Hello All!

I have a client that is:

1. a Non Profit Organization,

2. That offer a variety of medical services (Both physical and mental health issues),

3. In a clinic type setting,

4. with 50% of their billing income coming from governmental programs (other than Medicaid/Medicare).

Let me elaborate a bit on 4:

They service children (for example) and the bills go to the local Board of Education. There are other programs, both federal and state, that they bill. Each program has their own forms (no electronic option yet) and, in at least one case, their own procedure codes.

They typically get authorizations from these programs to perform certain services, possibly within a period of time (e.g., 20 physical therapy sessions between 1/1 and 3/31/99). Visits need to be validated against authorizations and documentation requirements (one program requires a written status report from the clinician) need to be tracked.

Billing is done periodically so unbilled visits need to be tracked as "work in process".

The software should also have the ability to support very flexible
receivable and billing reporting by department, service, payor, clinician, etc. Reports must clearly delineate between receivables and work in process.

The client also sells prosthetic devices and services them. For medicare, this requires Claim form C so the software should handle this too.

One additional requirement revolves around patient clinical data. The organization is developing a patient information system. This system should share data with the billing system and can trigger billable events into the billing system as well as share scheduling, patient demographics, payor information, authorizations, etc.

If you have any ideas on this, please e-mail me at bazianm@idt.net.

Thanks in advance for your help.