. The results: uncomplicated, conciseinput and output increasing staff and patient under-standing and satisfaction.

TrackingKeeping Accounts Receivable at a minimum de-pends on tracking and follow-up of account bal-ances. ZyMed helps staff identify and act on unpaidservices with several tracking reports. Reports per-mit selection of many options to tailor the reportoutput to suit varied needs. ZyMed's aging reportsare extremely effective at uncovering unpaid, lostor misfiled services.

Today, it is common for a patient's insurance cover-age to change. ZyMed easily maintains the bal-ance and responsible parties as insuranceinformation is stored with each claim.

Encounter Form tracking enables management toautomatically find and flag No Shows and findmissing services.

ZyMed tracks the approved and payment amountsreceived from each insurance company for eachCPT code, by provider and location. This informa-tion is used to alert staff when payments are postedthat differ from previous amounts.

Once a service is entered, ZyMed begins trackingto make sure that services rendered become serv-ices paid.

Claim FilingInsurance claims can be submitted electronically orprinted on HCFA forms to a primary, secondary oradditional insurance carrier during account post-ing. Alternately, insurance claims can be placed onhold or batched by insurance type and printed later.

Other submission methods (such as telephone)can also be designated.

The claim filing process is so fast that the daily taskof sending claims is easily kept current.

Electronic Data InterchangeElectronic Data Interchange (EDI) is a rapidly ex-ploding technology. See ZyMed EDI for the fullstory.

Electronic Claim Submission (ECS) is a part of EDI,and is the primary focus of most offices. ZyMedsends claims electronically to an expanding list ofinsurance carriers, with NO PER CLAIM CHARGE.Claims are usually processed within 24-48 hours oftransmission and paid sooner than paper claims.Medicare claims are automatically sent on to sec-ondary MediGap and Crossover carriers for co-payprocessing.

ECS is the claim processing choice for any prac-tice. Staff time, claim errors and turnaround aregreatly reduced, leading to faster reimbursementand lower cost.

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Claim Management TechniquesC

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A companion to ECS, ZyMed Automated PostingSystem is used to electronically retrieve and post ex-planation of benefits from insurance carriers. APS, aproven ZyMed product since 1991, is used by over90% of ZyMed practices. APS produces efficienciesthat easily justify the cost of the entire system.

Patient BillingZyMed produces professional quality bills that arethorough, easy to read and understand.

Patient bills and receipts can be printed on demand atcheck-out time. Patient Bills are generated weekly,monthly or even daily by the automatic billing cycle.Individual or standard messages, due dates, pay-ment plans and finance charges can be attached. Thestraightforward format serves to reduce staff time an-swering questions and insures prompt payment.

Bills are printed on plain paper and are window-envelope ready with all types of printers. Preprintedforms are not required. A laser printer is recom-mended for fast, quiet operation and creates the bestvisual impression. On Multi-user systems, bills maybe printed while others are using the system.

You can optionally have ExpressBill handle your pa-tient billing. This involves creating a billing file andsending it to ExpressBill via their software or throughthe Internet. This service includes envelopes, print-ing, stuffing and mailing. The mailing is completedwithin 24 hours of receiving the file. Now your staffcan concentrate on collecting money! Please contactus for the current per bill charge.

Account PostingPatient accounts and claims are quickly opened withminimal keystrokes. Each service is directly ac-cessed by number or located by patient account dis-play. Posting is fast and accurate with the help ofstored default values to reduce entry time and errors.

The User enters information as it appears - ZyMedtakes care of the rest. Contractual allowances and re-maining balances are assigned to the responsibleparty automatically. The Transaction Journal invisiblyrecords all transactions and posts to the properledger, including reversing entries.

The ZyMed Automated Posting System (APS) canelectronically receive EOB's from an increasingnumber of insurance carriers. Payments and adjust-

ments are posted automatically, saving hundreds ofemployee hours per year.

“Hot Key” Patient BalanceOne key displays a Patient Balance Summary forquick reference. When a patient phones with a billingquestion, press the hot key and the billing summaryinstantly appears.

Callers are satisfied when their questions are an-swered at once; the staff can avoid taking messagesand making callbacks, further improving efficiencyand practice profitability.

Insurance SensitiveZyMed helps practices comply with HCFA and insur-ance carrier regulations and billing requirements inseveral ways: flagging non-covered procedures andpre-authorization requirements; providing built-informs for workmen’s compensation, auto accidentand other special billing situations; automatically cal-culating post-op periods, co-pays and deductibles.

Furthermore, Auditron responds quickly to embraceand support programs made available by insurancecarriers, such as Direct Access Service's CareCon-nect, and integrates them into the ZyMed software.

Auditron takes pride in the ability to consistently re-lease industry required changes to ZyMed productsBEFORE deadlines arrive!

