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Let’s face it.
A lot of what is included in the Protected Health Information
(PHI) is not critical to the day-to-day work of clinical practitioners.
We don’t see 150 patients in a week; rather, ours is a
profession of often intimate relationships with our clients/patients.
Many sessions may pass before we need to modify diagnoses, CPT
code, progress to date, prognosis, treatment plan, etc.
Many professionals simply do not need to refer to this
information as a “reminder” about the patient they are about to see.
Notes 444 automates
the PHI. Most fields are
simply carried over from note to note until you choose to modify them.
User-modifiable “Symptoms discussed” checkboxes simplify the
process. Write a line or
two and the PHI is done. Seamlessly
move onto the Psychotherapy Note.
Really easy. Notes 444 was designed to be
immediately accessible. If you can click a button and read, you can use Notes
444. Menus are almost never used; simply press the buttons so very
apparent on the screen.
Unlike other health professions, much of the
does not change therapy session to session. For many of us,
a single CPT code remains in effect during the entire course of
treatment. Similarly, diagnoses may remain intact for extended
periods of time.
This is appreciated by Notes 444. You enter this
information on the "Lookup Field" page (accessed by the
"Lookup Field button", naturally) and it automatically appears
on every session note At The Time Of Writing. Any changes
to a Lookup Field do not change past notes. So, when your patient
is cured of his Snake Phobia, and you remove 300.29 from his diagnoses,
all future sessions will display his gain, while previous sessions
At any time, you can override the entry of a Lookup
Field as a one time event. So if your typical individual
psychotherapy (90806) includes a family member, simply click on the
field and choose 90847. Future sessions will not be affected
unless you change the value of the Lookup Field.
Absolutely. Notes 444 is designed to be
user-friendly while simultaneously completely customizable. Want
to add a diagnosis or remove a CPT code that you never use? No
Simply click on the field and type away. Hey,
you never know when you have to diagnose Elephant Impersonation Syndrome
There are many data fields that a minority of users
want or desire that we carefully considered and decided not to include.
As an example, consider the inclusion of a pulldown list for GAF (Global
Assessment of Functioning.) We did not include a GAF pulldown for two
reasons: 1) The majority of our users do not routinely include a GAF
score in their daily session notes. They would regard a pulldown list
that they do not use appearing in every note screen as an annoyance and
a waste of the very limited screen real estate. 2) A pulldown list that
includes 100 entries (1 - 100) is not ergonomically effective; it is
easier to type a number from 1-100 than select it.
However, the "PHI Templates" feature is
perfect for this use. By HIPAA definition, the GAF must be part of the
PHI, and cannot be limited to the Psychotherapy Note. Add the heading,
"GAF:" to the PHI Templates section of Global Settings. The
heading will appear in every PHI text box and it will be an easy matter
to insert the GAF value. The heading for almost any specifically desired
field, such as "Participants:," "Start-Stop Times:,
"Medication Notes:" etc. can be placed in PHI Templates and
will then become a custom field.
No need to even use your mouse. When a field is
selected, either automatically (as in the case of the Patient Name field
in either the Read- or Write-Notes windows) or by tabbing between
fields, you merely have to begin typing the desired choice. As
soon as you have entered enough characters so that the choice is unique,
it is selected for you; press return and the correct choice is entered.
For example, if you have two patients with the names
Smith and Smythe, once the Patient Name field is selected you merely
type “S”, “M” and on the input of the third letter, the correct
patient is chosen for you. Your hands never have to leave the
This is a handy field for you to quickly enter the
symptoms actually addressed during the course of your session. It
is a completely modifiable checklist. You may change both the
labels of columns and the symptoms that follow each label; the default
information is only given to you as a place to start.
Such customizability recognizes the fact that our
practices vary greatly. If you work with the developmentally
disabled, you might want to have a column of ADL's. The
interpersonal difficulties of a child might not merit the same symptom
characterization as that of an adult. If you do not deal with
psychotic disorders, you may wish to remove psychotic symptoms.
