comprehensive brain health assessment - phycon … health evaluator/bhe_email...comprehensive brain...
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A rapid evaluation of the 6 systems of brain health and function.
Renua MedicalTM
Comprehensive Brain Health Assessment
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or email us at [email protected].
Copyright © 2013 Renua MedicalTM, A Health First Technologies, Inc. Company. All rights reserved.
I. Brain Health Evaluator ................................................. 1
II. Clinician’s Guide for Patient Assessment .............. 4
III. E.O.B. .................................................................................. 14
IV. Speci�cations ................................................................. 26
V. FAQs ................................................................................... 28
VI. Testimonials .................................................................... 30
Is the Renua MedicalTM Brain Health Evaluator FDA registered?
1
BRAIN HEALTH EVALUATION:ADVANCED, FAST, AND EFFECTIVE
» Heart rate variability measures (SDNN, VLF/LF/HF) are linked to anxiety and stress related conditions and cognitive decline.1
» Low HRV predicts heart disease incidence and is linked to cognitive impairment.2-6
Why does Renua MedicalTM offer HRV testing?
Why does Renua MedicalTM offer EEG with normative database comparison testing?» The resting brain speed (alpha) is a reliable marker of cognitive capacity and is a
reliable marker for early detection of mild cognitive decline.7,8
» EEG shows how well functioning brain regions compensate for dysfunctional regions which allows specific determination of varied treatments and an ability to track changes over time.9
» Renua MedicalTM Brain Health Evaluator EEG analysis can identify the specific electrical frequency markers of physiological aging and memory performance.10-12
» Event-Related Potentials (ERP) measure real-time cognitive processing essential for healthy brain functions and early risk measures of dementia including:- decision making, organization, attention, memory (N2, P3a, and P3b)13-18 - visual processing (P1, P2)19 - language processing (N4, P6)20,21
» Inattention, impulsivity, motor processing speed, and reaction time linked to cognitive impairment are also measurable using ERP testing.22
Why does Renua MedicalTM offer advanced ERP testing?
» Yes, the Renua MedicalTM Brain Health Evaluator is FDA registered.
BHE SYSTEM DATA COLLECTION AND ANALYSIS CYCLE
Assessment
Data Upload
Analysis
Completed Report
Physician Review
™ ™
™ ™
™
2
BRAIN HEALTH EVALUATION:
3
NOTES:
A breakdown on patient evaluation
3
A breakdown on patient evaluation
5
Patient: Xxxx Xxxxxxxx
Page 4 of 10
Screener Global Score: 62
54
50
50
50
75
69
0 20 40 60 80 100
Motor
Sensory
Affec5ve
Word Fluency
Execu5ve & A?en5on
Memory
Spatial Navigation 92 Temporal Orientation 94 Procedural Actions 60 Episodic Memory for Places 83 Face Recognition 42 Semantic Word Knowledge 42
Metric Result Reference Range
Motor speed/Reaction time 562 ms <= 500 ms Reaction time variance 73.1 ms <= 10 ms Omission errors 34.3 % <= 10 % Commission errors 13.5 % <= 3 %
Brain Function Screener
Memory Subtypes
Behavioral Measures
Patient: Xxxx Xxxxxxxx
Page 5 of 10
Metric Cardiac Waveforms and R-‐R Variability
Cardiac Waveform (P-‐Q-‐R-‐S wave)
Image taken from pre-‐
artifacted ECG Heart Rate Variability
(Rhythmicity)
Metric Result Reference Range
Heart rate 77 bpm 50 -‐ 80 bpm
QRS duration 0.106 sec 0.06 -‐ 0.12 sec
QTc interval 481 ms < 440 ms
SDNN (HR variability) 54 ms 75 -‐ 150 ms Total power 415 ms² >= 800 ms² LF:HF ratio 0.6 > 1.5
Very Low Frequency (VLF)
72 ms² low
Low Frequency (LF) 125 ms² highest
High Frequency (HF) 218 ms² low
HRV Frequency Spectrum
HRV Frequency
VLF LF HF
0:50 0:53 0:55
70 80 90 100 110 120400
600
800
0.1 0.2 0.3
2
4
6
8
10
12
Heart Metrics
2015
10
5
0
-5-10
-200 0 200 400 600 800
I. Brain Function Screening
II. Heart Metrics (stress & health)
III. Brain Processing Speed
IV. Brain Localization (EEG)
REPORT:CLINICIAN’S GUIDE FOR PATIENT ASSESSMENT
6
Patient: Xxxx Xxxxxxxx
Page 1 of 10
Patient: , Xxxx Xxxxxxxx Date of Birth: xx-‐xx-‐xxxx Date of Test: xx-‐xx-‐xxxx
Report Code: xxxxxxxx Age: xx Gender: x Handedness: x
Symptoms: xxxxxx, xxxxxxxxx, xxxx, xxxxxxxxx xxxxx
Medications: xxxxxxxxxx, xxxxxxxxx
Screener: Data analyzed Behavioral Measures: Data analyzed Heart Metrics: Data analyzed
Evoked Potentials: Data analyzed Eyes Open EEG: Data analyzed Eyes Closed EEG: Data analyzed • References and definitions are based on peer reviewed literature relating to the lab test values. This is not intended to replace medical
judgment or to provide clinical recommendations, diagnoses or treatment decisions. The report is intended as an adjunctive resource. • Note: results do not account for medication effects on CNS and ANS measures unless specifically stated. Detection of spike and wave
discharges in the cortical EEG and other paroxysmal activity was not performed in this analysis. If seizure activity is suspected a referral to a neurologist should be made. Correlated functions are based on peer reviewed literature references.
