PAIN MANAGEMENT SOLUTION WHY TEST & WHEN? WHY MONITOR PAIN MEDICATION? ABOUT US TECHNOLOGY ONLINE SERVICES Medytox Advantage Reporting
Medytox’s sophisticated, state-of-the-art, secure, internet-based laboratory information management system; Medytox Advantage is a physician portal, enabling physicians to readily access patient results on demand. Medytox Advantage is a paperless web based software program accessible wherever there is internet access. As the premier medical managed service our commitment is to provide quality, leading edge clinical testing, real time tracking of results, and excellence in service to ultimately enhance patient care. With Medytox you can submit online lab requisitions, check patient results and manage the automatic selection of patients for urine drug monitoring and access a wide array of informative reports—24 hours a day, 7 days a week. Medytox Online Services make this valuable information always available and easy to use. Our software is integratable with any EMR software you currently use, making it easier for you to implement urine drug monitoring into your practice.
Submit Lab Requisitions
Submitting your lab requisitions online saves both time and paper. It’s the same information required for paper requisitions, yet patient data needs to be entered online only once. All subsequent requisitions will automatically include your preferred monitoring panel, patient data and diagnosis code of the previous processed specimen for your confirmation or modification. Medication and specimen information is also verified and validated for added accuracy. The rapid screen result is quickly updated with just a few clicks. With this secure and paperless system, your patient billing and insurance information is saved so that it’s instantly available for future requisitions.
Chain of Custody
With Medytox Advantage Reporting you can track the specimen every step of the way. An icon will appear in your software for each completed step. Specimen collected, Manifest created, received at the laboratory, results available, and even an alert for non-compliant test results. You are able to be in control the whole way with a much reduced workload and a time efficient program.
PAIN MANAGEMENT SOLUTION WHY TEST & WHEN? WHY MONITOR PAIN MEDICATION? ABOUT US TECHNOLOGY Laboratory Testing and Cutting-Edge Techniques in Analytical Toxicology
Our Physicians have found great comfort in knowing that Medytoxâ€™s specialized clinical laboratory testing and toxicology screening provides the most intricate and specific testing available. We are SAMHSA/DHHS certified and a member of DATIA. The lab process identifies and quantifies the specific drug or metabolite for a broad range of controlled medications, providing the physician with the specific amount of drug detected. Every initial positive result is confirmed. Our process exceeds the most demanding standards and may include the following tests: EA-Enzyme Assay, EIA-Enzyme Immuneassay, ELISA - Enzyme-linked Immunosorbent Assay, RIA - Radio-Immunoassay, TLC - Thin Layer Chromatography-Mass Spectrometry, LC/MS/MS - Liquid CHromatography-Tandem Mass Spectrometry. Liquid chromatography-mass spectrometry is an analytical chemistry technique that combines the physical separation capabilities of liquid chromatography with the mass analysis capabilities of mass spectrometry. LC-MS is a powerful technique used for many applications which has very high sensitivity and specificity. The applications of LS-MS are extensive and varied, ranging from pharmacokinetics studies to protemic analysis to drug development. Medytox specifically utilizes laboratories that use this technique for bioanalysis of biological fluids to test for drugs. The potency of modern drugs requires more sensitive bioanalytical assays than traditionally used in order to reliably determine and quantify these drugs at lower concentrations. This has driven improvements in technology and analytical methods and given rise to the novel application of LS-MS in bioanalysis. Medytox is at the pinnacle of cutting edge techniques in analytical chemistry and bioanalysis
Advantages of LC/MS/MS Analyze more samples in a shorter amount of time without compromising data quality Quickly detecting, identifying & quantifying drugs Applicable to the analysis of many different drugs from several classes
PAIN MANAGEMENT SOLUTION WHY TEST & WHEN? WHY MONITOR PAIN MEDICATION? ABOUT US
COMPLIANCE PROTECTION PROFIT
Why Medytox? As the leader in managed services to pain management doctors and clinics we offer a one-stop turnkey program that creates compliance, protection & profit with no out-of-pocket cost and no contractual obligation. We show you how to reduce your workload while improving your revenue. The “Medytox Advantage” promises to maximize the value of pain medication monitoring while offering you ease and simplicity. We pride ourselves on creating a synergistic relationship so you can be compensated without adding a burden to your staff. We partner with our physicians by providing support, laboratory testing and state-of-the-art billing services. That translates into an easy compliance; rapid results and a turnkey program for your workers’ comp patients in the treatment of their chronic pain. We offer complete solutions, reliable results and a comprehensive review of the patient’s urine test results with laboratory certification.
