Menachem,

In a previous life that ended about 6 months ago I did a lot of electronic medical billing work. A few warnings. In my experience, medical billing in the United States is the most complex job on Earth. Writing even a simple medical billing app makes writing a multi-state payroll app look like a walk in the park.

For this reason, the players in the field are few, well established and specialized. For instance, there are very few vendors providing Nursing Home packages, there are others concentrating on private practice, others on clinics, and so on. These established vendors are pretty much your only choice unless you want to develop.

The only saving grace is that nearly all insurance companies have gone over to what is called "National Standard Format" for electronic billing. Except, of course, New York state Medicaid, which retains its ancient proprietary format that can only be obtained in the form of photocopies that appear to be made from photocopies of photocopies of photocopies...

>Hello All!
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>I have a client that is:
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>1. a Non Profit Organization,
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>2. That offer a variety of medical services (Both physical and mental health issues),
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>3. In a clinic type setting,
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>4. with 50% of their billing income coming from governmental programs (other than Medicaid/Medicare).
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>Let me elaborate a bit on 4:
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>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.
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>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.
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>Billing is done periodically so unbilled visits need to be tracked as "work in process".
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>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.
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>The client also sells prosthetic devices and services them. For medicare, this requires Claim form C so the software should handle this too.
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>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.
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>If you have any ideas on this, please e-mail me at bazianm@idt.net.
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>Thanks in advance for your help.