Backing Up – Time Machine Troubleshooting

Here it is, six months after moving to the Leopard OS on the Mac, and all is well … almost.

Time Machine, the backup feature of Leopard, has decided to quit working … again.

Time Machine is such a great program, that I figured I would go into a little more detail about it.

Here are the pros and cons of Time Machine.

Pros:
The “set it and forget it” aspect of it is incredible.
The interface is beautiful.
Incremental backups are awesome.
Network backups are easy.

Cons:
It stops working for no reason.
Not reliable enough to be your only backup method.

So, what’s the problem? It doesn’t like our new hard disk and then just fails to backup from that point on.

OK, I have to go into some detail here about what Time Machine is all about.

Time Machine backs up everything on your computer (unless you tell it to omit stuff). Wow, that’s easy. Turn it on, everything gets backed up.

And restoring files is easy, too. Go into Time Machine, go back to the time and date of the file you want to restore, and click “Restore.” It even asks you if you want to keep the old copy of the file you are restoring, or just replace it.

So, let’s say you screwed something up but didn’t notice it until today. You remembered that everything was OK last Monday, so you just go back to last Monday in Time Machine and restore the file as it was on that date.

Network backups mean you can have Time Machine find a hard disk somewhere else and back up to that, too. Let’s say you want to back up your office computer. You might want to use Time Capsule (the network backup feature of Time Machine) to backup to a hard disk at home to create an off-site backup automatically.

So when it works, Time Machine is awesome.

But, Time Machine can get finicky and just stop working. Thankfully, there is this little icon in the upper right corner of your screen which alerts you to that, but I hate troubleshooting my backups when I would much rather be doing something else.

So what are the issues?

Make sure you reformat your hard disk

First, Time Machine prefers a Mac formatted hard disk (but never alerts you to this). There are some tricks to doing this properly which are detailed here. Time Machine will work without doing this, but will eventually fail. Before using Time Machine, make sure you reformat your backup hard disk properly.

Then, even if you have a Mac formatted hard disk, and Time Machine has been backing up successfully for a couple of weeks, it just stops – usually with the message, “The backup disk cannot be found.” But the disk is there, right on your desktop, so what’s the problem?

It appears that if there is any hiccup during the backup process, Time Machine just stops.

Then, you have to turn off Time Machine (because it hides all the backup files if it is on) and restart your computer. It is easier to unplug the hard disk, too, because it doesn’t take much for the Mac to grab your hard disk and hide everything again.

What you need to do is delete the last backup that didn’t finish, then turn Time Machine on again. Instructions for doing this are found here.

I also use DiskWarrior to do a hard disk repair just to make sure that the hard disk is working properly before turning Time Machine on again.

Update the firmware on your hard disk

Also, since the external hard disk we were using was a Western Digital MyBook, we found there was a firmware update for the drive. It appears that Western Digital drives with older firmware can go to sleep in the middle of a backup and screw things up. I have updated the firmware and have found it not to have improved the reliability of Time Machine at all.

As of right now, Time Machine has not been reliable with the Western Digital MyBook. Previous backups using a Lacie drive and the SimpleTech drive were more reliable, but there were still backup issues at times.

Disabling Intel CPU Power Management

During the troubleshooting process, I decided to reinstall Mac OS 10.5.5. I found a web site that explained how to perform a reliable update of the OS. Part of the update process involved installing a small file called IntelCPUPMDisabler.kext which disables AppleIntelCPUPowerManagement.kext which makes Software Updates freeze. You need a separate installer to perform the update called Kext Helper b7 to install the disabler. Then after the installation, you need to restart the computer.

After the restart, I began installing Mac OS 10.5.5. While the update was installing, I noticed that Time Machine was backing everything up. I did not reboot after installing the update to see if Time Machine would finish (which it did). I then rebooted to finish the installation of OS 10.5.5 as per the instructions.

Lo and behold, Time Machine has been working flawlessly ever since. There seems to be a conflict with the Intel chip Macs and the AppleIntelCPUPowerManagement.kext. Once disabled, Time Machine seems much happier.