ReportsZyMed claim management reports track account bal-ances by age, provide accounts receivable reports byaccounting period, compile managed care/insurancereimbursement profiles and provider productivity re-ports, all designed to help manage practice opera-tions and provide planning information.

Reports include:

� Transaction Journal with deposit reconciliation

� Cash Journal

� Accounts Receivable

� End of Period Reports

� Productivity by Provider(s), by Location(s), byUser, by CPT Codes, by Insurance Company

� ... and many, many more

Claim Management Techniques

Reports are a principal tool in effectively manag-ing a medical practice. Good reports provide per-formance information and insight into the mix ofpatients, services, insurance company reim-bursement and cash flow. ZyMed excels atquickly compiling a wide range of highly selecta-ble reports.

As there are thousands of combinations in thereport system, it’s impossible to list all possiblepermutations.

REPORT FLEXIBILITYEach report is made flexible and semi-custom withseveral filter selections available in each report.ZyMed will create reports for one, all or a group of pro-viders, locations, CPT codes, etc. Examples of com-mon selections include:

� Provider: all or any combination, with or with-out subtotals for each

� Location: all or any combination

� User: one or all

� Primary, secondary, tertiary, all or selected in-surance carrier(s) in each group

� Procedure: all or any combination

� Diagnosis: all or any combination

� By Payor: all or any combination

� Recall code: all or any combination

� Patient Type: all or any combination

� Referral source and other codes

� Adjustments: all or any combination

� Date Range includes:Date of service - Select, Range, AllDate last seen - Select, Range, AllDate of birth - Range, MonthlyPatient age rangeDate of Referral - Select, AllException Date - RangeAppointment Date - Select, All

� Age of service:By service dateBy submission or billing date

� Balance Due - Patient, Insurance or both

� Alpha or numeric order

� Output may be printed to screen, disk file ordirectly to printer choice

� Some reports contain the ability to export toDIF format allowing integration into third partyprograms for mailmerge, label, graphing orother purposes.

Memorizing ReportsZyMed can “memorize” settings for most of the re-ports in the system. This enables the User to replicatethe report each time it is desired without having to re-enter the criteria or lookup previous reports. This is adistinct advantage when tagging groups of CPT or Dxcodes for analysis.

A “tagging” function in reports includes selection ofCPT, diagnosis, insurance, Providers and more, Aspossible selections range into the thousands, memo-rization provides efficiency for the User and ensuresconsistency each time the report is selected. Memo-rized reports can be edited or deleted at any time, de-pending on User level. There is no limit to the numberof times or permutations in which any report can besaved for later retrieval. Storing the report criteriamakes the User’s life easier.

Batch ReportsWaiting for lengthy reports to process can be like wait-ing for a pot of water to boil! ZyMed has a way to over-come this bothersome task.

Once reports are memorized, they can be saved to-gether into a “batch”. The batch can be run immedi-ately or scheduled for another time - even afterbusiness hours! Batched reports can be output to aprinter or file for later viewing. This feature can savehours so time can be spent working on more produc-tive issues.

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REPORTS AVAILABLEThe report listing below gives an overview of themany reports included with the system. Currentreports are updated and new reports are addedcontinually. Custom reports are available at anhourly programming fee.

Under each report heading, Users may tailor thereport by many criteria options. See the RE-PORT FLEXIBILITY section for a partial listing.

Financial

� Transaction Reports

Daily Business Summary

Patient Payments Only

Insurance Payments Only

Adjustments Only

Charges Only

� Payor Reports

Daily Business Summary

Patient Payments Only

Insurance Payments Only

Adjustments Only

Charges Only

� Exception Report

� Cash Journal

� Adjustments Journal

� Accounts Receivable

Patient and Insurance Due

Patient Due Only

Insurance Due Only

All Carriers

Primary Only

Secondary Only

Specific Carrier(s)

� End of Period Closing Reports

Managed Care

� CPT Analysis by Carrier

� CPT Category and Carrier

� Patient Insurance Counts

� Primary Insurance List/Charges

� Patient Visit Analysis

Patient

� Patient Recalls & Recall Reports

� Master Printout

� Patient Demographics

� Labels

� Encounter Forms

� Encounter Tracking

� by CPT with Financial

� Insurance Coverage

� Patient Ledger

� Patient Service History

Service

� Insurance Productivity

� Place of Service

� Patient Labels by CPT or Diagnosis

� CPT Service List

Philadelphia, PA KIDS program

� Submission Report

� Charge Entry Report

Referrals

� General Report

� Referring Sources

� By Patient

� Labels for Referring Offices

Utilities

� Batch Report Management

� File Viewer with Search and Print Capabilities

� Global Option Management

Code Management

� Procedure Codes

� Diagnosis Codes

� Insurance Companies

� Referring Providers

� Facilities

Reports

Managed Care is dominating the medical indus-try. Tracking referrals, reporting encounters anddocumentation have become major issues for allpractices. Until now, primary care and other capi-tated or “episode-of care” providers (such asCardiologists or Gastroenterologists) have beenforced to do twice as much work to track and re-port capitated services. Specialists have had noefficient way for tracking referrals. Referral Man-agement Database and Encounter Entry areZyMed's solutions.