Medytox —The Power to Understand More As the leading provider of urine drug monitoring, only Medytox’s pain medication monitoring solutions can help physicians determine if a patient is taking his or her pain medication as prescribed. Medytox identifies and quantifies specific drugs or metabolites found in each sample, providing the physician with the specific amount of drug and metabolite detected. Medytox then applies its proprietary methods for certain prescribed drugs to determine whether a patient’s normalized result falls within an expected range. After testing is complete, Medytox certifying scientists review and validate each result for a final check of accuracy. This information opens the door to a dialogue with the treating physician to discuss how better outcomes can be achieved. Medytox pain medication monitoring solutions are an invaluable tool for better managing both injured workers’ care and costs. Working together with clinicians, you can use this valuable knowledge to make more informed decisions about an injured worker’s care, so he or she can get back to work and back to life. Medytox pain medication monitoring solutions are also important for the bottom line of your organization, providing efficient management of your cases and reducing the overall care costs due to non-compliant behaviors. As a leader in pain medication, only Medytox offers the comprehensive solutions case managers and clinicians need to manage pain patients’ cases efficiently and effectively.
PAIN MANAGEMENT SOLUTION WHY TEST & WHEN? WHY MONITOR PAIN MEDICATION? With urine drug monitoring, you obtain the critical information and insight to help you evaluate your patients’ pain medication use and achieve better outcomes.
Effective pain therapy requires more than choosing the right drugs for your patients. You also need to be confident and assured that your patients are adhering to their prescribed regimens. Pain medication monitoring provides that insight—and helps you evaluate whether chronic pain patients are using their medications as prescribed. Monitoring also helps to identify medications you may not have prescribed and/or illicit drugs. A recent national study showed that 75% of the patients in the study may not be taking their pain medications in a manner that is consistent with their prescribed regimens. In the same study, more than 38% of the patients had no detectable level of their prescribed medications, and 42% had drug levels above or below the expected levels. There are numerous reasons why patients may not adhere to their prescription regimens. For example, patients may: Choose not to take their medication regularly due to fear of addiction. Take too little medication or none at all, because of the costs or side effect. Take too much medication because of inadequate pain control or addiction. Divert their pain medications – whether unintentionally or intentionally. In order to reduce medication misuse and abuse, you need to know that every one of your chronic pain patients is taking his or her medication as prescribed. It’s vital information for assuring that your patients receive the right treatment for the best outcomes—and protecting the safety of both your patients and your practice. “The statistics underscore the importance of making urine drug monitoring integral to chronic pain continuum of care.” The 2007 National Survey on Drug Use and Health reports a steady increase in the number of Americans abusing prescription pain relievers. Rising rates of prescription drug abuse and emergency room admissions related to prescription drug abuse, as well as an increase in the theft and illegal resale of prescription drugs, indicate that drug diversion is a growing problem nationwide. The main source of drug diversion is unlikely the prescriber as was once assumed, but rather from theft by family, friends and workers in the home or from the sharing and selling of medications though often with good intentions.
Medytox - The Industry Leader
As a leader in pain medication monitoring solutions, Medytox provides the important information you and your staff needs to help improve outcomes for your chronic pain patients and your practice. Our state-of-the-art laboratory services and proprietary methods of analysis are backed by exceptional service and clinical support to help you create a pain medication monitoring program that meets the needs of your practice. Our laboratories in Florida, North Carolina & California process thousands of specimens a day with the highest degree of accuracy, reliability and sensitivity. Most urine drug testing simply determines the absence or presence of a certain class of drugs. The “Medytox Advantage” process utilizes state-of-the art initial screening and confirmatory testing. Our analytical technology identifies and quantifies a wide range of prescribed and non-prescribed medications—at some of the lowest detection levels in the industry.
Medytox supports the highest standards of patient and practice safety
Only Medytox combines this level of expertise and innovative technologies with exceptional service and support. This unique combination is the reason our pain medication monitoring solutions are fast becoming an integral part of the best chronic pain care in the USA.