You decide what, and how many symptoms will appear for you to check off.
When it comes time to print out the PHI, only the
selected symptoms appear; the checkboxes are gone.
The text box frame is only a visual reference; there
are no practical limitations on size of entry.
Simply type, and a scroll bar will appear if necessary.
The Important Info field is always in view when you read your session notes. It is not part of either the PHI or Psychotherapy Note. This is the place to put reminders or cues.
You many enter data as a Lookup Field, so the reminder automatically is inserted for each session note (until you choose to remove it.) Some helpful uses include:
Anniversary of a death, trauma or critical event
You may also enter information directly into the Important Info field. This will only appear in that note. This is useful when you desire a reminder for the next session only. This can include a question to ask or topic to follow up.
After beta testing, it became clear that no matter how
elaborate, no matter how thorough, individual preferences on these forms
were so vast that a satisfactory template simply could not be generated.
So the solution to this problem is simple. Customize
your own template in your word processing program (if you haven't
already done so.) Then generate the appropriate Intake, Testing or
Discharge summary as needed, and simply cut and paste this formatted
text, in its entirety, right into the PHI field. Remember, HIPAA
requires this information to be part of the PHI.
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Not unless you reveal your password, which is required
when you open Notes 444.
Press a button, and a backup copy is made. If
you like, add a date and you can have a paper trail of serial backups.
Notes 444 is a FileMaker Pro runtime application.
FileMaker is one of the oldest names in personal computing, providing
product upgrades and backward compatibility since the mid-eighties. It
was the reason we choose FileMaker Pro for developing Notes 444.
Notes 444 makes it easy for you to change your
password. Select Global Settings:Personal Preferences. Enter your old
password (the default is "psyche"), your new password and
watch as Notes 444 changes your password on every protected file.
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By doing everything!!! Every time you write a note
with a valid CPT code, a charge is automatically created. And Notes 444
is really smart. It knows that you do not charge all of your
patients/clients the same fee. And that different fees apply to
different CPT codes. So if you want to charge Sally Smith $100 for
individual therapy and $125 for family therapy, while Tom Jones is
charged $150/$175, Notes 444 will automatically charge the correct fee
based on name and CPT code.
Notes 444 handles this automatically. Indicate the total fee and co-pay amount for each
patient/client for each applicable CPT code just once, and the correct
fees are automatically charged.
Three separate bill formats
are available for your patients/clients:
The CMS-1500, which
replaces the HCFA-1500 (the standard, universally accepted insurance
form,) and is mandatory as of April 2, 2007. It can be printed in
Medicare-required Flint Red or black ink. It is printed on plain
paper; no need to purchase forms.
A Co-Pay bill, designed for
your patient/client, indicating the amount anticipated from the
insurance company, their fee responsibility, any payment made, and both
total and patient responsible balances.
A No-Insurance bill, for
patients/clients without third-party payer involvement.
Set one or more of these
bill types as your patient's/client’s default, and Notes 444 knows
which bill formats to print.
After you set your patients’/clients’ default choices, (i.e. amounts
per CPT code, which fee statement(s) to use, etc.) you can batch print
any or all of your bills for any time period with a click of a button.
The task of monthly bill printing now takes five minutes.
Click a button. The CPT code is replaced with
PC/NS-C (Patient Cancelled/No Show – Charge).
Contact (or any other text indicator) and no charge will be created.
Readily available glassine
window envelopes allow you to simply fold and go.
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Now Notes 444
really shines. Given that
insurance companies are asking for records simply as a means of auditing
(to insure that billable sessions have actually taken place), therapists
must be certain to take advantage of their Psychotherapy Note Exemption.
Click a button, select a patient and a date range, and
automatically get a printout of just the PHI;
your Psychotherapy Notes are always stored in a distinct and separate
Click a button. Type
in a date range. The number
of billable sessions instantly appears.
one of the many advantages of electronic notes.
Click a button, enter a date and identifier (i.e. four weeks, OTR
due), and you will receive a timely reminder.