Brain Function Screener Result Reference Range
Correlated Function
Memory 69 >= 60 %
Executive & Attention 75 >= 60 %
Word Fluency 50 L >= 60 % hindered language processing141,142,143,144; impaired working memory141; concussion/brain injury118
Affective 50 L >= 60 % hindered memory132,133; affective and mood disturbance132,133,134; concussion/brain injury118
Sensory 50 L >= 60 % hindered sensory processing137,138,139; concussion/brain injury118
Motor 54 L >= 60 % motor processing deficiency128,129; skeletal-‐muscular abnormality128,129; concussion/brain injury118
Behavioral Measures Result Reference Range
Correlated Function
Motor speed/Reaction time 562 ms H <= 500 ms hindered cognitive or motor processing127,128,129; hindered visual discrimination130; concussion/brain injury118
Reaction time variance 73.1 ms H <= 10 ms lack of focus/sustained concentration145,146,147; cognitive impairment20; concussion/brain injury118
Omission errors 34.3 % H <= 10 % inattention148; concussion/brain injury118
Commission errors 13.5 % H <= 3 % impulsivity148; hindered visual discrimination130; concussion/brain injury118; questionable comprehension of task
Patient Information» Name, DOB, test date, age, gender» Symptoms» Medications
Patient: Xxxx Xxxxxxxx
Page 1 of 10
Patient: , Xxxx Xxxxxxxx Date of Birth: xx-‐xx-‐xxxx Date of Test: xx-‐xx-‐xxxx
Report Code: xxxxxxxx Age: xx Gender: x Handedness: x
Symptoms: xxxxxx, xxxxxxxxx, xxxx, xxxxxxxxx xxxxx
Medications: xxxxxxxxxx, xxxxxxxxx
Screener: Data analyzed Behavioral Measures: Data analyzed Heart Metrics: Data analyzed
Evoked Potentials: Data analyzed Eyes Open EEG: Data analyzed Eyes Closed EEG: Data analyzed • References and definitions are based on peer reviewed literature relating to the lab test values. This is not intended to replace medical
judgment or to provide clinical recommendations, diagnoses or treatment decisions. The report is intended as an adjunctive resource. • Note: results do not account for medication effects on CNS and ANS measures unless specifically stated. Detection of spike and wave
discharges in the cortical EEG and other paroxysmal activity was not performed in this analysis. If seizure activity is suspected a referral to a neurologist should be made. Correlated functions are based on peer reviewed literature references.
Brain Function Screener Result Reference Range
Correlated Function
Memory 69 >= 60 %
Executive & Attention 75 >= 60 %
Word Fluency 50 L >= 60 % hindered language processing141,142,143,144; impaired working memory141; concussion/brain injury118
Affective 50 L >= 60 % hindered memory132,133; affective and mood disturbance132,133,134; concussion/brain injury118
Sensory 50 L >= 60 % hindered sensory processing137,138,139; concussion/brain injury118
Motor 54 L >= 60 % motor processing deficiency128,129; skeletal-‐muscular abnormality128,129; concussion/brain injury118
Behavioral Measures Result Reference Range
Correlated Function
Motor speed/Reaction time 562 ms H <= 500 ms hindered cognitive or motor processing127,128,129; hindered visual discrimination130; concussion/brain injury118
Reaction time variance 73.1 ms H <= 10 ms lack of focus/sustained concentration145,146,147; cognitive impairment20; concussion/brain injury118
Omission errors 34.3 % H <= 10 % inattention148; concussion/brain injury118
Commission errors 13.5 % H <= 3 % impulsivity148; hindered visual discrimination130; concussion/brain injury118; questionable comprehension of task
Analyzed Data Summary
Patient: Xxxx Xxxxxxxx
Page 1 of 10
Patient: , Xxxx Xxxxxxxx Date of Birth: xx-‐xx-‐xxxx Date of Test: xx-‐xx-‐xxxx
Report Code: xxxxxxxx Age: xx Gender: x Handedness: x
Symptoms: xxxxxx, xxxxxxxxx, xxxx, xxxxxxxxx xxxxx
Medications: xxxxxxxxxx, xxxxxxxxx
Screener: Data analyzed Behavioral Measures: Data analyzed Heart Metrics: Data analyzed
Evoked Potentials: Data analyzed Eyes Open EEG: Data analyzed Eyes Closed EEG: Data analyzed • References and definitions are based on peer reviewed literature relating to the lab test values. This is not intended to replace medical
judgment or to provide clinical recommendations, diagnoses or treatment decisions. The report is intended as an adjunctive resource. • Note: results do not account for medication effects on CNS and ANS measures unless specifically stated. Detection of spike and wave
discharges in the cortical EEG and other paroxysmal activity was not performed in this analysis. If seizure activity is suspected a referral to a neurologist should be made. Correlated functions are based on peer reviewed literature references.