PAIN MANAGEMENT SOLUTION WHY TEST & WHEN? Urine Drug Screening (UDS) is medically necessary to determine the risk of initiating, changing or maintaining an opioid narcotic. A urine drug screening (UDS) is usually performed as a Point Of Care testing (POC) while the patient is in the physician’s office. It should not be primarily used as a forensic test although forensic information can be obtained from the test. The primary indication for the test is to either initiate or monitor opioid therapy. UDS is therapeutic drug monitoring of high risk medications. Urine Drug Testing (UDT) through Medytox Medical Management Solutions utilizes Liquid Chromatography Mass Spectralanaysis LC-MS/MS. UDT is performed by a Laboratory to provide confirmations of UDS. Studies at Brigham and women’s Hosp. as reported in 2003 Anesthesia and Analgesia have shown that self-report is unreliable in 45% of patients receiving opiate therapy when UDS performed (KATZ). Medytox helps physicians determine if a patient is taking his or her pain medication as prescribed. This critical insight and knowledge allows all those involved to make more informed decisions regarding pain management and achieve better outcomes. By achieving better outcomes, payers can lower the costs of managing this “chronic disease.” When patients are taking their medication as prescribed, payers can control — even reduce — costs, optimize patient outcomes and improve the overall quality of chronic pain management for all their members. We provide the vital information and assurance necessary to manage chronic pain effectively. POC testing utilizes single-use immunoassay devices which offer rapid results, are inexpensive and require little training. POC testing only identify the drug class not the presence of a specific drug. A UDT laboratory can provide information to distinguish between codeine morphine, hydrocodone, hydromorphone, oxycodone and oxymorphone. A UDT Laboratory should have a Physician Medical Director available to provide to the ordering physician expert consultation in the interpretation of UDS and UDT as well as a Laboratory Scientist that staffs the Laboratory and may aid the ordering physician as to methodology of UDS and UDT. With Medytox you can relax with the comfort of knowing that experts are available to answer any questions.
When should a UDS should be performed? 1. When considering initiating opioid therapy. 2. When considering escalating opioid therapy to determine if the patient is actually compliant with current regime. 3. If the patient has a history of non- compliance or unreliable historian such as a previous UDT that has revealed a medication that was not reported such as a benzodiazepine or narcotic that could potentially synergistically cause respiratory depression or cardiovascular collapse. This should be considered in patients who have a history of cardiorespiratory disease and or the elderly.
4. 5. 6. 7.
Previous negative drug screen for current opioid therapy without a clear explanation. Aberrant behavior with hx of bipolar or psychosis. When a community is endemic with overdose and abuse. When considering opiate detox referral or treatment.
Patients may be discharged due to cross sensitivity of opiates causing a false positive. Opiates are positive from hydrocodone, many antidepressants cause false positives for methadone. Protonix causes false positive for THC. Some NSAIDs cause a false positive for Benzodiazepines. A false negative may occur if the point of care testing urine speciman contains the analyte below the cutoff of the screen. Combination of the in-office urine drug screen and confirmations by laboratory having LC-MS/MS liquid chromatography Mass Spectralanalysis will optimize treatment of chronic pain patients by minimizing overtreatment,under-treatment, diversion and over-dosage. A UDT will repeat the screen and quantitate the analyte and correct the false negatives, it then will identify the exact drug that is screened positive. The UDT should break each drug class Positive from the screen into the positive and negatives of each drug class. The UDT should be provided in a detailed report such as that provided by Medytox.
PAIN MANAGEMENT SOLUTION
Why Monitor? With the cost of pain medication rising and a $61 billion industry, there is an epidemic
in the US that must be addressed. More and more cases are arising that point the lay of blame on the treating physician for mistreatment, under-treatment, drug diversion, addiction, etc. How can you reduce your liability while maintaining the best continuum of care for your chronic pain patients? By participating in the urine drug screening to monitor your patients as recommended by the Division of Workers Comp and ACOEM to provide a better outcome of pain treatment, getting your patients back to work and back to life.