Referral ManagementZyMed's referral tracking capabilities make organiz-ing referral information effortless. Referral manage-ment includes the ability to input and track referralinformation for patient accounts and services. Utiliza-tions and expirations based on time or visits can beeasily tracked.

The referral information is integrated into the ZyMedAppointment Calendar and service entry.

Auto Recognition and ImportingA manual referral tracking system cannot efficientlytrack referrals. These referrals are imperative to get-ting paid for the specialist. ZyMed' s computerized re-ferral tracking makes the difference. For instance:

When adding a claim, the referral status pop-up infor-mation window appears. This window includes refer-ral number, issue and expiration dates, number ofvisits issued/used, type and status. The User high-lights the appropriate referral and confirms the entry.The referral is applied and the number of visits used isincremented. ZyMed imports the referral number intothe claim for paper or electronic claim submissionthus eliminating manual entry and data entry errors.

Measure this included feature against com-

petitive systems; we're sure you'll not find

this level of integration and ease of use!

Appointment Calendar IntegrationHow many times do patients call to make an appoint-ment and want to know if they need a new referral?Or, would you like to know a referral is about to expirebefore scheduling an appointment? ZyMed automati-cally recognizes if the patient has referrals and re-ports referral status upon adding an appointment. Ifthe patient has expired referrals, the system also noti-fies the User. Staff can then inform the patient that anew referral is required. If a referral is active, the sys-tem will report important information such as expira-tion date, visits remaining, and more.

Practices without ZyMed's referral tracking, areforced to manually search for referral informationwhen a patient calls for an appointment - impossible ifthere are multiple offices! Utilizing ZyMed, the timespent making an appointment is drastically reducedwhich is beneficial to the patient, staff and practitioneralike!

Quick Referral ReferenceAn instant “Hot Key” will pull up the patient’s referralinformation from almost anywhere in ZyMed. Thiseasy to use feature is another tremendous time saver.

When a patient calls to see if they are in need of a re-ferral, the answer is one keystroke away! No moresearching through the patient’s chart to find the mostrecent copy of their referrals! Practices with multipleoffice locations can centralize the collection and dataentry of the referral information.

EDI ReferenceReferrals through EDI (Electronic Data Interchange)are available for AETNA/US HEALTHCARE, Cignaand Keystone carriers. Auditron is working closelywith managed care carriers to implement these EDI

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Managed Care ControlM

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and other options into the ZyMed Practice Manage-ment System.

The new systems will replace POS (Point of Service)systems currently in use by the carriers. The goal is toeliminate paper based referrals. This will streamlinethe office process and reduce costs for all involved,including Primary Care and Specialists offices.

Ease of UseFor Users already familiar with paper referrals, add-ing referrals into the ZyMed system is elementary.

The referral entry screen was designed to mimic thetypical managed care referral. Lookup features areavailable for fields requiring carrier-specific data inputwith allowances for several diagnoses and proce-dures for each referral. There is no practical limitationto the amount of referrals that may be entered for anypatient. ZyMed makes living with managed care,manageable!

ReportsThrough the ZyMed Reports module, Users can printa completely user-defined report based on referral in-formation.

For example, a report can be used to evaluate thenumber of visits per episode-of-care over a time peri-od for a particular location.

Or, maybe you would like a list of expiring referralswith visits left unused.

A Primary Care Provider may like a report of the refer-rals issued to compare against the reports given bythe managed care carrier.

Perhaps the most commonly requested report liststhe patients and number of referrals based on refer-ring source (or referred-to).

All of these are possible with this flexible report inter-face.

Practices can track the number of referrals issued orreceived by date, by referring provider for specifiedcarriers.

Selection criteria includes:

� By Insurance Carrier(s)

� By Provider(s)

� By Valid Referral “from” Date.

� By Referral Expiration Date.

� By Referral Type.

� By Number of Visits Remaining.

� By Referring Source.

� By Location.

Encounter EntryOne of the most time consuming tasks of the primarycare or capitated practice is tracking the necessarymanaged care encounter visits. Practices are usuallyrequired to imprint the patients ID card on carboncopy forms which must be manually filled out andmailed.

ZyMed has integrated the ability to enter and trackmanaged care encounters, effortlessly. This neces-sary tool for primary and capitated providers is indis-pensable. Instead of time consuming paperwork,encounters may be entered into the system like “fee-for-service” claims. By acknowledging that the entrywill be an encounter, the system automatically zero'sout the fee amounts except for the patients copay-ment, if any, and labels the service as an encounter.

The encounters may be printed on a standard HCFA1500 form or electronically submitted to participatingcarriers thus eliminating the need for filling out carrier-issued encounter forms.

