Global Economy

We have all heard that we are a "global society" and this includes healthcare. Today we see hospitals using overseas radiologists to read radiology films in the middle of the night, and physicians sending their transcription work to India. This trend has also become popular with billing companies and collection agencies. For billing services, this may include using an overseas company to handle the entire claims billing process or maybe just certain portions of their work such as payment posting. This practice has been termed offshoring. While RADMAX realizes that we live in a global economy, we are concerned that many people who use billing services are unaware that their claims are offshored.

There are many reasons why companies are starting to offshore their work. Most, if not all, reasons are economic. For many companies located in bigger U.S. cities, the availability of talented, dependable workers at a reasonable pay scale has become increasingly harder to find. Because of this, many companies are looking to overseas help to fill the void. RADMAX does not outsource or offshore any of our billing and we write this into our client contracts. We even go as far as to obtain permission from our clients before we use any outside consultants or additional services (i.e. collection agency or coding consultant).

Because we are located in Tyler, Texas, the cost of living is very affordable and, therefore, pay scales are reasonable. We also have a large talent pool in this area with three large hospitals and many physician clinics and offices. Healthcare is one of the most prominent businesses in Tyler and employs a large part of the working population. RADMAX believes in giving local talent the opportunity for jobs. We stay competitive by reducing costs using technology to streamline processes, not by using overseas help.

HIPAA and Security Issues

We are not aware of any laws that say billing companies cannot send work overseas to such countries as India, but this may change in the future. Sen. Hilary Clinton (D-N.Y.) and Rep. Edward Markey (D-Mass.) recently introduced bills in Congress that affect offshore teleradiology services under HIPAA. The bills would require patients to provide written consent for any radiology read that is sent overseas. Another concern we have is governing law for other countries in the event of a problem - basically, how do you impose U.S. law on another country? What about computer security?

With all the news today about identity theft on the rise, RADMAX takes security very seriously and want to take all steps necessary to protect our clients' data. Call us control freaks, but we like having control over our own computer systems, located in house. We also feel that the more "hands" in the billing process, the more chances for problems. RADMAX, LTD is dedicated to providing the best service possible and maintaining the confidentiality and security that our clients have come to depend on.

ASP (Application Service Providers)

Another recent trend is to use an Application Server Provider (ASP) to basically rent billing software and computer space on someone else's server. This has become popular because it keeps a new company from producing a large up-front investment that is necessary for computer servers, databases and billing software, not to mention security needs and IT support services. Typical ASP providers will charge a flat monthly fee or per user fee to their clients and the billing service simply dials into the off-site server through a high-speed connection to work accounts. While one advantage to this type of service is cost savings, the disadvantage is flexibility - you cannot easily tweak the system yourself and you have little control over such areas as security!

Early on, we made a decision to purchase our own in-house servers, which are stored in a climate-controlled, safely secured area of our building. We use Dell PowerEdge Xeon P4 dual processor servers with battery back cache for embedded RAID. For data protection we follow strict standards for backups, including a weekly complete backup and nightly incremental backups. Our backup software is Veritas, which is the industry standard, and all backups are kept off-site in a fireproof vault.

For our billing software, we utilize an award winning, fully HIPAA compliant, next generation software program called A4 HealthMatics Ntierprise. This state-of-the-art Microsoft Windows based product is developed on an n-tiered architecture with Visual Basic 6.0, COM 6.0, COM + I.Q., Internet Information Server, and SQL Server. The architectural strategy called Microsoft DNA (Distributed interNet Applications Architecture) makes this product a highly scalable multi-tier solution that takes advantage of the internet and is extremely well suited for interfacing with today's wireless and internet enabled technologies.

Questions You Should Ask Any Billing Service

RADMAX believes that service oriented companies, such as a billing service, have the obligation to let potential clients know how their accounts will be handled and where the data will reside. We do suggest that anyone looking for a billing service ask these few simple questions before making a decision:

• Who is working my accounts in your company and how does the process work logistically (i.e. departmentalized or individuals(s) assigned to client)?
• Will any of my billing be offshored or outsourced? If so, how much and who is the offshore company? What is involved?
• If my billing will be offshored, whom will my patients call if they have billing questions?
• Where are your computer servers and software located (i.e. in-house or ASP)?
• If you are using an ASP provider, what steps are being done to safeguard my billing data?