Why Medytox? The “Medytox Advantage” promises to maximize the value of pain medication monitoring while offering you ease and simplicity. We partner with our physicians by providing full support, and superior laboratory testing. We offer complete solutions, reliable results and a comprehensive review of the patient’s urine test results with laboratory certification. Physician Benefits
Substantial incremental revenue stream Minimal time commitment for staff
Quicker return to work and/or P&S status
Insulation from regulatory intervention
True pain level assessment
State-of-the-art billing expertise and paperless software
Tx compliance to get better physically
Guaranteed HIPAA compliancy
Decreased abuse of prescribed medications
Confirmation of treatment plan Accurate assessment of patient’s condition Validation of patient compliance Diversion detection Improvement of doctor/patient dialogue Drug cross-reactivity
Carrier/Employer Benefits Tx compliance means lower medical costs on claim file Return to work when appropriate; lower indemnity costs
Management of prescribed medications
Decrease the odds of dependency on drugs being prescribed
No cost to the Physician
Lower overall claim file costs
Medytox pain medication monitoring solutions are an invaluable tool for better managing both injured workers’ care and costs. Working together with clinicians, physicians can use this valuable knowledge to make more informed decisions about an injured worker’s care, so he or she can get back to work and back to life.
At last, a chronic pain care management solution to better evaluate my personal care for a better outcome of my pain care regimen. One that treats the individual and not the masses. I no longer have to worry about addiction or adverse side-effects thanks to a simple test to monitor my patients’ intake levels. - Dr. Thomas F. Mendolia, Miami, FL
A national study found that 75% of Workers' Compensation claimants on chronic opioid therapy aren’t taking their pain medication as prescribed.
Medical Managed Services V Laboratories EXPERT BILLING & REIMBURSEMENT TEST PANELS LABORATORY GETTING STARTED
4-Step Implementation Process
CLIENT SERVICES Corporate Offices:
1080 E. Indiantown Rd., Ste 100 Jupiter, FL 33477 Tel: 561.746.6868 Fax: 561.746.6844 email@example.com
Tel: 954.591.9182 Fax: 866.278.8540 firstname.lastname@example.org
1. 2. 3. 4.
Consultation & Needs Evaluation Kick-off Meeting with Key Players Training of Staff Members Testing & Results Report
Medical Managed Services V Laboratories EXPERT BILLING & REIMBURSEMENT TEST PANELS LABORATORY GETTING STARTED
4-Step Implementation Process
1. 2. 3. 4.
Consultation & Needs Evaluation Kick-off Meeting with Key Players Training of Staff Members Testing & Results Report
Medytox makes start-up easy. We offer an easy four-step process to integrate pain medication monitoring into your practice. Our goal is to seamlessly synthesize monitoring with complete account set-up & training while avoiding interruption to your practices’ workflow.
Step 1: Consultation & Needs Evaluation - Your dedicated Account Manager will work with the key decision makers in your practice to assist you in determining your pain medication monitoring needs for all existing and new patients. We will provide any information necessary for you to select monitoring panels based on your needs and complete all start-up paperwork. A “Welcome Kit” will arrive with everything you need to begin monitoring. Step 2: Kick-off Meeting with Key Players - it takes a team of people to make your practice work and so it is important that everyone on your team realizes the importance of participating in the urine drug screening for better outcomes in your patient care and practice protection. Your Account Manager will educate your team on the benefits and value that this program brings and share with your billing department the CPT codes for claims. We’ll review our comprehensive services, and the tools and resources available, including Medytox Online Services and the Medytox Auto Reminder. Step 3: Training of Staff Members - Your dedicated Medytox Account Manager will train key staff members and work alongside your team to implement the testing into a daily routine. They will train your staff on the best protocols for testing and management of the Medytox Advantage Reporting. We’ll review why pain medication monitoring is important in chronic pain management. We’ll thoroughly discuss each step of the process from how to fill out the online requisition forms to sending out a specimen. Your Account Manager will demonstrate how to use our comprehensive array of tools and resources. Step 4: Testing and Results Report - Your Account Manager will help integrate monitoring into your practice and show you how to retrieve your chronic pain patients’ results report. Our Client Services Team will be available to you should you need any help and support when you start testing by yourself. Reports will be available 48 hours after the “Medytox Advantage” process. Our Lab Technicians are available for interpretation and further explanation of results.