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The Federal Health Information Portability and
Accountability Act, whose Privacy regulations took final effect on
"Protected Health Information." For
all non-psychotherapy health fields, it means the whole chart and any
other information about the client/patient. For professionals
legally engaged in the provision of psychotherapy (psychologists, social
workers, psychiatrists, etc.), it refers to all of the Health
Information not specifically addressed by the Psychotherapy
Given the highly personal and sensitive nature of
psychotherapy, HIPAA includes a Psychotherapy Note Exemption.
Critical information, such as that of process notes,
transferential content, and other delicate data can be maintained
separately from the PHI. Some
data cannot be restricted from the PHI, such as date and times of
session, Progress to date, Prognosis, Treatment Plan, and other information;
these restrictions are determined not only by HIPAA, but state laws.
In order to employ the Psychotherapy Note Exemption,
you must maintain a separate and distinct file.
Notes 444 accomplishes
this by keeping psychotherapy notes in a completely distinct electronic
file, the electronic equivalent of two manila folders.
You must generate this separate file content at the
time of writing your session PHI.
Only you can truly answer this question, with the help
of legal counsel from your attorney, your national and state
But consider the following scenario — psychotherapists need to be prepared for
unprecedented requests for complete PHI records.
All fields of medicine are subject to such requests. Even if you technically do not need to be HIPAA compliant,
you may find yourself in the position of arguing this fact with third
party providers. They will
be accustomed to requesting the PHI. If they withhold reimbursement while you argue the point, and
tell your patients that “they will not be receiving payment because
their provider is not supplying the necessary health records”, will
you be jeopardizing your ongoing service?
If you have nothing to do with insurance companies and
run an all-cash practice, many of your patients will still be submitting
your fee statements directly to their insurance providers, who then may
be asking for the PHI.
Legal opinion has been put
forth that HIPAA requirements may well be argued as the defacto
definition of Usual and Customary Practice, since all fields of medicine
will be in required to comply. If you should end up in court for
any reason, the cross-attorney will likely address lack of HIPAA
compliance; will the judge and/or jury be receptive to the argument that
it doesn’t apply to you?
There really is good reason
why all of the therapy professional organizations strongly recommend
that all psychotherapists be HIPAA compliant.
If you do not keep a separate and distinct
Psychotherapy Note file, you do not qualify for the Psychotherapy
Note Exemption. This
information cannot be culled out later, but must be generated at the
time of note-taking.
Authorizations (Release of Information) can no longer
be signed once for the life of the psychotherapy. Authorizations must
automatically expire, and it must say so on the form. The actual number
of days for auto-expiration is determined by your state.
Notes 444 asks you to set your authorization
field value in the Global Settings (or be conservative and use the 60-day default.)
Fifty days later (or any date you set,) you will receive a timely
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The download version is fully functional.
Enjoy reading through the psychotherapy
sessions of some Middle Earth patients, and begin to enter your own
clients/patients. If you
decide to purchase Notes 444,
you will not have to reenter any data.
You will simply continue your newfound ease of practice.
It is already included in your 30-day trial.
Not a problem.
The price of $325 for Notes 444 and $150 for
the Billing Module are the only charges for a single user license. No
annual fee is assessed. While you may make copies for your own personal
use, and maintain it on both your office and home computers, we ask that
you respect our intellectual property and not give Notes 444 away
except as a demo copy.
To date, we have not charged one penny for upgrades;
not for minor upgrades, and not for the major changes in the current
revision to v.2.xx. Despite the fact that v.2.xx has much greater power
and features including automatic bill printing, and the cost was
increased by $150, we gave this upgrade to our previous registered users
at no charge! Our users are loyal to us, and a large portion of
our sales comes from word of mouth. Consequently, we are loyal and
responsive to our users.
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Notes 444 is native for both PC (XP and higher) and Mac (OS 10.X)
We will respond to you within 3 business
days. (Most of our responses are same day.)
** Your privacy will be respected. Your email address will
not be shared.
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