From: Jeff Fagerman [jafager@hiwaay.net]
Sent: Monday, November 20, 2006 9:47 AM
To: support@remsys.com
Subject: MedLook 3.0.97 - ready for NPI

Good day MedLook Users.
This is started out as a brief note to inform you of the recent changes in MedLook in 3.0.  Well, my brevity fell to pieces and this has turned into an essay.  In any case, I hope you will find this information useful.  Most of this will eventually makes its way into the Help files and the manual.

NPI CHANGES FOR THE CMS 1500 REVISED FORM

In providing for the NPI fields changes have been made to the following dialogs:  Edit Doctor, Edit Referral, and Edit Hospital.  Each of these now includes the NPI data field.  None of the other items have been removed and will remain until they become obsolete.

In addition to entering the NPI fields you must set the HCFA Options::Layout for insurance claims to point to an NPI enabled layout file.  A default file is provided as c:\program files\rem systems\medlook\template\CMS1500NPI.xml.  This file sets up the electronic portion for claims generation.  I have not yet taken the effort to modify the printed portion to be "close" to the final (as you know every printer behaves a 'little' differently) layout required.  Furthermore, when you display the claim a NEW button is available. If you select this button the new NPI-ready 1500 form is displayed.
 
Primarily the NPI changes include:
    Box 17 a/b - UPIN & NPI
    Box 24 c - TOS has been dropped, EMG is now in box c
    Box 24 e - pointer to box 21 only, no more codes allowed
    Box 24 i - top is for special coding, etc.
    Box 24 j - top for old 24k info, bottom for NPI
    Box 24 - top of a-h for supplemental information.
                    to enter this information the Charge Notes must begin with an "!".
    Box 32 a/b - NPI and old info
    Box 33 - phone number is above all other fields in new position
    Box 33 a/b - NPI and old info
 
Also worth noting is that if you display the old form with the old layout the items in box 33 will appear to be lower than they used to be.  In fact they are not.  The old background 1500 image was stretched in this area and I had to compensate for it before.  Since I now support both the old and new form I cannot make exceptions for the old form.  The data is still in the right place in the file but looks out of place on the form.  Of course, you can move the fields up if you wish.
 
LAYOUT EDITING
 
You will also notice that the HCFA Options no longer has Configuration, Y Values, X Values Part 1, 2, and 3.  These have been replaced by the Layout files.  The disadvantage of this change is that it is... CHANGE.  Plus no longer are items grouped per logical line on the form.  This was becoming a problem as certain carriers were making life more difficult by changing the vertical alignment of some items on the form that seem to be in alignment but they only wanted half the line moved.  Now every item can be completely and independently manipulated.  Fortunately, using XML Notepad still makes changing an entire line quite easy.
 
To edit the layout files you need to download and install www.remsys.com/xmlnotepad.exe.  Then you need to use ML Tools->Options::Misc Options::Layout Editor and set it to c:\program files\xml notepad\xmlpad.exe.  Henceforth, whenever you need to edit a layout for patient billing or insurance claims XML Notepad will be invoked.  This is a VERY simple editor - DO NOT BE AFRAID.
 
1500 LAYOUTS - EDITING AND DEFINITION
 
The insurance layouts have two sections:  Electronic and Paper.  Additional sections can be added but these two MUST be present and their names are case sensitive.  If you need to experiment with a section but don't want to completely get rid of the current values you can easily duplicate an entire section.  Right click on the folder icon to the left of either of these sections and select Duplicate.  You can then rename the duplicate (e.g. PaperDup) so you can retrieve it later if needed.
 
ELECTRONIC ALIGNMENT
 
The Electronic section considers all Top, Left, Width, and similar fields in regards to characters.  The range for Left is from 1 to 80 characters (1 being the far left and 80 the far right).  The Top ranges from 1 to whatever NumLines is set to.  This value cannot exceed 66 though.  Basically an electronic page cannot exceed 80 characters wide by 66 lines.  The page can be shortened by setting NumLines to some value less than 66, typically 62 or 63.  Top starts with 1 at the top and NumLines down the page.
 
The Electronic section allows you to move the top and left of each item by a single line or character.  You can move all the data fields by altering the top and left fields that appear as data elements of Electronic (you should edit these using XML Notepad as mentioned above).  You should not set either of these to a value less than 0 (that just doesn't make sense).  Additionally, this is where you define how many lines are in an electronic claim (usually 62 or 63) and also the three claims files used to store the generated claims (Claims-File1, 2, 3).  You should provide a full path as c:\claims\claims.txt or something like that.
 