Medical Managed Services V Laboratories EXPERT BILLING & REIMBURSEMENT TEST PANELS LABORATORY Medytox Managed Solutions uses only the highest quality testing laboratories in the US. At Medytox, along with our contracted premier laboratories across the US, we are committed to providing the highest quality of clinical laboratory testing by offering the latest instrumentation and technology available in the field of analytical toxicology and patient drug monitoring solutions. Medytoxâ€™s laboratory relations utilize the latest technology in liquid chromatography interfaced to (tandem) mass spectrometry (LC/MS/MS) to deliver an unparalleled level of accurate and extensive data analysis. LC/MS/MS is the new gold standard of analytical toxicology and is an indispensable tool.
Introducing LC/MS/MS at a glance
Analytical chemistry technique with extensive and varied qualitative and quantitative applications Physical separation capabilities of liquid chromatography + mass analysis capabilities of mass spectrometry High sensitivity, specificity, and selectivity Very effective technique of drug screening Use of LC/MS/MS to screen biological samples for drug use or abuse for accurate and extensive data analysis. LC/MS/MS is the new gold standard of analytical toxicology and is an indispensible tool
Quantitative Analysis at a glance
Opiates are a class of drugs used for pain relief. Despite the therapeutic value and use of opiates, this class of drugs have a high frequency of illicit use. This has prompted the need for analysis of biological samples for opiate use. Urine is one of many matrices utilized to test for illicit use. LC/MS/MS is a powerful technique employed to screen biological samples for drug use or abuse.
Amphetamines Barbiturates Benzodiazepines Cannabinoids Carisoprodol (SOMA) Cocaine and its metabolite Tramadol Ethanol Heroin and its metabolite Hydromorphone
Codeine Morphine Methadone Oxycodone Fentanyl Hydrocodone Hydromorphone
Medical Managed Services V Laboratories EXPERT BILLING & REIMBURSEMENT TEST PANELS Amitriptyline (Elavil) Bupropion (Wellbutrin) Citalopram (Celexa, Cipramil) Desipramine (Norpramin) Doxepin (Adapine) Escitalopram (Lexapro) Fluoxetine (Prozac) Imipramine (Tofranil) Maprotiline (Ludiomil) Nefazodone (Serzone) Nortriptyline (Aventyl, Pamelor) Paroxetine (Paxil) Sertaline (Zoloft) Trazodone (Desyrel) Venlafaxine (Effexor)
Carbamazepine (Carbatrol, Tegretol) Oxacrbazepine (Trileptal)
Amobarbital (Amytal Sod) Butabarbital (Butisol) Butalbital (Fiorinal) Mephobarbital (Mebaral) Pentobarbital (Nembutal) Phenobarbital (Donnatal) Primidone (Mysoline) Secobarbital (Seconal Sod) Thiopental (Pentothal)
Alprazolam (Xanax) Chlordiazepoxide (Librium) Clonazepate (Clonopin, Klonopin, Rivotril) Diazepam (Valiumn, Valrelease) Flunitrazepam (Rohypnol) Flurazepam (Dalmane) Lorazepam (Ativan) Midazolam (Versed) Nordiazepam (Calmday) Oxazepam (Serax) Quazepam (Doral, Dormalin) Temazepam (Restoril) Triazolam (Halcion)
Buprenorphine (Buprenex, Suboxone, Subutex) Butorphanol (Stadol) Codeine (Tylenol 2,3,4, Fioricet w/ Codeine) Fentanyl ( Actiq, Duragesic (Patch) Heroin (Diamorphine) Hydrocodone ( Vicodin& ES, Norco) Hydromorphone ( Dilaudid) Ketamine (Ketalar) Meperidine (Demerol, Mepergan) Methadone (Dolophine) Morphine (MS Contin, Kadian) Nalbuphine (Nubain) Oxycodone (OxyContin, Percocent) Oxymorphone (Numorphan) Pentazocine (Talacen) Propoxyphene (Darvocet) Tramadol (Ultram)
Carisoprodol (Soma) Meprobamate (Equanil) Zolpidem (Ambien)
Amitriptyline (Elavil) Bupropion (Wellbutrin) Citalopram (Celexa, Cipramil) Desipramine (Norpramin) Doxepin (Adapine) Escitalopram (Lexapro) Fluoxetine (Prozac) Imipramine (Tofranil) Maprotiline (Ludiomil) Nefazodone (Serzone) Nortriptyline (Aventyl, Pamelor) Paroxetine (Paxil) Sertaline (Zoloft) Trazodone (Desyrel) Venlafaxine (Effexor) THC (Cannabinoids)
Medical Managed Services V Laboratories EXPERT BILLING & REIMBURSEMENT
Providing pain medication monitoring solutions that are affordable to everyone is an important way Medytox helps you to continue to provide chronic pain care that leads to better outcomes. We assist by educating clients/physicians on billing and extend help with any billing issues. Our strong relationships with leading insurers and managed care organizations also help ensure broad coverage. Medytox keeps the billing and reimbursement process as simple and direct as possible to help you better spend your time on the care of your chronic pain patients. We offer a variety of billing options to meet the needs of our clients.
