Knowing which programs are best suited for your practice needs can be overwhelming. Four software experts share their knowledge about finding the right software for you.

Technological progress does not untangle all the knots of running an office. In fact, buying the wrong software system can complicate problems now more than they could be in the days of manual billing and filing. To smooth out the wrinkles of purchasing a billing and documentation system for your practice, Chiropractic Products called on four experts to weigh in on the topic.

Peter G. Fernandez, DC, is a 1961 Logan College graduate and past president of the Florida Chiropractic Association. Fernandez has been a practice consultant for the past 23 years and has worked with more than 5,000 DCs and helped to open over 2,500 new practices.

Barry J. Lieberman, BS, DC, has been developer of a software program for more than 10 years. Lieberman, who has been in practice for over 15 years, maintains a private practice in Beverly Hills.

Mark Sanna, DC, is a second-generation chiropractor and CEO of Breakthrough Coaching, a practice development system. Founded in 1988, Breakthrough is recognized for systems that are outcome-oriented and respected by a diverse cross section of modern health care providers.

John Turner, DC, has been in practice for 18 years in Atlanta and runs a 6,000-square-foot integrated health facility. He has always embraced the latest technology to improve efficiency within the office.

What advice do you have for new practitioners or first-time buyers, or for established DCs or doctors who wish to upgrade?

Fernandez: Purchase quality equipment that will efficiently serve you now and be able to easily accommodate your growth over the next few years. Purchase a system that includes a daily automatic backup program to CD, zip disk, or tape that can be taken home every night. Purchase from a reputable source that will be there when needed.

Lieberman: For new practitioners: The best thing you can do is keep track of all the details of your patients on your own software package. You don’t have to wait until you have enough money to buy an expensive program. Buy something that will get you started as soon as possible. A software package that is open database-compatible should be able to export your data for future needs.

For the established DC: Make sure your new software package is easy and intuitive for your staff to use and that changing your address is as simple as entering a new patient record. Another important item for you is to verify that your software is open database-compatible so that all the time you’ve spent inputting data won’t be lost if you ever change your software program.

Sanna: Be sure you purchase from a company that specializes in chiropractic software. The costs involved in converting medical software to chiropractic use will outweigh any initial savings. Most important, the software company should be well established (in business for 10 years or more) to avoid losing an investment in software that may never be updated or supported if the company folds.

Purchase a comprehensive chiropractic software program that includes billing, accounting, report writing, and practice management features. It should also have a robust security system and be HIPAA-compliant. It can also be expensive to purchase these programs a la carte rather than as components of a complete system. First-time buyers and established DCs should look for a complete software package. Modular programs are like dining a la carte; it can get very expensive to add on modules later.

Turner: The best advice for any first-time buyer is to evaluate the software to see if it will grow with the practice. You might not need all the features now, but in the future you will be glad that these features exist. Evaluate the market and do comparative shopping. Ask venders to share with you why their product is better than that of their competitors.

For established doctors, I have found that it is important to spend some time evaluating your practice requirements. Talk with your staff and listen to their wants and needs to make their job more productive. Ask yourself if this software will allow for growth in your practice? Is the scheduling program large enough to handle multiple providers? Does the software supply adequate month-end reports that will provide all the information to manage your practice. Does this software integrate with your existing software? Does this company provide a conversion from your old software to the new?

What are the most important features DCs should look for in their billing and/or documentation software?

Fernandez: Your task time and completion accuracy are impacted by how many tasks your software can do and how interactive it is within itself. However, if your software is not user-friendly, its benefits are greatly reduced by inevitable user mistakes and the additional time and training needed to use it. Last, you need to know that when a glitch comes up, you need to be able to get immediate support from knowledgeable technicians.

Leiberman: Ease of use, cross-platform compatibility, open-database compatibility are important.

Sanna: It should include features such as patient welcome and follow-up letters, attorney statements for PIP, and claim follow-up letters. Patient contact features are important for practice growth such as recall letters and thank-you letters for referrals, and queries that allow the office to target specific groups of patients for mailings (age, gender, insurance type, patients who haven’t been in for a certain period). Billing features should allow for electronic or paper claims without much hassle and include claim checks for missing information to help avoid rejections. Statistical information should be available so doctors can know where their patients are coming from, where the money is, and when claims and bills are overdue.

Turner: One of the most important features is making sure that both programs can integrate together, especially if they are purchased from separate companies. If you can purchase only one program at a time, find out what other available companies’ software will work well together with your planned system. For example, if documentation software is integrated with billing software, then the charges and diagnoses entered into the documentation software for today should appear in the billing software at the front desk. Another good feature to look for in your billing software package is a way to review claims for their accuracy before they are printed or sent.

What are the most common mistakes or misconceptions doctors make or have when purchasing billing or documentation software?

Fernandez: They let the software salesperson tell them what they need. Instead, seek the advice of a consultant who has the experience of thousands of practices operating on various computer systems.

Leiberman: If the software is not intuitive to use, you will spend many hours on the phone with technical support, which is not usually cheap. Also, as office staff turnaround occurs, retraining your staff can become a significant expense if the program is not easy to learn or use.

Sanna: Doctors should be careful to check references and not to make an impulse buy without doing your research. One of the most common misconceptions is that if you have the right software, the practice will run itself. Doctors may try to use state-of-the-art software on antiquated hardware with poor results. Always check on the system requirements of the software.

