Frequently Asked Questions

Table of Contents

User Ease

How does Notes 444 make my noting taking easier?

How hard is it to use Notes 444?

What are Lookup Fields?

Can I add my own additions to the pull-down fields?

Suppose I want to overwrite the available pull-down fields?

I need/my state requires/managed care demands (insert specific need here.) How can Notes 444 help?

What is “Smart Select?”

I don't understand "Symptoms Discussed?"

Suppose I want to write a note longer than the text box on the Write Notes page?

What are some good uses for the Important Info field?

Does Notes 444 provide any special type of templates for Intake, Testing or Discharge Summaries

Security and Reliability

What about security?  Can anyone read my notes?

Is there backup protection?

Will Notes 444 become obsolete? What do I do when technology becomes upgraded?

Password Protection

Automatic Billing

How can Notes 444 help me with my billing?

What about Co-Pay patients/clients?

What kind of fee statements does Notes 444 provide?

How automatic is “automatic Bill Printing?”

I charge my patients for missed sessions or inadequate cancellation notice. How does Notes 444 handle this?

What about entering non-billable data, like the content of a phone call?

What about addressing envelopes?

Insurance Company Requests

How does Notes 444 help me deal with insurance companies?

It drives me nuts to always have to count the number of sessions from the last certification period. Can Notes 444 help?

Can Notes 444 remind me when I need to recertify or submit an OTR?

HIPAA

What is HIPAA?

What does "PHI" mean?

What is the Psychotherapy Note Exemption?

Do I really need to be HIPAA compliant?

Even if I do not accept insurance?

What about HIPAA and ‘Usual and Customary Practice?

What about waiting until my client’s/patient's insurance company asks for their record?

What is the "automatic-expiration" requirements of authorizations?

Ordering Information

What features are disabled in the 30-day downloadable trial?

Can I try out the Billing Module?

I don’t like to use my credit card over the net.  Can I use snail mail?

Are there any additional fees or costs?

Other

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User Ease

How does Notes 444 make my noting taking easier?

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.

I am not the sharpest computer-tack in the box.  How hard is it to use Notes 444?

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.

What are Lookup Fields?

Unlike other health professions, much of the PHI 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 remain intact.

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.

Can I add my own additions to the pull-down fields, such as Diagnoses, CPT codes, Treatment Plan entries, etc.?

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 problem.

Suppose I want to overwrite the available pull-down fields?

Simply click on the field and type away.  Hey, you never know when you have to diagnose Elephant Impersonation Syndrome NOS.

I need/my state requires/managed care demands (insert specific need here.) How can Notes 444 help?

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.

What is “Smart Select?”

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 keyboard.

I don't understand "Symptoms Discussed?"

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.

Suppose I want to write a note longer than the text box on the Write Notes page?

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.

What are some good uses for the Important Info field?

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:

Wedding Anniversary
Childrens' Names
Siblings' Names
Anniversary of a death, trauma or critical event
Girlfiend's name.

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.

Does Notes 444 provide any special type of templates for Intake, Testing or Discharge Summaries?

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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Security

What about security?  Can anyone read my notes?

Not unless you reveal your password, which is required when you open Notes 444.

Is there backup protection?

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.

Will Notes 444 become obsolete? What do I do when technology becomes upgraded?

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.

Password Protection

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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Automatic Billing

How does the Notes 444 Billing Module help me with my billing?

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.

What about Co-Pay patients/clients?

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.

What kind of fee statements does Notes 444 provide?

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.

How automatic is “automatic Bill Printing?”

Completely automatic.  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.

I charge my patients for missed sessions or inadequate cancellation notice.  How does Notes 444 handle this?

Click a button.  The CPT code is replaced with PC/NS-C (Patient Cancelled/No Show – Charge).

What about entering non-billable data, like the content of a phone call?

Chose Nonsession Contact (or any other text indicator) and no charge will be created.

What about addressing envelopes?

Readily available glassine window envelopes allow you to simply fold and go.

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Insurance Company Requests

How does Notes 444 help me deal with insurance companies?

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 file.

It drives me nuts to always have to count the number of sessions from the last certification period.  Can Notes 444 help?

Click a button.  Type in a date range.  The number of billable sessions instantly appears.

Can Notes 444 remind me when I need to recertify or submit an OTR?

Yes.  This 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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HIPAA

What is HIPAA?

The Federal Health Information Portability and Accountability Act, whose Privacy regulations took final effect on 4/14/2003.

What does "PHI" mean?

"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 Note Exemption.

What is the Psychotherapy Note Exemption?

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.

Do I really need to be HIPAA compliant?

Only you can truly answer this question, with the help of legal counsel from your attorney, your national and state professional organizations.

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? 

Even if I do not accept insurance?

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.

What about HIPAA and ‘Usual and Customary Practice? 

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.

What about waiting until my client’s/patient's insurance company asks for their record?

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.

What is the "automatic-expiration" requirements of authorizations?

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 reminder.

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Ordering Information

What features are disabled in the 30-day downloadable trial?

Absolutely none.  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.

Can I try out the Billing Module?

It is already included in your 30-day trial.

I don’t like to use my credit card over the net.  Can I use snail mail?

Not a problem.

Are there any additional fees or costs?

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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System Requirements

Notes 444 is native for both PC (XP and higher) and Mac (OS 10.X)

Other

My question isn't listed here.

Email techsupport@notes444.com. 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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* (Notes For Four/Fourteen, 2003, the date HIPAA became effective)