Brain Function Screener Result Reference Range
Correlated Function
Memory 69 >= 60 %
Executive & Attention 75 >= 60 %
Word Fluency 50 L >= 60 % hindered language processing141,142,143,144; impaired working memory141; concussion/brain injury118
Affective 50 L >= 60 % hindered memory132,133; affective and mood disturbance132,133,134; concussion/brain injury118
Sensory 50 L >= 60 % hindered sensory processing137,138,139; concussion/brain injury118
Motor 54 L >= 60 % motor processing deficiency128,129; skeletal-‐muscular abnormality128,129; concussion/brain injury118
Behavioral Measures Result Reference Range
Correlated Function
Motor speed/Reaction time 562 ms H <= 500 ms hindered cognitive or motor processing127,128,129; hindered visual discrimination130; concussion/brain injury118
Reaction time variance 73.1 ms H <= 10 ms lack of focus/sustained concentration145,146,147; cognitive impairment20; concussion/brain injury118
Omission errors 34.3 % H <= 10 % inattention148; concussion/brain injury118
Commission errors 13.5 % H <= 3 % impulsivity148; hindered visual discrimination130; concussion/brain injury118; questionable comprehension of task
Assessment Summary» Patient Scores» Reference range» Correlated Functions
Demographics and Summary Findings
17
Brain Function Screening
Patient: Xxxx Xxxxxxxx
Page 4 of 10
Screener Global Score: 62
54
50
50
50
75
69
0 20 40 60 80 100
Motor
Sensory
Affec5ve
Word Fluency
Execu5ve & A?en5on
Memory
Spatial Navigation 92 Temporal Orientation 94 Procedural Actions 60 Episodic Memory for Places 83 Face Recognition 42 Semantic Word Knowledge 42
Metric Result Reference Range
Motor speed/Reaction time 562 ms <= 500 ms Reaction time variance 73.1 ms <= 10 ms Omission errors 34.3 % <= 10 % Commission errors 13.5 % <= 3 %
Brain Function Screener
Memory Subtypes
Behavioral Measures
Patient: Xxxx Xxxxxxxx
Page 4 of 10
Screener Global Score: 62
54
50
50
50
75
69
0 20 40 60 80 100
Motor
Sensory
Affec5ve
Word Fluency
Execu5ve & A?en5on
Memory
Spatial Navigation 92 Temporal Orientation 94 Procedural Actions 60 Episodic Memory for Places 83 Face Recognition 42 Semantic Word Knowledge 42
Metric Result Reference Range
Motor speed/Reaction time 562 ms <= 500 ms Reaction time variance 73.1 ms <= 10 ms Omission errors 34.3 % <= 10 % Commission errors 13.5 % <= 3 %
Brain Function Screener
Memory Subtypes
Behavioral Measures
Patient: Xxxx Xxxxxxxx
Page 4 of 10
Screener Global Score: 62
54
50
50
50
75
69
0 20 40 60 80 100
Motor
Sensory
Affec5ve
Word Fluency
Execu5ve & A?en5on
Memory
Spatial Navigation 92 Temporal Orientation 94 Procedural Actions 60 Episodic Memory for Places 83 Face Recognition 42 Semantic Word Knowledge 42
Metric Result Reference Range
Motor speed/Reaction time 562 ms <= 500 ms Reaction time variance 73.1 ms <= 10 ms Omission errors 34.3 % <= 10 % Commission errors 13.5 % <= 3 %
Brain Function Screener
Memory Subtypes
Behavioral Measures
Patient: Xxxx Xxxxxxxx
Page 4 of 10
Screener Global Score: 62
54
50
50
50
75
69
0 20 40 60 80 100
Motor
Sensory
Affec5ve
Word Fluency
Execu5ve & A?en5on
Memory
Spatial Navigation 92 Temporal Orientation 94 Procedural Actions 60 Episodic Memory for Places 83 Face Recognition 42 Semantic Word Knowledge 42
Metric Result Reference Range
Motor speed/Reaction time 562 ms <= 500 ms Reaction time variance 73.1 ms <= 10 ms Omission errors 34.3 % <= 10 % Commission errors 13.5 % <= 3 %
Brain Function Screener
Memory Subtypes
Behavioral Measures
Memory Subtypes» Six subtypes most affecting daily living» Hindered in aging, brain injury, and affective disorders
Global Score» Overall score based on six functional domains
Patient: Xxxx Xxxxxxxx
Page 4 of 10
Screener Global Score: 62
54
50
50
50
75
69
0 20 40 60 80 100
Motor
Sensory
Affec5ve
Word Fluency
Execu5ve & A?en5on
Memory
Spatial Navigation 92 Temporal Orientation 94 Procedural Actions 60 Episodic Memory for Places 83 Face Recognition 42 Semantic Word Knowledge 42
Metric Result Reference Range
Motor speed/Reaction time 562 ms <= 500 ms Reaction time variance 73.1 ms <= 10 ms Omission errors 34.3 % <= 10 % Commission errors 13.5 % <= 3 %
Brain Function Screener
Memory Subtypes
Behavioral Measures
CPT» Four common measures of attention and function using an attention and reaction time task.» Hindered in aging, brain injury, and affective disorders.