But not every carrier is capitated!? No problem. Eachpractice can indicate which carriers are capitated. Iteven allows the User to enter ”fee-for-service” claimsfor these carriers when necessary, i.e.. immuniza-tions.

Patient receipts can be printed on the spot for copay-ments and unlike manual encounters, providers haveaccess to Managed Care Reports through ZyMed'sReport module. These reports can help evaluate par-ticipation with managed care carriers, a valuablepractice management function.

Managed Care Control

Electronic Data Interchange (EDI) is an all en-compassing term for electronically communicat-ing information, transmitting documents andsharing databases with insurance carriers, hos-pitals, pharmacies, medical libraries and others.

The most common uses of EDI in the medical in-dustry are for claim submission, EOB retrieval,status information, electronic patient recordsand inter-office/remote communications.

Electronic Claim Submission

ZyMed Advantages

� Easy to use!

- Average training time is 15 minutes!

- Functions are almost 100% automated!

� Save money!

- NO per claim fees for direct carriers!

- NO costly paper forms or mailing fees!

- Faster turnaround!

- Reduce receivables!

- Increase cash flow!

� Wide variety of carriers!

� Use with confidence!

- Approved by major carriers

- In use for many years.

- Constantly updated for new regulations.

� Advanced technology!

- Retrieve Submission Analysis Reportselectronically for incomplete/invalid claimrejections.

- Electronic EOBs - Retrieve EOBs for Medi-care and PABS using ZyMed APS (opt).

- Automatically post directly to patient ac-counts using ZyMed APS (opt).

- ZyMed ECS supports the fastest modemrates available today.

Medicare CarriersZyMed includes direct submission to HCFA Con-tracted Medicare Carriers.

Blue Shield CarriersZyMed includes direct submission to the followingBlue Shield Carriers (others are being added - call forspecifics):

� Highmark/PA Blue Shield

� Blue Shield of Delaware

PABS DataStreamDataStream is Direct Access Services' Claim Clear-inghouse (DAS is a division of Highmark/PA BlueShield). Claims submitted through DataStream areforwarded for processing within 24 hours of receipt.

DataStream's Tier 1 provides FREE submission to:

� PA Blue Shield Private Claims

� IBC Personal Choice

� Highmark Claims/Encounters

� Keystone Health Plan East/West/Centralclaims and encounters

� Amerihealth Administrators, (formerly Blair MillAdministrators)

� Amerihealth - Delaware, New Jersey

� Inter-County Health Plan

� Amerihealth

� Capital Blue Cross - HealthOne

� Clarity Vision

EnvoyEnvoy Clearinghouse provides electronic submissionservices to hundreds of carriers free of per claim fees!

Services available:

� FREE electronic claim submission to over 600carriers.

� AETNA/US HEALTHCARE and Cigna referralsubmission and retrieval.

� Electronic submission of patient bills to Ex-pressBill. They print and mail bills for you!

Automated Posting System

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The ZyMed Automated Posting System (APS) isone of the most powerful tools available today asinsurance EOBs can be received electronically andposted in seconds! Please read the enclosed APSliterature for more detailed information.

Auditron BBSThe advanced Auditron Bulletin Board System isavailable 24-hours a day enabling Users to:

� Automatically retrieve and perform systemupdates including new features and docu-mentation!

� Users perform updates according to theirschedule!

� No waiting for updates!

Electronic Patient RecordsZyMed has been programmed to interface withElectronic Medical Records (EMR) packages. Thisenables automatic updating to occur from ZyMedto the EMR package. So as patient information ischanged in ZyMed, it is automatically modified inthe Electronic Medical Records program.

Please consult your ZyMed representative for lat-est availability and fees for this service.

ExpressBill - Electronic PatientPatient billing can be done electronically throughExpressBill.The billing cycle is completed in ZyMedand the data sent to ExpressBill via direct modemlink or through the Internet. Bills are printed andmailed within 24 hours. Please consult your ZyMedrepresentative for latest fees regarding this serv-ice.

The cost benefit is derived in staff having muchmore time and energy to concentrate on the collec-tion process, since the billing is done for them! Thecost is only about a nickel per bill over doing it inhouse.

Hospital LinksMany hospitals provide the means for physicians toaccess patient information by modem. Contact usfor further information for specific hospitals.

Inter-Office/Home LinksInteroffice connections and Provider home-to-office connections are “old hat” for ZyMed Users.No bringing charts and service slips back and forthbetween offices. The Provider no longer needs torun to the office when an emergency room calls at2AM for a list of medications - just call into the officecomputer for complete access including print capa-bilities. This can also be done over the Internet withthe appropriate software in place!

Inquiry ProductsMPIplus and CareConnect are accessed by mo-dem using ZyMed communications software, in-cluded in the base package.

