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CAP TODAY Product Guides

Cortex Medical Management Systems, Cortex Medical Billing RCM+

Billing/Accounts receivable/RCM systems, May 2017

Contact Information

Cortex Medical Management Systems
Carrie Cohen
2107 Elliott Ave., #207
Seattle, WA 98121

Name of billing/accounts receivable/revenue cycle management system Cortex Medical Billing RCM+
Configuration of billing/AR/RCM system available as a standalone product that can interface with other companies’ central LISs or EHRs and as a dedicated Cortex module
• Percentage of billing/AR/RCM system clients that use another company’s LIS 40%
Year company began selling billing/AR/RCM systems 1983
Most recent billing/AR/RCM system installation (based on March 2017 survey deadline) March 2017
Last major release or update of featured billing/AR/RCM system
No. of contracts for sites operating billing/AR/RCM system 39
• No. of sales of billing/AR/RCM system between March 2016-March 2017 3
• No. of installations of billing/AR/RCM system between March 2016-March 2017 2
No. of sites operating billing/AR/RCM system (HL/IL/PP/PO/OL/FI)* 39 (0/0/37/1/1–emergency room/0)
Market billing/AR/RCM system outside the U.S. no
Human languages (other than English) supported by system
No. of inpatient invoices handled by installed sites annually
No. of outpatient requisitions handled by installed sites annually average, 75,000
No. of user workstations in sites operating billing/AR/RCM system 1–26 (average, 8)
No. of employees in company 13
• No. of employees dedicated to billing/AR/RCM system development, install, support 5
Provide list of client sites to potential customers on request yes (with approval from clients)
Clients restricted from sharing with others their experience with company or software no
• Patient demographics transferred via interface from LIS to billing/AR/RCM system installed
• 1500 claim form generation (paper version) installed
• UB-04 claim form generation (paper version)
• Client invoice generation installed
• Patient or family invoice generation installed
• Generate reprints of claim forms and invoices on demand installed
• Key indicator tracking (online view of site-assigned key indicators) installed
• Billing by test profile installed
• Component billing installed
• Medical-necessity screening for Medicare
• Professional component billing installed
• Auto delete of nonbillable procedures
• Billing for technical component only installed
• Retain demographic data for repeating patients installed
• Account and patient payment posting
• Accounts receivable system installed
• Management and/or marketing report generation installed
• Automatic balance billing to patients installed
• Capitation billing plus billable tests installed
• Generate utilization reports for managed care installed
• Generate global charges for lab tests installed
• Unlimited user-defined fee schedules installed
• Track financial classes installed
• Allow open-item accounting (each line item on bill can be handled separately) installed
• User report writer installed
• User-defined collection system installed
• Client services or call tracking module installed
• Credit card processing
• Business analytics
• Patient Web portal
• Benefit eligibility checking available via another of company’s products
• Guarantor billing
Means by which billing/AR/RCM system tracks profitability test, payer, client (user’s choice)
Advanced system capabilities rules-based processing, claims scrubbing, bundling/unbundling
Standards and coding systems supported HIPAA transaction sets, ICD-9-CM, ICD-10, CPT
System supports electronic data interchange with third-party payers and claims clearinghouses yes
• Electronic functions offered claims, payments, rebill, others
Third-party rules and coding updates supported by system
Billing/AR/RCM system provides indexed field in each test definition for LOINC code
• Provides LOINC dictionary for each new installation no
Client receives copy of source code placed in escrow
Methods by which users can tailor billing/AR/RCM system in their own setting wraparound programming, ad hoc query tools, user-defined interfaces, dictionary settings
Billing/AR/RCM system received ONC-ATCB certification
Billing/AR/RCM functionality available via ASP or cloud-based data center available as a local server or an ASP or cloud-based product (client’s option); for the latter, installation, training, monthly maintenance fees based on number of users
Total cost for smallest standalone billing/AR/RCM system install** $35,000 (annual fees, $10,000)
Total cost for largest standalone billing/AR/RCM system install** $250,000 (annual fees, $45,000)
Total incremental cost for smallest install using billing/AR/RCM** as a dedicated LIS module $35,000 (annual fees, $10,000)
Total incremental cost for largest install using billing/AR/RCM** as a dedicated LIS module $200,000 (annual fees, $40,000)
Distinguishing product features (supplied by company)
* HL=hospital labs, IL=independent labs, PP=pathology practices (only surgical pathology/ cytology services), PO=physician offices, OL=other U.S. locations, FI=foreign installations
** total cost includes hardware, software, installation, and training
Note: A dash in lieu of an answer means company did not answer question or question is not applicable.
All information is supplied by the companies listed. The tabulation does not represent an endorsement by the CAP.