Functional Domain Scores» Six domains affecting daily living
7
Patient: Xxxx Xxxxxxxx
Page 5 of 10
Metric Cardiac Waveforms and R-‐R Variability
Cardiac Waveform (P-‐Q-‐R-‐S wave)
Image taken from pre-‐
artifacted ECG Heart Rate Variability
(Rhythmicity)
Metric Result Reference Range
Heart rate 77 bpm 50 -‐ 80 bpm
QRS duration 0.106 sec 0.06 -‐ 0.12 sec
QTc interval 481 ms < 440 ms
SDNN (HR variability) 54 ms 75 -‐ 150 ms Total power 415 ms² >= 800 ms² LF:HF ratio 0.6 > 1.5
Very Low Frequency (VLF)
72 ms² low
Low Frequency (LF) 125 ms² highest
High Frequency (HF) 218 ms² low
HRV Frequency Spectrum
HRV Frequency
VLF LF HF
0:50 0:53 0:55
70 80 90 100 110 120400
600
800
0.1 0.2 0.3
2
4
6
8
10
12
Heart Metrics
Patient: Xxxx Xxxxxxxx
Page 5 of 10
Metric Cardiac Waveforms and R-‐R Variability
Cardiac Waveform (P-‐Q-‐R-‐S wave)
Image taken from pre-‐
artifacted ECG Heart Rate Variability
(Rhythmicity)
Metric Result Reference Range
Heart rate 77 bpm 50 -‐ 80 bpm
QRS duration 0.106 sec 0.06 -‐ 0.12 sec
QTc interval 481 ms < 440 ms
SDNN (HR variability) 54 ms 75 -‐ 150 ms Total power 415 ms² >= 800 ms² LF:HF ratio 0.6 > 1.5
Very Low Frequency (VLF)
72 ms² low
Low Frequency (LF) 125 ms² highest
High Frequency (HF) 218 ms² low
HRV Frequency Spectrum
HRV Frequency
VLF LF HF
0:50 0:53 0:55
70 80 90 100 110 120400
600
800
0.1 0.2 0.3
2
4
6
8
10
12
Heart Metrics
Patient: Xxxx Xxxxxxxx
Page 5 of 10
Metric Cardiac Waveforms and R-‐R Variability
Cardiac Waveform (P-‐Q-‐R-‐S wave)
Image taken from pre-‐
artifacted ECG Heart Rate Variability
(Rhythmicity)
Metric Result Reference Range
Heart rate 77 bpm 50 -‐ 80 bpm
QRS duration 0.106 sec 0.06 -‐ 0.12 sec
QTc interval 481 ms < 440 ms
SDNN (HR variability) 54 ms 75 -‐ 150 ms Total power 415 ms² >= 800 ms² LF:HF ratio 0.6 > 1.5
Very Low Frequency (VLF)
72 ms² low
Low Frequency (LF) 125 ms² highest
High Frequency (HF) 218 ms² low
HRV Frequency Spectrum
HRV Frequency
VLF LF HF
0:50 0:53 0:55
70 80 90 100 110 120400
600
800
0.1 0.2 0.3
2
4
6
8
10
12
Heart Metrics
ECG Raw Trace» Demonstrate P-wave, QRS complex, T-wave
HRV Wave-trace» Demonstrates rhymicity of the fluctuations of R-R intervals
Patient: Xxxx Xxxxxxxx
Page 5 of 10
Metric Cardiac Waveforms and R-‐R Variability
Cardiac Waveform (P-‐Q-‐R-‐S wave)
Image taken from pre-‐
artifacted ECG Heart Rate Variability
(Rhythmicity)
Metric Result Reference Range
Heart rate 77 bpm 50 -‐ 80 bpm
QRS duration 0.106 sec 0.06 -‐ 0.12 sec
QTc interval 481 ms < 440 ms
SDNN (HR variability) 54 ms 75 -‐ 150 ms Total power 415 ms² >= 800 ms² LF:HF ratio 0.6 > 1.5
Very Low Frequency (VLF)
72 ms² low
Low Frequency (LF) 125 ms² highest
High Frequency (HF) 218 ms² low
HRV Frequency Spectrum
HRV Frequency
VLF LF HF
0:50 0:53 0:55
70 80 90 100 110 120400
600
800
0.1 0.2 0.3
2
4
6
8
10
12
Heart Metrics
ECG Statistics» Heart rate, QTc interval, QRS duration
» Key ECG metrics indicating heart, risk of coronary artery disease and myocardial infraction
HRV Wave-trace» SDNN, Total power, VLF, LF, HF balance
» Important measures of ANS balance, heart health, physical and mental stress and stress resilience.
HRV Spectrum» Distribution of power in very low frequency (VLF), low frequency (LF) and high frequency (HF) bands
Heart Metrics
8
Brain Processing Speed
Patient: Xxxx Xxxxxxxx
Page 6 of 10
ERP Component Waveform Result Reference Range
Visual processing
144 ms -‐17.9 uV < 250 ms
Auditory processing
Indiscernible < 250 ms
Attention/Vigilance (P3a)
488 ms 19.0 uV < 450 ms
Information processing / Working memory (P3b)
528 ms 19.1 uV < 450 ms
Midline Gradient Distribution (P3b) Suggested amplitude increases from anterior to posterior.
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
-15-10
-50
O2-Checkerboard
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
-2
0
2
CZ-White Noise
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
0
10
20CZ-Checkerboard
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
05
101520
PZ-Large Circle
Evoked Potentials
Anterior
Posterior
0 10 20 30 40
Patient: Xxxx Xxxxxxxx
Page 6 of 10
ERP Component Waveform Result Reference Range
Visual processing
144 ms -‐17.9 uV < 250 ms
Auditory processing
Indiscernible < 250 ms
Attention/Vigilance (P3a)
488 ms 19.0 uV < 450 ms
Information processing / Working memory (P3b)
528 ms 19.1 uV < 450 ms
Midline Gradient Distribution (P3b) Suggested amplitude increases from anterior to posterior.