PAPER ALIGNMENT
 
The Paper section measurements are all in regards to hundredths of an inch (0.01 inches).  The Top is 0.00 and the Left edge is 0.00.  The bottom right corner would have Top = 8.50 and Left = 11.00 for an 8.5 x 11 sheet of paper (a typical 1500 form).  Since each field can be controlled to within 0.01 inches every item can be placed in near perfect position on the 1500 form.  To move the equivalent of one character horizontally change the Left value by 0.10 (roughly 8.5 inches divided by 80 characters).  To move the equivalent of one line vertically, change the top value by 0.17 (11 inches divided by 66 lines).
 
1500 LAYOUT DEFINITION
 
If a field appears as a boolean (yes/no, true/false) type of field then generally a 0 is false, and anything other than a blank or 0 is true.  You should use 1, or True, to denote a true value.  For instance, Box24aCopyFromIntoToIfEmpty is 0 (false) if you do not want to automatically copy the data from box 24a "from" into the "to" data field if the "to" date field is empty.  If you do want to automatically copy it, then set the value to 1.
 
Likewise, Box13PrintSignatureOnFile is generally 1, meaning you do want to print the Signature On File in box 13.
 
Beyond this each area of the 1500 claims form is logically grouped by its area.  For example, Box1 has the following elements:  Medicare, Medicaid, Champus, Champva, GroupHealth, Feca, Other, aInsuredsId.  These are all elements anybody working with the1500 form should be very familiar with.  There is nothing new here.  Each of these elements in turn have attributes for Top, Left, Width, and Visible.  In general you would want to leave the Width blank (automatically determined), Visible is generally 1 (you want to print it if appropriate), and the Top and Left should be set to their proper position in the file to appropriately fill their respective areas.
 
FORMATTING 1500 FIELDS
 
Formatting the data allows for much more flexibility than before.  Let's look at formatting dates first.  Box 3 has a DOB field. The additional field is Format.  Normally it would be something like "mm dd yyyy" to print 2-digits for the month and day and 4-digits for the year with a space separating each field.  If you needed no spaces and only 2-digits for the year you could use "mmddyy".  There is a lengthy section of comments in the layout file giving further formatting details for dates.
 
Formatting phone numbers is very flexible.  Typically you may want to have the area code separated by a space followed by the 7-digit local number.  You do this simply by setting the Format to "@@@ @@@@@@@".  The @ sign is used to print a character in this position starting from the right.  Alternatives include, but are by no means limited to:
    "(@@@)@@@-@@@@"
    "@@@.@@@.@@@@"
 
Formatting numeric fields.  To provide the greatest flexibility, all numeric fields (box 21 codes, $ fields, etc.) use the same strategy as phone numbers.  Here are a few examples of how to format $12345.67:
    @@@@@@@    gives    1234567 (no spaces or decimals)
    @@@@@.@@   gives    12345.67 (a decimal/period included)
    @@@@@ @@    gives    12345 67 (a space included) 
 
Sometimes printing requires filling from the left, not the right, as in printing Box 21 codes.  In this case the last character should be an "!".  For example, a typical format may be @@@@@@!.  Here are a few examples using "@@@@@@!":
    If the value is 123.00 the output is "12300 "
    If the value is 123 the output is "123   "
    If the value is 123.5 the output is "1235  "
 
SPECIAL FIELDS/BOXES
 
Box 5 Phone.  There have been requests in the past to allow for determining which phone number from the patient data prints in this field.  To allow for all possible combinations the following fields have been added for this box:
    None
    WorkOrHome
    WorkFirst
    WorkOnly
    HomeOnly
If None is true, then nothing is printed.
If WorkOrHome is true then we follow these rules.  If WorkFirst is true AND there is a work phone number then the work phone will print; otherwise the home phone will print.  If HomeFirst is true the opposite rules apply.  If neither number is available nothing is printed.
If WorkOnly is true, then only the work phone number will print.
If HomeOnly is true, then only the home phone number will print.
 
 
Box 24 has six (6) lines.  Each line and each field in the line must be edited individually.  The Top values for each line should be constant throughout the line (at least that makes sense).  Still, you cannot change only one item and expect the rest to "follow" it.  Each item must be changed individually.
 
Box 14 Type.  Recently there has been a request to print textual information in box 14 to the right of the red triangular widget to clarify the data entry.  If this box is set to true (1) then the following information will print:
    I if Illness,
    LMP if Pregnancy
    A if accident
 
Box 17 ReferralNPI.  The new field is printed using this field. 
 
Box 24 Line 1...6 dCPT/dModifiers.  By default the modifiers will print as necessary with the CPT values.  However, it is possible to control the format of the modifiers separate from the CPT values.  If the modifiers are enabled (visible set to 1) then the CPT width should be shortened to the five (5) character field width required for the CPTs.
 
Box 24 Line 1...6 NPI.  This field is available and ready.  The field directly above it is used for the old numbers and additional qualifiers.
 
Box 24 Line 1...6 cTOS/iEMG.  On the new 1500 form the TOS field is no longer available and the EMG field has been moved to this location.
 