(Continuity in Your Account Management) Acquire accurate information and details for proper billing Initial coding performed correctly and at highest level Prompt claim follow up to expedite claim payment Prompt recovery of proper copays account balances Maintenance of all account billing records Fully HIPAA compliant Financial accountability of all charges and revenue Good communication skills in all areas of billing and recovery Expedient problem solving Ongoing education in technology, proper coding and governmental regulatory requirements Organization in all aspects of work performed
BASIC SERVICES Multi-Specialty Billing Mail collection, organization, processing and responses Revenue collection, deposit preparation, deposit with deposit report All expenses (supplies, phone, postage, paper, equipment, software and personnel) provided by Medytox Physician charges processed daily Revenue posted daily and patient balances billed immediately Claim follow-up and insurance correspondence performed daily All patient calls handled by Medytox Charge and revenue reports provided weekly and monthly Practice analysis and productivity reports provided for physicians
QUALIFICATIONS Monthly patient claim volume experience of 5200 new patients per month Monthly revenue produced on claim volume $1.5 million per month Collection rate range 78% to 96% dependant on physician plan participations Initial claim rejection experience less than 2% Certifications for ongoing coding and technical education and regulatory seminars Billing personnel experience at 7 years and greater Multi-specialty experience in Emergency Medical Services Retained solo physicians and physician groups since 1993 Excellent references
Medical Managed Services V Laboratories Why work with a medical management company when I can work with the laboratory directly? As a managed service we have specific advantages over working directly with a laboratory. The BIG difference is we help you maximize your revenue stream by training you and your staff on in-house rapid screen testing. We show you what the laboratories are afraid to and that is how to realize the reimbursements to your own bottom line. By becoming a CLIA waived facility you can start urine drug screening, recording the results and billing for the tests when medical necessity is in line with the patientâ€™s continuum of care. You then ship the rapid screen test to one of our contracted laboratories for confirmatory. This prevents any false negatives that can be caused by a number of different factors.
Medytox Medical Management Solutions V Laboratories We can: Contract several laboratories to offer urine drug screen confirmatory to create non-bias relations. Provide Billing Agents in your office for high volume accounts Employ the very best relations for dispensary items at reduced costs Employ experts in the field of workers' comp to improve your numbers of referrals Employ independent consultants to collaborate with you on individual cases to improve patient care Supply account managers who have your best interest at heart and not the laboratories Employ independent billing services not related to the lab Provide web-based, paperless software for 24/7 access wherever you have an internet connection not owned by the laboratories
When I first started looking at vendors to provide my practice with urine drug screen monitoring I was lost with all the choices. Then I met my representative with Medytox and the choice was obvious. When you weigh it all up, using a medical management service removed all the doubt and provided me with all the solutions I needed to assess and manage my patients treatment
48 - 72 hour turnaround Easy to read comprehensive lab reports for scripts - 24 hour turnaround 4 convenient ways to receive your lab reports 1. Online paperless software 2. Secure ftp access 2. Encrypted emails 3. Fax EMR integration
Medytox has collaborated with academics in several arenas to create a correlation report to better assist you in reading the reports and understanding the metabolized rates of each drug in accordance to your individual patients. There are a lot of monitoring facilities that attest to being able to do this in their lab reports. This in turn has caused a lot of unrest amongst the medical industry as there is no exact formula for this and is a misrepresentation of fact. The Medytox correlation manual trains the treating physician to better evaluate the patient on opioid therapy giving way to better outcomes in pain management therapy for your workers' comp patients.
- Dr. Thomas F. Mendolia, Miami, FL