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
-15-10
-50
O2-Checkerboard
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
-2
0
2
CZ-White Noise
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
0
10
20CZ-Checkerboard
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
05
101520
PZ-Large Circle
Evoked Potentials
Anterior
Posterior
0 10 20 30 40
Patient: Xxxx Xxxxxxxx
Page 6 of 10
ERP Component Waveform Result Reference Range
Visual processing
144 ms -‐17.9 uV < 250 ms
Auditory processing
Indiscernible < 250 ms
Attention/Vigilance (P3a)
488 ms 19.0 uV < 450 ms
Information processing / Working memory (P3b)
528 ms 19.1 uV < 450 ms
Midline Gradient Distribution (P3b) Suggested amplitude increases from anterior to posterior.
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
-15-10
-50
O2-Checkerboard
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
-2
0
2
CZ-White Noise
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
0
10
20CZ-Checkerboard
-200 -100 0 100 200 300 400 500 600 700 800 900 1000
05
101520
PZ-Large Circle
Evoked Potentials
Anterior
Posterior
0 10 20 30 40
ECG Raw Trace» Visual (VEP), Auditory (AEP), Cognitive (P300a, P300b) EP’s» Measure of brain processing speed in each domain
ECG Raw Trace» Amplitude and latency relate to cortical health and function» Known association between aging and pathologies such as Alzheimers, dementia, TBI, cognition, attention, memory
ECG Raw Trace» P300b power distribution» Known association between power distribution and cognitive impairment due to frontal lobe pathologies
9
Patient: Xxxx Xxxxxxxx
Page 7 of 10
EEG tracings are filtered 2 – 30Hz and artifacted for eye blinks and excessive movement.
100 Microvolts
EYES OPEN
EMG Artifact: Frontal
100 Microvolts
EYES CLOSED
0:50 0:55 1:00
O2O1P8P4PZP3P7T8C4CZC3T7F8F4FZF3F7
FP2FP1
0:50 0:55 1:00
O2O1P8P4PZP3P7T8C4CZC3T7F8F4FZF3F7
FP2FP1
EEG Tracings
EEG Tracings
Frontal Leads
Central and Temporal Leads
Posterior Leads
Patient: Xxxx Xxxxxxxx
Page 7 of 10
EEG tracings are filtered 2 – 30Hz and artifacted for eye blinks and excessive movement.
100 Microvolts
EYES OPEN
EMG Artifact: Frontal
100 Microvolts
EYES CLOSED
0:50 0:55 1:00
O2O1P8P4PZP3P7T8C4CZC3T7F8F4FZF3F7
FP2FP1
0:50 0:55 1:00
O2O1P8P4PZP3P7T8C4CZC3T7F8F4FZF3F7
FP2FP1
EEG Tracings
Eyes Open EEG Trace» Shows 10 seconds of 19-channels raw EEG» Clinician can identify gross abnormalities such as Beta Spindles, excess slowing, Spike & Wave
Eyes Closed Raw EEG Trace» Shows 10 seconds of 19-channels raw EEG» Clinician can identify Alpha patterns and gross abnormalities such as Beta Spindles, excess slowing, Spike & Wave
10
Patient:
Page 10 of 10
Individual Posterior Peak Frequency 9.1 Hz
Theta : Beta Ratio 1.4
Individual Posterior Peak Frequency 8.8 Hz
Digital EEG Analysis -‐ Headmaps
Eyes Open
Eyes Closed
EEG Reference Database Headmaps
Eyes Open and Eyes Closed» Reference database comparisons of EEG power over the entire head» 1Hz frequency band represented by each headmap
» Indicates excess power in a region» Dysfunction in associated neurofunction is likely
Yellow and Red» Indicates deficit of power in a region» Dysfunction in associated neurofunction is likely
Blue
Patient:
Page 10 of 10
Individual Posterior Peak Frequency 9.1 Hz
Theta : Beta Ratio 1.4
Individual Posterior Peak Frequency 8.8 Hz
Digital EEG Analysis -‐ Headmaps
Eyes Open
Eyes Closed
Patient:
Page 10 of 10
Individual Posterior Peak Frequency 9.1 Hz
Theta : Beta Ratio 1.4
Individual Posterior Peak Frequency 8.8 Hz
Digital EEG Analysis -‐ Headmaps
Eyes Open
Eyes Closed
Patient:
Page 10 of 10
Individual Posterior Peak Frequency 9.1 Hz
Theta : Beta Ratio 1.4
Individual Posterior Peak Frequency 8.8 Hz
Digital EEG Analysis -‐ Headmaps
Eyes Open
Eyes Closed
» Indicates idling rhythm of the brain» Measure of brain health, cognitive performance and memory » Known to be associated with pathologies such as Alzheimers, TBI and chronic fatigue
Individual Peak Frequency
11
» Indicates deficit of power in a region» Dysfunction in associated neurofunction is likely
Patient:
Page 8 of 10
power deficit power excess
Region: Anterior Cingulate
Brodmann Area (BA):
10
Frequency: 2Hz (3.2 SD)
Function: motor, memory recall, judgment, syntax/lexicon, attention, executive function; decision making involving conflict and reward
Secondary BA: 32
Region: Precuneus
Brodmann Area (BA):
7
Frequency: 14Hz (2.7 SD)