Box 32 NPI.  This field is available and ready.
 
Box 32 Phone.  This field is typically turned off but is available if required.
 
Box 33 NPI.  This field is available and ready.
 
Box 33 Phone.  The phone number on the new 1500 form appears on the first line of box 33.
 
 
XML NOTEPAD
 
Using XML Notepad has some real advantages.  For instance, all the items on any one of the box 24 lines can be quickly changed to a new value by using the Edit Replace feature and selecting Content in the Search In boxed area.  Simply enter the first value (The Top of Box 24 Line1 aFromDate) and Search and Replace like you would in any other document (replacing all of the remaining Top values only for Box 24 Line 1).  Exercise care when doing an operation like this to make sure you are only changing the values in the boxes intended.  Similar operations can be performed on vertically aligned fields.  For instance, changing the left value for items in boxes 2, 5, 9, 17, 19, 25 and 31 can all be done very quickly.  Simply select the left value in Box 2 Patient Name and begin Search and Replace on matching values, replacing with your new value.  This was impossible with the older dialog.
 
 
PATIENT FORMATTED BILLS
 
The formatted patient bills (batch or individual) can now also be reformatted (within reason).  There is a layout file that allows you to move data very much like defined above for the 1500 form.  In the patient bill layouts there are two sections:  PreprintedPatientBill and BlankPaperPatientBill.  Editing these files follows pretty much the same rules as for the Printed section of the 1500 - everything is done in inches (so they go to a printer).
 
Some things worth noting include the Top and Left properties of each section.  You can set these to less than 0 if necessary.  However, it would be better to change the Page/Margins fields instead.  By default the margins are all 0.50 inches which is pretty typical.  Changing the margins will affect the entire document just as it would in Word or on a typewriter.
 
For most fields there are two related items.  For instance, PatientNum and TitlePatientNum.  PatientNum is where the actual patient number will print.  The TitlePatientNum is the shaded box containing the similar title.
 
In addition to having the typical Top, Left, Width, and Visible fields patient bills also have Height, Title, Bold, Italic, Underline, FontName, and FontSize.  Height is similar to width and will rarely if ever be changed.  Bold, Italic, and Underline are all booleans (0 is false, 1 is true).  These give basic formatting features.  FontName and FontSize are similar to what you'd find in Word giving additional flexibility to every field.  Title may be of more interest to some than others.  For instance, there have been requests to change the text in the "Payment Due Now" field.  This can now be done easily.  Simply select the proper section and TitlePaymentDue.  Select the Title field and change the value from Payment Due Now to whatever you would prefer it to print.
 
Most of the items are named in such a way that with just a minimum of tinkering you can figure out what you're changing.  Always keep a backup of your latest layout.
 
 
DEFAULT TEMPLATES.
 
Default templates can be found in c:\program files\rem systems\medlook\template.  These should not be overwritten.  Additionally it is not recommended to point to these layouts for regular usage as software updates may overwrite these.  If these are by some accident corrupted, there are copies of the originals in the template\defaults folder.  If these are additionally messed up then the only recourse to recovering these files is to copy them from another computer, re-installing the software, or emailing us for the defaults.  The defaults will eventually be posted to our website as well.
 
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RECENT MEDLOOK RELEASE NOTES

November 16, 2006 - Version 3.00.98

Layouts.  Fixing inconsistencies in the delivered layouts, particularly for printing the 1500 forms.

Procedure Code Sub-folders.  Added Collected, Patient Due, and Ins1 Due to the Financial sub-folders for procedure codes.

Patient Batch Billing.  If disabling the Aging Balance display but enabling the aged comments, the comments would not appear.  The problem was that the software was not computing aging at all so therefore the aged comments could not be shown.  Now aging is computed if either of these are enabled.  It is only shown if Aging Balance is checked.

Edit Procedures.  If displaying some of the procedure codes sub-folders an error would occur trying to open the code for editing.

Procedure Code sub-folders.  Three additional sub-folders have been added to the procedure codes:  Proc Payments, Proc YTD Payments, Proc Last Year's Payments.  These differ from the "Financial" sub-folders in that the computed amount is the amount COLLECTED during the given time period which may be considerably different than the DOS.

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November 13, 2006 - Version 3.00.97

Utilities.  To the utility "Write-off open charges with insurance due" some changes have been made to add more flexibility.  It is now called "Write-off open charges" with the additional options of:
        With Primary Insurance Due
        With Secondary Insurance Due
        With Patient or Other Due

Patient Formatted Bills.  Added ability to change page width and top, left, right, bottom margins.

Credit Card Processing.  Added X-Charge interface for credit card processing.