� MPIplus is a free program from HGS Admin-istrators Services. Careconnect is High-mark/PABS ‘s program. These programsallow access to information such as:

- Claim status.

- Fee schedule and limiting charge data

- Procedure code information.

- Check / EOB information.

- Forms, policy, billing procedures & pub-lications.

- Post Payment Review Requests.

- Provider Address & Telephone/Faxnumber changes.

- EMC Source information changes, suchas updating address/telephone, modemprotocol & participation status.

- Patient enrollment/benefit information

- Allowance information - including theprovider's current charge, usual charge,fee schedule allowances & UCR allow-ances for procedure codes.

- Enrollment & claim status informationon 65 Special/Security 65 claims.

- Access to eligibility & benefit informa-tion for KHP East/West/Central plans.

- Ability to create/send/lookup referrals.

Electronic Data Interchange - EDI

ZyMed Automated Posting System (APS) is cur-rently available for claims electronically submit-ted to Medicare and PA Blue Shield PrivateBusiness.

ZyMed APS retrieves an electronic file from theinsurance carrier, and posts the explanation ofbenefits (EOB) directly to patient accounts forclaims submitted electronically via ZyMed ECS.This is made possible by ZyMed's use of DialupReconciliation, referred to as “RECON”. APSeliminates the need for manual posting of theseclaims.

How long does it take your staff to post a 10, 20,30 or 100 page EOB? A 30 page EOB is proc-essed by ZyMed APS in seconds!

Billing staff can spend this regained time improv-ing collections in more productive ways: keepingabreast of insurance policies and procedures,concentrating on reviews, follow-ups and edu-cating patients. They can be reassigned to otherduties, or staff hours can be reduced! Think whatyour office could do with that extra time andmoney! Typically, ZyMed clients have reducedtheir Accounts Receivable by 40-60%!

ZyMed APS savings easily justify the cost of anentire computer system, and improve the finan-cial performance of the practice.

Advantages�Faster reimbursement and staff-time savings

of over 60 to I!

�Accurate! No clerical errors!

�Savings easily justify cost of the entire com-puter system!

� Increased staff satisfaction and substantialpayroll savings!

�NO per claim fees!

�Can be used in as little as one week from sys-tem installation!

�Flags patient balances for billing.

�Flags coinsurance for batch printing.

� Informs User of misspelled names.

�APS Report lists posted data in an easy toread format for a selected EOB.

�Posting Log lists data changes for differing ap-proved amounts and rejected claims within aselected EOB.

�RECON Reports can list several types of claimstatus, including: pending, rejected, Medicaland Utilization review, completed & paid, andcompleted & not paid.

�One RECON Report lists all claims containedwithin the selected EOB. The report includesANSI codes and explanations sent by the car-rier.

�APS Posts to the INDIVIDUAL Service Linethe:

Approved Amount.

Deductible.

Payment.

Contractual Allowance.

Billing Note.

How APS WorksLittle training is required. As in all ZyMed programs,simplicity is of the utmost importance. An ElectronicReconciliation Summary Report (RECON) is re-trieved from the carrier. The RECON file may containone or more electronic Explanation of Benefits(EOBs), as well as details on other claims, includingthose pending or rejected.

ZyMed analyzes the RECON and displays the checknumbers for paid claims and amounts. The User high-lights the check number, presses a key and ZyMeddoes the rest. No complicated programs or languageis necessary. The entire process is completed in a fewminutes.

ZyMed will NOT post claims with unusual circum-stances requiring further review. This could be a zeroapproved amount, an existing payment, etc. Theseclaims are set aside and included in the APS PostingLog. Our users report this amount to be very small(under 2%).

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AccuracyZyMed APS makes posting mistakes a thing ofthe past. Entry errors account for virtually all post-ing problems and balancing problems at the end ofday. Posting a lengthy explanation of benefits leadsto staff fatigue and increased errors. APS makesnumerous cross-references and verifications herebefore the data is posted to a service which en-sures accuracy!

Cost JustificationHours of staff time are normally dedicated to enter-ing EOB statements each week. APS reduces thistime to minutes.

APS Posting LogThe APS Posting Log includes items where:

� Patient name does not match carrier’s rec-ords.

� HIC number does not match carrier’s rec-ords.

� Claims are marked for secondary batchprinting.

� Approved amount differs from normal ap-proved amount.

Also included are payments not posted due to:

� Rejections.

� Insurance Company mismatch.

� Patient ID mismatch.

� Posting information already exists.

� Charges were not equal to charge field.

� Approved Amount from carrier is zero.

� Interest.

� Procedure code mismatch.

Balance BillingAPS will automatically flag claims for Batch Proc-essing where the secondary carrier is responsiblefor the balance. Medigap and ComplementaryCrossover carriers are automatically omitted.Flagged claims can be batch printed immediately!

Balances due from the patient are automaticallyflagged for billing. User defined notes are automati-cally attached to these services for select situa-tions, i.e. deductible, copay, non-covered.