Function: visuo-‐motor coordination, attention, auditory, emotion processing, self-‐reflection, language, memory, motor, pain, object and face perception, reading; temporal context recognition, processing tool-‐use gestures
Secondary BA: 5
Region: Anterior Cingulate
Brodmann Area (BA):
32
Frequency: 22Hz (2.6 SD)
Function: auditory, depression, language, memory, motor, speech, pain, touch, visuo-‐motor
Secondary BA: 24
Digital EEG Analysis – Source Localization
EYES OPEN
Patient:
Page 9 of 10
power deficit power excess
Region: Anterior Cingulate
Brodmann Area (BA):
10
Frequency: 24Hz (-‐2.3 SD)
Function: motor, memory recall, judgment, syntax/lexicon, attention, executive function; decision making involving conflict and reward
Secondary BA: 32
Region: Medial Frontal Gyrus
Brodmann Area (BA):
9
Frequency: 27Hz (2.1 SD)
Function: auditory, depression, language, categorization, inferential reasoning, planning, memory, executive control of behavior,olfaction, object/shape perception, touch, vision; planning
Secondary BA: 6
Region: Superior Temporal Gyrus
Brodmann Area (BA):
42
Frequency: 23Hz (-‐2.1 SD)
Function: auditory, visuo-‐spatial attention, language, working/episodic memory, motor, speech, balance, visuo-‐motor
Secondary BA: 22
EYES CLOSED
Patient:
Page 8 of 10
power deficit power excess
Region: Anterior Cingulate
Brodmann Area (BA):
10
Frequency: 2Hz (3.2 SD)
Function: motor, memory recall, judgment, syntax/lexicon, attention, executive function; decision making involving conflict and reward
Secondary BA: 32
Region: Precuneus
Brodmann Area (BA):
7
Frequency: 14Hz (2.7 SD)
Function: visuo-‐motor coordination, attention, auditory, emotion processing, self-‐reflection, language, memory, motor, pain, object and face perception, reading; temporal context recognition, processing tool-‐use gestures
Secondary BA: 5
Region: Anterior Cingulate
Brodmann Area (BA):
32
Frequency: 22Hz (2.6 SD)
Function: auditory, depression, language, memory, motor, speech, pain, touch, visuo-‐motor
Secondary BA: 24
Digital EEG Analysis – Source Localization
EYES OPEN
Eyes Open and Eyes Closed» Reference database comparisons of EEG power » Source localization of abnormalities» 1Hz frequency band represented by each headmap
Red» Indicates excess power in a region» Dysfunction in associated neurofunction is likely
Blue» Indicates deficit of power in a region» Dysfunction in associated neurofunction is likely
Source Localization for Deviations
12
NOTES:
13
Sample and Current E.O.B.’s
EOB Summary and Information for BHE Testing
777 E. William Street, Suite 210 Carson City, Nevada 89701 (888) 923-6438
Confidential Renua MedicalTM 2013
EOB Summary & Information for BHE Testing Reimbursement Income Analysis
* Only billable with Renua MedicalTM Balance suite
15
CPT and ICD-9 Code Samples for BHE Testing
777 E. William Street, Suite 210 Carson City, Nevada 89701 (888) 923-6438
Confidential Renua MedicalTM 2013
CPT and ICD-‐9 Code Samples for BHE Testing
CPT Code Meaning
96120 Neuropsych testing by computer
95957 Digital EEG Analysis
95816 EEG recording including awake and drowsy
95930 Visual evoked potential (VEP) testing
92585 Auditory evoked potentials for evoked response
99090 Analysis of data stored in computers
93040 Rhythm ECG, 1-‐3 ECG leads with interpretation and report
ICD-‐9 Codes Meaning
290.1 Presenile Dementia, uncomplicated 300.02 Anxiety
307.42 Chronic Insomnia 309.29 Other adjustment reaction with disturbance of emotions 310.1 Personality Change due to conditions classified elsewhere 331.0 Alzheimer's Disease
331.2 Senile Degeneration of Brain 331.82 Dementia with Lewy Bodies 331.83 Mild Cognitive Impairment
345.11 Generalized convulsive epilepsy with Intractable epilepsy 780.79 Malaise and Fatigue
780.93 Memory Loss
296.80
296.89 Bipolar ii
16
07/24/2013 8:34AM FAX 15099280861 FAMILY MED L.L. 0002/0047
Remit: 1/4
UNITED HEALTHCARE INSURANCE COMPANY
ServiceDate(s)
ProcedureCode-Mod/Units
Billed/AllowedAmount
Now AllowedAmount/Adj Code
DeductibleAmount
Co-InsAmount
Co-PayAmount
Payment/Late FilingReduction
Health CareRemark Code
96120/1
95957/1
95816/1
95930/1
92585/1
96004/1
93042/1
93040/1
175.50/98.44
685.15/446.49
597.10/398.91
275.29/0.00
157.41/0.00
197.23/0.00
12.66/0.00
22.93/12.60
77.06/45
238.66/45
198.19/45
275.29/16
157.41/16
197.23/85
12.66/97
10.33/45
5.00
89.30
79.78
-
-
-
-
2.52
93.44
357.19
319.13
-
-
-
-
10.08
N115
N115
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Messages16 : Claim lacks information which is needed for adjudication97 : Payment is included in the allowance for the basic service85 : Claim/service denied/reduced because usage guidelines were not met45 : Charges exceed reasonable and customary amounts