* * * * * * * * * * * * * * * * * * * * * * *

Here it is now a few weeks down the road and I have hit a few Time Machine hiccups. Looks like the solution to keep Time Machine running well is not difficult though.

On occassion, Time Machine decides to stop working. The usual error is something like “Backup Disk not found”. Of course, my first instinct was to restart my computer, and that did work once or twice, but lately, it has not been successful at all.

Fortunately, I have two user accounts on my computer. So here is what I do, and so far (knock on wood) it has worked every time.

I restart my Mac and log in as the other user. Then I run Time Machine in this other user account, which seems to work ok. I then log out of this other user, log in with my main user account, and Time Machine seems happy again.

So far, this has solved my Time Machine problems on every occassion that the error occurred.

And, luckily, Time Machine was there when I needed it just last week when something was accidentally deleted from my computer.

Using KIP to bill for DME Claims

You can send Medicare DMERC claims via iPlexus and Zirmed. KIP may be compatible with other electronic claims clearinghouses as well.

First, you need to set up a new Billing Provider just for DMERC (such as “Johnson Podiatry (DME)”) and then click the DME tab and choose DME and Medicare.

Then, set up a new insurance carrier such as “DMERC A” – setting the insurance class as “04” and the Electronic Claim Payor ID as “1295” (for DMERC A. Look up the correct payer ID for the DMERC carrier in your area).

Then make sure you enter DMERC A as one of the insurance carriers for each patient (This works best when set as INS 3 since most patients have Medicare primary and a Medicare supplemental plan as secondary).

Remember to use the billing provider “Johnson Podiatry (DME)” and the correct insurance carrier (INS3) on the invoice. DO NOT enter anything on the invoice’s DME tab.

Then, when you go to send the claims electronically, remember you have to select “Johnson Podiatry (DME)” as the billing provider – then send the claims as any other claim.

A/R Reports – A Closer Look

Accounts Receivables can make or break your practice. Keeping them under control is a must. That’s where the Accounts Receivables Reports come in. They give you insight into where your money is and how long it is taking you to receive it.

There are three main types of A/R Reports:

1) Insurance Summary
2) Sort by Insurance
3) Sort A-Z

Let’s take a closer look at these and how they can help keep your receivables low.

Insurance Summary report

The Insurance Summary report is a snapshot of where all your money is. It shows you how much is owed to you by each insurance plan sorted by 30, 60, and 90 days. If you are looking down the Insurance Summary report and notice that Blue Cross owes you $95,000 for more than 90 days and all your other insurance companies owe you $3000 or less, this is a signal for you to find out why. You need to start following up on all these Blue Cross claims ASAP.

Sort by Insurance report

The Sort by Insurance report is more detailed than the Insurance Summary Report. It lists each insurance carrier, with contact information, followed by a list of all patients and their open invoices.

(Beginning with KIP version 10.3.61, the open invoices only include invoices to that insurance carrier – otherwise, they were marked as billed to Ins1, Ins2, Ins3, or Ins4).

This list contains everything you need to call an insurance carrier and request payment information. There is no need to refer back to the computer for claim numbers or policy numbers.

Use this list to call insurance carriers.

Receivables Report Sort A-Z

This is an alphabetical list of all your patients and their balances, both insurance balances and patient balances (also broken down into 30, 60, 90 days). Use this report to get a quick glance as to which patients accounts are past due and require the most attention.

It’s like getting a big bonus check

Spending time reducing the amount of money owed to you is like getting a big bonus check. If you can reduce your receivables from $200,000 to $150,000 in one month, it’s like getting paid an extra $50,000 bonus check this month.

Don’t just rely on your staff to keep up with it. Practice owners should print the Insurance Summary report and keep tabs on their receivables. When you see a large number for one or two insurance carriers looming in the 90 day column, ask why. Print up a Sort by Insurance report for those carriers and see which patient’s money is tied up and make sure you find out why. Next month, check it again. If those patients are still looming in that report, find out what’s going on.