The result: Coinsurance claims and patient bills arebilled immediately after the EOB is posted.

APS ReportsThere are several reports that can be generatedfrom the APS system. The Posting Report lists allclaims that were updated during the posting ses-sion. Information includes:

� Patient name and account number.

� Claim number.

� Insurance coverage.

� Charges.

� Approved Amounts.

� Contractual Allowances.

� Payments.

� Deductibles.

� Balances and who owes them.Other reports resemble the carriers EOB, wherethe messages are also printed with the service in-formation. The most commonly used are:

� Pending Claims Report.

� Completed Claims, Paid or not Paid.

� Rejected Claims.

� All data which is the same as the EOB!

RequirementsZyMed Automated Posting System requiresZyMed ECS and the ZyMed Base Package.

Dialup Reconciliation is available to electronic bill-ers exclusively. Paper claims submitted toMedicare and PA Blue Shield Private Businesscannot employ automated posting.

As regulations differ between Medicare and Privatecarriers, please contact our office for specificguidelines.

Automated Posting System - APS

Group practices with multiple offices need acomputerized appointment system, and solopractices benefit from reduced appointmentscheduling delays and on-hold time, too. Yet of-fices which have computerized appointmentschedules rarely use them. Why? Complexity, in-flexibility and slowness compared to a manualsystem. ZyMed is different. One entry and thefirst twenty open appointments are presented forpoint-and-shoot selection.

User DefinedThe ZyMed Appointment Calendar (ZAC) is capableof handling multiple physicians and offices with aneasily designed and quickly accessed appointmentschedule. Additionally, ZAC begins patient registra-tion, tracks cancellations and no-shows, and createsencounter forms that include the patient's treatmentand diagnosis history and financial aging. Each ap-pointment may be specially designated for problemtype, a new or established patient, and time require-ments.

Pop-Up AnytimeBecause ZAC is a pop-up program, it can be ac-cessed by more than one person from almost any-where in the ZyMed program. This eliminates menuhopping and losing your place. ZAC is only one key-stroke away!

The Calendar is integrated with the patient database.One key lookup function simplifies finding patient in-formation. The patient's phone number is accessed,displayed and optionally updated from within ZAC. In-formation for new patients may be entered directlyinto the patient database when scheduling their firstappointment. This simplifies updates of file data andbecomes an integral part of the appointment process.

The system also allows for alarms to be set for spe-cific patient types. This feature is User definable andpresents a blinking message every time the patient’sfile is accessed. One common use is to designate col-lection accounts.

Referral IntegrationWhen scheduling appointments for patients withmanaged care referrals, an information window auto-matically appears alerting the User as to the status ofreferrals stored on the system. No more having a pa-

tient show up and the referral is expired! The staff per-son can immediately inform the patient of the need fora new referral!

Free Form MemosIn a manual system, notes are written sideways orsqueezed between lines. ZAC allows memos to bewritten in any time slot with or without a scheduled ap-pointment. These work like electronic Post-it notes.One keystroke opens a freeform memo area which al-lows unlimited information to be entered. The“MEMO” indicator alerts the user to the presence of amemo when viewing a day's appointments. The dailyappointment schedule report dynamically adjusts toprint the entire memo.

Procedure SpecificTime slots can be designated to be “procedure” spe-cific using user-defined codes. For example, the Usercan flag 1PM and 4PM slots on Tuesdays and Fridaysfor New Patient Visits. Users can then search for thistype of appointment when scheduling.

Open Slot SearchUsers have the ability to select open appointmentslots using a variety of parameters. These include:provider, user-defined codes, date, time of day andday of the week. Once the search parameters are se-lected, the computer will display up to 20 available ap-pointments meeting the criteria selected. The userhighlights the preferred slot and the appointment isentered.

When entering an appointment for an existing patient,the program will display the number of previous ap-pointments made, canceled and no-shows. Any pop-up or recall notes attached to the patient also appear.The User is alerted of any future appointments sched-uled for this patient.

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Patient Appointment SearchAfter an appointment is made, patients may call toclarify the appointment time. Enter the patientnumber directly, or use the one key lookup func-tion. The computer will display the date and time ofthe patient's appointment instantly.

Canceling/ReschedulingLocate the patient's scheduled appointment andcancel or reschedule with one keystroke.

Encounter/Superbill TrackingEncounter Forms (AKA Superbills) are printed for aselected day. (Individual on demand forms canalso be printed.) These forms are numbered fortracking. Following charge entry for the same day,the encounter tracking program is run. This en-ables management to find and flag no shows andfind services that are missing - performed but notentered.

ReportsZAC's daily appointment schedule report prints allappointment times and types, patient name andnumber, insurance coverage and memos. Foropen slots, lines are printed to add entries duringthe day as they occur. Usage reports and countsare also available. On HP compatible laser print-ers, each hour is shaded to ease viewing.