Turner: The most common mistake is looking for the cheapest software available. Another mistake is thinking that a software program will solve all of our practice management problems. Last, assuming that your staff is computer literate does not mean that they will not need training on billing or documentation programs. Empower your team to be trained properly even if this is an extra expense above the purchase price of the software.

What are the costs associated with purchasing a new program or an upgrade?

Fernandez: We typically allocate $2,000 for a new software program and first-year support. However, this will vary according to type and size of the practice. The expense of an upgrade will vary according to its purpose. If an upgrade doesn’t offer a benefit to you that is worth more than what you will have to pay for it, don’t buy it.

Leiberman: My new program is $199. Upgrades are 50% reduced from retail price, and there is no charge for bug fixes.

Sanna: Hardware upgrade/replacement costs can run as much as $1,800 for a new business-grade PC, and sometimes a server ($2,500–$8,000) is required. The software cost is the basic cost of using the package on a single computer. Some companies charge a license fee to use their software on multiple computers. If you don’t have cash on hand to finance your purchase, some practices find leasing an attractive alternative.

Turner: Some of the costs in purchasing new software programs and upgrades may be in hardware—upgrades in faster computer stations, a newer version of Windows®, more computer stations, a larger server to handle the increase in storage space, etc. Also, an additional expense is purchasing more user licenses (workstations) above the allowed limit.

What technical and customer service should DCs expect from a software company? Are there any fees involved?

Fernandez: Ask for names and telephone numbers of DCs currently using the software in your area, call them, and ask if they are happy with the support and how long it took the company to respond to and/or resolve problems. You also want to make sure that their telephone support is available to you during the hours that your practice is open. After your initial start-up period, you should expect to pay a yearly fee for good support.

Leiberman: Bug fixes should be free. Technical support should be available by email for a lower cost and options other than a 1-year contract. Tech support should be available by phone on at least a quarterly basis.

Sanna: Be sure that you can receive quick, friendly, and ongoing software support. Software support is added cost and training. Updates to the software should be included in the service contract and should stay current with legislation. DCs need to remember that software companies are not hardware support.

Turner: Obviously good customer support and availability are important. What is the customer support availability during your normal work hours? What support and training do they provide or include in the initial purchase of the software? If is inevitable that you will most likely have to purchase support contracts at an additional fee. Many support contracts include your upgrades with training for free or at a minimal charge.

How has HIPAA affected current software? What advice do you have for upgrades and HIPAA compliance?

Fernandez: Use only HIPAA-compliant software. It is the only way to be able to efficiently abide by these federally mandated regulations.

Leiberman: Password protection is the key to your HIPAA compliance. Every time you launch your program, you need to enter your personal password. Until you exit or quit the program, that password gives you automatic access. Unauthorized access becomes highly unlikely with this simple system in place. Your computer should be set up to go to a screen saver or a blank screen when not in use for a minute or two.

Sanna: Electronic claims processing is the way of the future, and it is important that the software program that you purchase is able to handle electronic claims in a HIPAA-compliant manner. Already, major insurance carriers have made electronic claims submissions using the new HIPAA X12N Standards, a requirement as the sole form of reimbursement. This precedent is sure to be followed by the other major insurance companies.

Turner: The main changes that you will notice will be security changes. The current software should have security sign-ins for authorized personnel. Also, any entries by an authorized user can be tracked. Any file with additions or deletions will be tracked to that user as well as the length of time that was spent in that file

What legal or legislative changes do you see that will have an impact on billing and documentation programs?

Fernandez: In 3 to 4 years, most insurance carriers will require electronic claims submission, just as Medicare and some carriers do now.

Leiberman: As CPT codes change or WC forms change, your program will need to be flexible enough to handle that change or offer minor updates to meet those changes.

Sanna: Data security is the next big thing. Some states have stricter laws than HIPAA (Georgia, California, and Texas to name a few) for privacy and security. This will impact software programs in kind with more security requirements in information access and billing, both paper and electronic. There are always changes to the way Medicare and Medicaid require billing to be done, as well as WC. PIP is also likely to amend its billing requirements. These changes will require software to be updated to meet the new requirements.

What technological advances do you foresee for practice software?

Fernandez: Improved touch screen and voice recognition systems at affordable prices. Improved portability and networking, where doctors can use a small remote device to instantly input and access all information from their computers at the touch of a screen. This system will also allow doctors to instantly communicate with their staff by paging or as an instant screen pop-up on the staff’s computer.

Leiberman: I foresee a program that will do most of what you need in practice software, extremely easy to use, and at a cost just the price of a few office visits.

Sanna: Technology will streamline the patient check-in process. Patients will use a smart ID card with an imbedded computer chip that contains all of their personal health information. In some practices digital radiographs have already replaced traditional film-based systems. Digital systems provide greater control over the image while decreasing the patient’s exposure to x-rays. The digital images can be stored on CDs, inserted into narrative reports, and transmitted online to radiographic experts for additional analysis when required.

Turner: Handheld documentation integrated with billing is an exciting advance that can increase efficiency. Software is in the marketplace that provides a check-and-balance system for the appropriate amount of documentation to the code being billed and matching the level of service or services to the diagnosis. Systems are moving toward a paperless office where all files can be stored on the computer, with the ability to scan other documents directly into the patient file. Voice recognition is improving for dictation of notes into the computer and eliminating the need to outsource this service. I think we can look forward to many time- and cost-saving additions into our offices with the advent of increased technology. CP

Julie Z. Lee is a contributing writer for Chiropractic Products.