Remember, after a certain period of time, that money is lost forever.

You will be surprised what you might find. You could find surgeries or procedures that somehow never got billed. Many insurance carriers refuse to pay if you don’t submit a claim within 90 days of the procedure. If that money is lost, you are just be working for free.

Make sure your staff is keeping your receivables low and that they know you are keeping track of things. It might be the most profitable thing you do.

Aligning the HCFA form (aka CMS 1500 form)

HCFA forms can be customized for any printer.

1) Go to Preferences and then HCFA FORM PREFERENCES.
2) Set your PREFERRED HCFA FORM to “Samsung ML2010” (this is now the universal HCFA form).
3) Make sure MERGE HCFA FORMS is unchecked.
4) In the FORM POSITION area, set all the numbers to zero.
5) Click the SAVE button and close the PREFERENCES window.
6) Print a HCFA form.
7) Check the alignment for the top part of the form only.

Hint: Use the SEX box as your guide.

If the “X” is above the place it is supposed to be, set the VERTICAL number on the HCFA FORM PREFERENCES higher (higher numbers make the “X” go lower on the page).

If the “X” is too far to the left, set the HORIZONTAL number on the HCFA FORM PREFERENCES higher (higher numbers make the “X” go right on the page).

Click SAVE and close the PREFERENCES window. Then print another HCFA form. Repeat this step until the top part of the form is aligned properly.

8) Now that you have the top part of the form aligned, move to the middle section (the HCFA lines). This area now should only need to be aligned vertically.

Hint: Use the CHARGES box on the HCFA form as your guide.

If the field is above the place it is supposed to be, set the MIDDLE number on the HCFA FORM PREFERENCES higher (higher numbers make the field go lower on the page).

Click SAVE and close the PREFERENCES window. Then print another HCFA form. Repeat this step until the middle part of the form is aligned properly.

9) Now that you have the middle part of the form aligned, move to the bottom section. This area now should only need to be aligned vertically.

Hint: Use the EIN SSN boxes on the HCFA form as your guide.

If the “X” is above the place it is supposed to be, set the BOTTOM number on the HCFA FORM PREFERENCES higher (higher numbers make the “X” go lower on the page).

Click SAVE and close the PREFERENCES window. Then print another HCFA form. Repeat this step until the bottom part of the form is now aligned properly.

10) If you are getting the bottom part of the form pushed onto the next page, try setting the PAPER SIZE FOR HCFA field to LEGAL (this does not work for all printers). If the problem is still happening, set the page size of your printer preferences (this is in your operating system, not in KIP) to legal.

Parallels – Amazing Program that Needs RAM

OK, so you’ve bought your new Intel Mac and now you want to run Windows. It’s time to invest in Parallels.

Parallels is virtual machine software, which means, it’s like running a Windows machine on your Mac.

How good is Parallels?

Well, for sure, it’s fast. I set up Parallels on a 2.4 GHz Intel iMac with 1 GB RAM and it runs my Windows software faster than on my 2.8 GHz Intel Dell computer with 2GB RAM. That is amazing.

But it did slow up all my other Mac programs somewhat while Parallels was running.

There are settings on Parallels so you can optimize your memory usage, but I chose to just upgrade my iMac to 4GB RAM.

One nice thing about Parallels – you can take a snapshot of your Windows system, let’s say, right before you install some questionable program, and if your install gets infected or corrupted, you can revert back to your snapshot of what your Windows system was at the snapshot.

And, of course, Time Machine, is backing up everything on your computer (including your Windows system) every hour (isn’t it?).

Parallels requires you to do an actual Windows install, so you will need a Windows XP or Windows Vista installation disk to start.

If you like Linux, you can try it on Parallels, too. In fact, you can have 3, 4, or 5 operating systems installed on your computer if need be.

I think the thing that got me was, and that still puzzles me, is how is Windows on a 2.4 GHZ iMac faster than a 2.8 GHz Dell? Let’s just chalk it up to the miracle of the Mac.