Multi-UserZAC is available in single or multi-user configura-tion. In the multi-user configuration, several peoplemay enter appointments in adjacent time slots si-multaneously, reducing scheduling delays and on-hold time.

Voice TelephonyZyMed can integrate with certain Voice Messagingsoftware products. Real voice messages are sentfrom files exported from the ZyMed AppointmentCalendar. Once the calls are completed the systemis made aware of the status and a report can begenerated. Think of the valuable staff time that willbe saved. It also greatly decreases no-shows aswell as patients arriving at the wrong time .

These systems also integrate with our recall sys-tem. In this way, the voice messaging software canimprove patient care, increase patient volume andis a powerful marketing tool.

If your practice verifies appointments, wants togrow or enhance patient care it is a MUST! If you’vebeen wanting or realizing that you need to be callingyour patients this is the perfect way to get started.Contact your ZyMed representative for details.

SpecificationsThe ZyMed Appointment Calendar has the follow-ing capacities.

Providers: Limited only by License Agreement

Users: Limited by operating system and/or User Li-cense Agreement

Operating Systems: Windows � compatible

(Win95/98/2000 or NT recommended), MS~DOS�(v6.x), IMS Real32 (v7.7x+), Novell, Lantastic , oth-ers.

Number of appointment slots on-line: 100,000,000depending on disk space available

Major Features

� easy to learn and use

� User designed encounter form which printsin batch or individual

� on-line Help!

� “hot key” entry into program

� user defined time slots and coding

� day at a glance

� flexible design

� one key cancel/reschedule

� multi-user to time slot level

� memo capability on any time slot

� move day-to-day, month-to-month andprovider-to-provider with one keystroke.

� Telephony integration

Appointment Calendar

Our CompanyIncorporated in 1978, Auditron Electronics Coor-poration (Auditron) has dedicated itself to the de-velopment of the ZyMed Practice ManagementSystem since 1984.

The company is very stable with no outstandingdebt. Our structure, management and approachto the ever-changing medical business rein-forces our financial stability.

This strong foundation enables us to keep upwith industry trends better than any of our com-petitors. Our clients do not wait to comply withHCFA changes.

Our StaffOur training, support and programming staff have ex-perience in the medical and insurance fields. Back-grounds include medical office management, billingpersonnel and insurance carrier claim processing.

Our office management experts advise practices howto run at utmost efficiency. Consulting is available forthose practices that require assistance. Dedicatedstaff keep abreast of the industry. They continually at-tend seminars and workshops sponsored by Medi-care, Blue Shield and medical consulting firms.Knowledge obtained is passed onto our clients andreflected in the software.

Everyone participates in the research and develop-ment of our products. The varied backgrounds com-bine to create truly innovative and productivemodules. Just one more reason why ZyMed inte-grates so well into the medical office.

HistoricalZyMed was originally developed in conjunction with asingle physician, single user practice. Processingclaims with ZyMed since 1985, they have prosperedsignificantly since its implementation. The practicewas sold, added several physicians, a second floor,and 9 terminals, including remote access. Moreimportantly, they continue to use ZyMed to processclaims.

ZyMed was designed from the operators viewpoint-simple and efficient. ZyMed conforms to office flow,and easily incorporates into the practice. Dramatic in-

creases in the efficiency and productivity of the staffresult in increased cash flow.

Initial marketing efforts began in late 1989, which re-sulted in the addition of several clients. The productwent through extensive rewrites and improvements in1990 and 1991. As always, recommendations and re-quests from clients were incorporated into the prod-uct. (see Philosophy)

On April 15, 1999 Auditron released Version 8.00.This was a major rewrite taking advantage of new pro-gramming techniques, adding many more systemfeatures and paving the way into the next millennium.

January 1, 2000 (Y2K) was a date we can happilystate was ”business as usual” for ZyMed Users. Inkeeping with ZyMed’s goal of continuing to provideour clients with the best service possible we were wellprepared for the arrival of Y2K.

InnovationsZyMed is an “on-line”, “real-time” system. Bills and re-ceipts print immediately. Work is complete at theclose of day. No batch saving. No batch processing.Our clients are up-to-date.

Electronic communication and claims processing isvery critical in today's medical office environment.Electronic Claim Submission (ECS) enables the prac-tice to transmit claims to third party payors via mo-dem. This results in rapid claim turnaround,increasing cash flow.

The companion module to ECS is ZyMed APS, ourautomated posting product. ZyMed APS allows theUser to post an entire Explanation of Benefits (EOB)directly to the patient accounts with one keystroke.Once a client received an EOB from Medicare whichtotaled 140 pages of data. This report, under a man-ual system, would have taken well over 7 man-days topost. Using ZyMed APS, the report accurately posted

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in under 18 minutes on a 386 computer! Now withfaster computers available, the same EOB only takesa minute or two!