Layout Editor.  Since Windows only cooperates 50% of the time with the Edit Layout command in patient and insurance billing (both individual and batch) an field was added to the Options dialog to select an appropriate XML Layout editor.  By default this field is blank and will therefore, or should anyhow, default to the pre-set XML editor.  However, since this fails so often you should point this to either MSWord.exe or install XML Notepad and point it to c:\program files\xmlnotepad\xmlpad.exe.

Insurance Claims.  Fixed problem in data files when Saving to a folder other than the default folder selected.

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October 30, 2006 - Version 3.00.96

Added NPI numbers.  NPI data fields have been added to the Edit Doctor, Referrals, and Hospitals.  In addition these numbers are printed as appropriate on the CMS 1500 form if selected an NPI enabled format. 

Patient Payment.  Here's a great new change.  Added an Unassign Payments option to the bottom grid of the payment dialog.  It is instant and irreversible with no questions asked so use it with care.  The button appears as a black exclamation mark, "!", in a yellow yield sign.  This makes fixing an overpayment problem a snap whereas it used to require about 10 steps.

Database Changes.  Removed HCFA layout tables from database.  Data is now stored in XML files for more convenient sharing between databases and users.

HCFA Options.  Removed the HCFA Configuration, Y-Values, X-Values (1, 2, 3) from the Insurance Billing.  Added a path to the HCFA layout file and an Edit Button to edit the file.  Recommend using XML Notepad (Freeware from MS) as the editor.

XML Layout Files.  Added layout files in Template (and Template/Default) folders for new and old CMS 1500 files as well as for patient billing.  The patient billing layout does not allow for 100% flexibility in moving items BUT it does give a tremendous amount of flexibility in moving items in a very sensible way.  Font, Size, bold, underline, italics, captions, etc., can be changed for every field as well as format, top, left, width, and height.

Patient Summary.  Added Marital Status and Referral to Patient summary screen.

Charge Comments.  If a comment is included with the charge AND it includes an EXCLAMATION ("!") as the first character AND the Box24/Supplemental field is properly enabled in the CMS 1500 layout file then the comment will print as directed.  This allows for the top line of each of the Box 24 procedures to be filled if appropriate.

Options.  Added option to Auto-save patient notes just like Quick Notes.

Sub-folders.  Added patient sub-folders as Zero Balance Due, Zero Patient Due, and Patients Not Billed.  Also modified Transactions YTD, Transactions Last Year, and Unposted Line Items to include TrNum and POS.  Added referral fields to Transactions YTD and Last Year.

Sub-folders.  Added Ins Aging Detail.  This report has a TON of fields in it but by default shows the insurance aging grouped by carrier and patient.  A patient header line shows account #, name, DOB, SSN, Policy and Group # with each aged patient procedure still open being shown and totals presented in the footer.  An EXCELLENT insurance report.

Scheduling.  Added option in Appointments Print command to appointments by a time range.  The default is to determine the "working day" for each day but as there may be appointments outside of the typical working day some means had to be included to catch those appointments as well.  The time is entered as "8:30am to 9:45pm".

Scheduling.  Fixed a few minor bugs found in the appointment printouts.

Insurance Billing.  Fixed bug in tax id/ssn where transitioning from doctor A using tax id to doctor B using SSN would cause the Tax Id/SSN field to be set incorrectly on one of the claims.  No user ever reported this as a problem as it would be unusual to have this situation.

Patient Transactions.  Fixed bug in Bal. Err column.  It was checking for out-of-balance conditions only by looking at the LESS THAN not the EQUAL TO comparison operator.  Also added a group condition and column to the bottom grid on the same dialog so the totals are presented there for convenience.

Patient Batch Billing.  The "No Payments Since" field would also exclude accounts with no payments ever.  This has been fixed.  If no payments have been received since the data given OR no payments have ever been received the record will be included.

Patient Billing. The formatted patient bill, whether for pre-printed or blank paper, now allows you to alter the position of every field.  You can change its top, left, width, and height attributes. You can also set a field to be hidden or invisible.  The caption for "boxed and titled" fields can be changed as well.  The fields can be adjusted but not altogether moved.  The transactions for instance are restricted in movement up and down to roughly 0.2 inches.

Individual Insurance Billing.  Secondary carrier information was not being printed in box 9.

Patient Charge.  The Box24E items were not being recalled for quick and speedy entry of a near duplicate claim.  It kept defaulting back to 1.


Download and run these setups.
www.remsys.com/updates/MedLook_Setup.exe (MedLook)

www.remsys.com/xmlnotepad.exe (XML Notepad for editing 1500 and billing format files)

Jeff Fagerman (jeff@remsys.com)
Fagerman Technologies, Inc.
56 Gilchrist Road
Somerville, AL  35670
Sales: 800.548.6148 or 256.778.0521
Tech:  800.835.6680 or 256.778.0319
Fax:   256.778.0525    www.remsys.com