Time Machine makes the Mac and Leopard a must

How important is it to back up?

It’s the most important thing you can do. So, the easier it is, the more of a chance that everything you have is protected.

Well, now, backing up is free and easy with Leopard (Mac OS 10.5). The backup scheme included in Leopard is called Time Machine.

Time Machine backs up every hour each day, then saves a daily copy for the last month, and then, it just keeps going. It’s as easy as plugging in a hard disk and turning Time Machine on.

So what happened recently?

A user had a power failure over the weekend. The server computer did have a battery backup, but it failed to protect the data. The data could be restored, but it took overnight, and some work was involved.

But imagine this.

Imagine if he had Time Machine on the server computer.

He could have restored his computer to last Saturday before the power failure, and could have been working again in a few minutes.

And you needn’t restore your whole computer either (although you could). You can just restore the files you need (or the ones that got corrupted).

It’s not often I recommend an entire new operating system based on one feature, but I think, in this case, it’s time.

You can either buy a new Apple Computer with Leopard pre-installed, or upgrade what you are using now.

Leopard runs great on G4 Macs as well as Intel Macs.

Get it today, and start backing up – before you need it.

Oh yeah, and do get a battery backup anyway, and take a copy of your data offsite every week or two, just in case.

Selecting Claims from a List

When you print a batch of claims or send a batch of claims electronically, you have the option to select which claims you wish to process from a list.

These lists are sortable on each column by clicking the column header.

As you can see by the sort arrow next to the column header Inv#, the list below is sorted by invoice number.

Click on Date to sort by date, Name to sort by name, and so forth.

You will find these capabilities on any list where you see a sort arrow in one of the column headings (such as the ledger).

Be sure to look for these arrows whenever you are using a list. You may find the list is sortable on any column.

CMS 1450 (UB04) Compatibility

The UB-04 (Universal Billing Form 04) is the replacement for the UB-92.

The UB-04, which is only accepted from institutional providers that are excluded from the mandatory electronic claims submission requirements, incorporates the National Provider Identifier (NPI), taxonomy, and additional codes.

Beginning with KIP Deluxe version 10.3.48, the UB04 form compatibility was established.

The UB-04 is the basic form that the Centers for Medicare & Medicaid Services (CMS) prescribes for the Medicare program. It is only accepted from institutional providers that are excluded from the mandatory electronic claims submission requirements set forth in the Administrative Simplification Compliance Act, Public Law 107-105 (ASCA), and the implementing regulation at 42 CFR 424.32.

It incorporates the National Provider Identifier (NPI), taxonomy, and additional codes. (Please refer to the crosswalk file attached to CR5072 to show how data elements crosswalk from the UB-92 to the UB-04.)

Note that while most of the data usage descriptions and allowable data values have not changed on the UB-04, many UB-92 data locations have changed, and in addition, bill type processing will change.

There are a few details that you should be aware of:

* The UB-04 (Form CMS-1450) is a uniform institutional provider bill suitable for billing multiple third-party payers. A particular payer, therefore, may not need some of the data elements.
* When filing, you should retain the copy designated “Institution Copy” and submit the remaining copies to your FI, managed care plan, or other insurer.
* Instructions for completing inpatient and outpatient claims are the same unless otherwise noted.
* If you omit any required data, your FI will either ask you for them or obtain them from other sources and will maintain them on its history record. It will not obtain data that are not needed to process the claim.
* Data elements in the CMS uniform electronic billing specifications are consistent with the Form CMS-1450 (another name for the UB-04) data set to the extent that one processing system can handle both. The definitions are identical, although in some situations, the electronic record contains more characters than the corresponding item on the form because of constraints on the form size not applicable to the electronic record. Further, the revenue coding system is the same for both the Form CMS-1450 and the electronic specifications.
* Also note that CMS is accepting valid NPIs on the UB-04 between March 1, 2007 and May 22, 2007, and the NPI is required as of May 23, 2007.