ServiceDate(s)
ProcedureCode-Mod/Units
Billed/AllowedAmount
Now AllowedAmount/Adj Code
DeductibleAmount
Co-InsAmount
Co-PayAmount
Payment/Late FilingReduction
Health CareRemark Code
96120/1
95957/1
95816/1
95930/1
92585/1
96004/1
93042/1
93040/1
175.50/98.44
685.15/446.49
597.10/398.91
275.29/0.00
157.41/0.00
197.23/0.00
12.66/0.00
22.93/12.60
77.06/45
238.66/45
198.19/45
275.29/16
157.41/16
197.23/85
12.66/97
10.33/45
5.00
89.30
79.78
-
-
-
-
2.52
93.44
357.19
319.13
-
-
-
-
10.08
N115
N115
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Messages16 : Claim lacks information which is needed for adjudication97 : Payment is included in the allowance for the basic service85 : Claim/service denied/reduced because usage guidelines were not met45 : Charges exceed reasonable and customary amounts
Healthcare Remark CodesN115:
Healthcare Remark CodesN115: 17
07/24/2013 8:34AM FAX 15099280861 FAMILY MED L.L. 0003/0047
Remit: 1/3
PREMERA BLUE CROSS
ServiceDate(s)
ProcedureCode-Mod/Units
Billed/AllowedAmount
Now AllowedAmount/Adj Code
DeductibleAmount
Co-InsAmount
Co-PayAmount
Payment/Late FilingReduction
Health CareRemark Code
96120/1
95957/1
95816/1
95930/1
92585/1
96004/1
175.50/110.11
685.15/453.64
597.10/390.85
275.29/178.36
157.41/151.52
22.93/0.00
65.39/45
231.51/45
206.25/45
96.93/45
5.89/45
22.93/97
25.00
-
-
-
110.11
428.64
390.85
178.36
151.52
-
-
-
-
-
-
-
-
-
-
-
-
-
Messages97 : Payment is included in the allowance for the basic service45 : Charges exceed reasonable and customary amounts
ServiceDate(s)
ProcedureCode-Mod/Units
Billed/AllowedAmount
Now AllowedAmount/Adj Code
DeductibleAmount
Co-InsAmount
Co-PayAmount
Payment/Late FilingReduction
Health CareRemark Code
96120/1
95957/1
95816/1
95930/1
92585/1
96004/1
93042/1
93040/1
12.66/12.66
22.93/22.93
65.39/45
231.51/45
206.25/45
275.29/96
5.89/45
192.23/96
12.66/96
22.93/96
25.00
-
-
-
-
110.11
428.64
390.85
-
151.52
-
-
N174
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Messages96 : Claim not-covered charges45 : Charges exceed reasonable and customary amounts
Healthcare Remark CodesN174:
-
-
175.50/110.11
685.15/453.64
597.10/390.85
275.29/275.29
157.41/151.52
197.23/197.23
-
-
- -
N174
N174
N174
18
07/24/2013 8:34AM FAX 15099280861 FAMILY MED L.L. 0004/0047
Remit: 1/6
MEDICARE SERVICE CENTER
ServiceDate(s)
ProcedureCode-Mod/Units
Billed/AllowedAmount
Now AllowedAmount/Adj Code
DeductibleAmount
Co-InsAmount
Co-PayAmount
Payment/Late FilingReduction
Health CareRemark Code
96120/1
95957/1
95816/1
95930/1
92585/1
96004/1
93042/1
93040/1
175.50/0.00
685.15/469.99
597.10/419.90
275.29/0.00
157.41/0.00
197.23/111.69
12.66/0.00
22.93/13.26
175.50/B15
215.16/45
177.20/45
275.29/50
157.41/50
85.54/45
12.66/B15
9.67/45
94.00
83.98
-
-
22.34
-
2.65
357.99
335.92
-
-
89.35
-
10.61
M25, N115
M25, N115
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
MessagesB15 : Claim/service denied because this service is not paid separately50 : These are non-covered services because this is not a medical necessity45 : Charges exceed reasonable and customary amounts
ServiceDate(s)
ProcedureCode-Mod/Units
Billed/AllowedAmount
Now AllowedAmount/Adj Code
DeductibleAmount
Co-InsAmount
Co-PayAmount
Payment/Late FilingReduction
Health CareRemark Code
96120/1
95957/1
95816/1
95930/1
92585/1
96004/1
93042/1
93040/1
175.50/103.62
685.15/469.99
597.10/419.90
275.29/166.06
157.41/132.25
197.23/111.69
12.66/0.00
22.93/13.26
71.88/45
215.16/45
177.20/45
109.23/45
25.16/45
85.54/45
12.66/B15
9.67/45
-
-
-
-
82.90
375.99
335.92
132.85
105.80
89.35
-
10.61
M80
-
-
-
-
-
-
-
-
20.72
94.00
83.98
33.21
26.45
22.34
-
2.65
MessagesB15 : Claim/service denied because this service is not paid separately45 : Charges exceed reasonable and customary amounts
Healthcare Remark Codes M80: M25: N115
Healthcare Remark CodesM80:
- - M80
M80
-
-
-
-
ReimbRate
HPHCPay Amt
RemarkCodeMA01/MA18
Outpatient AdjudicationESRD
Pay Amt
PercentPay Amt
NonpayComp Amt
MA01 - Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you,we require another individual that did not process your initial claim to conduct the appeal. Howerver, in order to be eligible for an appeal, youmust write to us within 120 days of the date you received this notice, unless you have a good reason for being late.MA18 - Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplementalbenefits to them.