As politicians push health care reform, Providers arebeing hit harder on the bottom line. ZyMed can pro-vide savings of the magnitude required to keep (ormake) the practice profitable. Changes in the industrywill make practice survival and profitability hinge onefficient claims processing and cash flow control.Products, like ZyMed APS and referral tracking, pro-vide the efficiency to prosper.

Philosophy

� Clients come first.Auditron’s number one priority is supporting our cli-ents. Support for what they need, when they need it.Our company, like a practice, values and cares for ourclients. And like your practice, referrals result fromhappy clients. That’s why programming and supportwill always take precedence over sales.

We encourage suggestions for product developmentand improvement. The best ideas have come fromthose on the “front line”. In this way, the User getswhat they want and ZyMed improves to be a better,more flexible product.

� Keep ahead of changes and regulations inthe industry.

Constant changes in claim processing regulationshave been Standard Operating Procedure for medi-cine. The future will be full of these changes. We willcontinue to provide these updates to our clients bef-ore they become law.

The medical office software industry is going throughthe traditional growing pains. Recent Medicarechanges caused some major companies to abandontheir product and client base. Why? Poorly designedsystems and inefficient customer support organiza-tions are just two factors. Other companies were un-prepared for the changes and their clients waitedmonths for the updates required to properly submitclaims.

� Design software that takes advantage oflatest technologies.

Incorporating ideas from users and support person-nel, our programmers take advantage of the latesttechniques and technologies available. ZyMedscreens are clear and coherent. Simple mnemonics,uniform function keys and flow-thru logic expeditesstaff training and duties. As the programs are very

fast, Users do not wait for processing or screenchanges.

Factoids

� Over 80% of our clients have had at least onepractice management system before purchas-ing ZyMed. Some have had as many as 4!

� 95% of our clients are submitting claims elec-tronically.

� 95% of our clients who submit electronically,use the ZyMed Automated Posting System.

� ZyMed Users have been enjoying the Auto-mated Posting System since 1991.

Corporate Profile

Training/SupportTraining at the clients location, with their own equipment, immediately follows installation.

Scheduling accommodates the individual practice needs.

We have designed and implemented a state-of-the-art on-line customer support system. Our own client baseclaims our support is far superior to any competitive offering. They should know. Over 80% used at least onecompetitive product before converting to ZyMed.

When our clients call, they speak to a live person. No message centers. No waiting hours, or even days, for areturn call.

HardwareZyMed utilizes advanced hardware and operating systems to increase efficiency in the office. Recommendedconfigurations incorporate cost effectiveness with flexibility for future growth. High speed, large capacityCPUs and hard disk drives provide years of service. Laser printers produce a quiet office environment, pro-fessional output and no paper changes. Only the highest speed Modems are used. Windows based systemsare encouraged, especially Windows 2000 for Internet access and flexibility.

For practices that have a local hardware supplier, Auditron will be happy to work with them to insure the sys-tem operates at peak efficiency.

When purchasing computer software, make sureyour vendor can offer the following:

� Assurance your office can be “on-line” in only 6-8 hours of on-site train-ing INCLUDING submitting claims electronically.

� Automated Posting of Medicare and Pennsylvania Blue Shield EOBs,active in as little as two weeks from installation.

� No testing required for Medicare Electronic Claim Submission and mostother carriers.

� HGS Administrators “Gold List” Vendor since the program's inception.

� Direct Access Services - Highmark/PA Blue Shield Preferred “Gold List”Vendor since the program's inception.

� Base Package which INCLUDES Electronic Submission to Medicare

carriers, Blue Shield Carriers and Envoy all with NO PER CLAIM FEES.

� “On-line” “Real-time” referrals for primary and secondary providers.

� Proof the system can reduce Accounts Receivable by 40-60% when re-placing competitive systems.

� Excellent support and update service. Real people answering thephones and immediately answering your questions!

� 24-hour Bulletin Board Service for software updates.

� Software Updates issued on a continuous basis.

� Affordability.

Ours does.

You Deserve the Best.

You Deserve ZyMed by Auditron

800-29-GO ECS

© 2001 Auditron Electronics Corp � All rights reserved

ZyMedPractice Management Solutions

ZyMed Software iswritten, owned and supported

by Auditron Electronics Corporation.

Auditron is an approved “Gold List” Vendor for:

HGS Administrators (Medicare)

Direct Access Services (Highmark/PA Blue Shield)

Auditron is an approved vendor for:

Envoy Clearinghouse

AETNA/U.S. Healthcare

Keystone Health Plans East/West/Central

Trailblazer Medicare

Blue Shield of Delaware

For more information, contact:

www.auditron.comAuditron Electronics Corporation

280 Moore RoadDowningtown, PA 19335

(800) 29-GO ECS(800) 294-6327(610) 458-2500

Fax: (610) 458-9986E-mail: [email protected]

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