19
CLA
IM V
OU
CHER
Empark Medic
al Plan 1 ORIGINAL CLAIMS Customer Service
Phone Number: 1 (888)849-3679
Date of Service
From
Through
Proc
Code
Modifier
Units
Billed
Amount
Allowed
Amount
Contractual
Adjustment
Paid By
Others
Deductible
Copay
Coinsurance
Not
Covered
Total
COB
Amount
Amount
Paid
Msg
Code
Risk
Withhold
Pati
ent Responsibility
Date of Service
From
Units
Billed
Allowed
Contratual
Copay
Total
PXN
Cont
ratu
al
Cont
ratu
al
Total
Copa
y
Total Embark
Medical Plan : ORIGINAL CLAIMS
Billed
Amount
Allowed
Amount
Contractual
Adjustment
Paid By
Others
Inte
rest
Paid
Risk
Withhold
Amount
Previously Paid
Amount
Paid
MAPD Enhanced Medical ORIGINAL CLAIMS Customer Service Phone Number: 1 (877) 508-7362
Claim Total
9921425
96120
95957
95816
95930
92585
96004
93042
93040
1 1 1 1 1 1 1 1 1
165.00
175.50
685.15
597.10
275.29
157.41
197.23
12.66
22.93
2288.27
110.20
484.09
432.50
171.04
136.22
115.04
13.66
1462.75
54.80
175.60
201.06
164.60
104.25
21.19
82.19
12.86
9.27
825.52
10.00
10.00
10.00
10.00
100.20
484.09
432.50
171.04
136.22
115.04
13.66
1452.75
M50
N01
M50
M50
M50
M50
M50
N01
M50
Total MAPD Enhanced Medical ORIGINAL CLAIMS
Billed
Amount
Allowed
Amount
Contractual
Adjustment
Paid By
Others
Inte
rest
Paid
Risk
Withhold
Amount
Previously Paid
Amount
Paid
2288.27
1462.75
825.52
1452.75
07/24/2013 8:34AM FAX 15099280861 FAMILY MED L.L. 0005/0047
20
07/24/2013 8:34AM FAX 15099280861 FAMILY MED L.L. 0006/0047
Washington Teamsters Welfare Trust2323 Eastlake Ave ESeattle, WA 98102-3305
Electronic Service RequestedCheck Number Amount
ServiceDate(s) Proced. Charge PPO
AdjustmentNon
Covered Code(s)* Allowed Deductible Co-pay Paidat% Benefit Other
Ins.
9304293040
12.6622.93
0.00-5.73
12.660.00
68 0.0017.20
0.000.00
0.000.00
0%90%
0.0015.48
0.000.00
CLAIM TOTALS 35.59 -5.73 12.66 17.20 0.00 0.00 15.48 0.00
Adjustment
Total Paid
Patient Responsibility
0.00
15.48
1.72
Charges have been discounted according to your First Choice Health Network or Beech Street contract. Discountsdisputes must be directed to First Choice Health Network Provider Relations. The patient is not responsible forthe discounted amount.Payment for this procedure has already been included in the allowance for another service/procedure. If you do notagree with these findings, please forward documentation to support the billing of the charge(s) to the Administrativeoffice identified at the top of this Provider Statement.
ServiceDate(s) Proced. Charge PPO
AdjustmentNon
Covered Code(s)* Allowed Deductible Co-pay Paidat% Benefit Other
Ins.
9612095957
175.50685.15
-57.85-171.11 0.00
117.65514.04
0.000.00
0.000.00
90%90%
105.89462.64
0.000.00
CLAIM TOTALS 2087.68 -517.46 1570.22 0.00 0.00 1413.20 0.00
9581695930
597.10275.29
-149.12-74.38 0.00
447.98200.91
0.000.00
0.000.00
90%90%
403.18180.82
0.000.00
9258596004
157.41197.23
15.74-49.26 0.00
141.67147.97
0.000.00
0.000.00
90%90%
127.50133.17
0.000.00
0.00
0.00
0.00
0.00
Adjustment
Total Paid
Patient Responsibility
0.00
1413.20
157.02
Charges have been discounted according to your First Choice Health Network or Beech Street contract. Discountsdisputes must be directed to First Choice Health Network Provider Relations. The patient is not responsible forthe discounted amount.Explanation of Codes:
68 Payment is included in the allowance for another service/procedure
21
Provider
N545
Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.
MA01
Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require
another individual that did not process your initial claim to conduct the appeal.
Contractual Obligations
Change exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability). This charge effective
7/1/2013: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use only with Group Codes PR or CO depending upon liability).
Legislated/Regulatory Penalty. At least one Remark Code must be provided {may be comprised of either the NCPDP Reject Reason Code or Remittance Advice Remark Code
that is not an ALERT.}
Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.
Patient Responsibility
Coinsurance Amount
06/19/2013 23:55 FAX 7323491690 COLTS NECK NEUROLOGY 0001/0005
File Name:
IN04X_06122013F3NK1P_NJMCR.835
Date of Creation:
06/12/2013
NOVITAS SOLUTIONS, INC.
PO BOX 890031
CAMP HILL, PA 170890031
Payee No.:
97349857923
Date:
06/12/2013
Check/EPT No.:
885630361
Patient:
Service Date
POS
Proc/Mods
Billed
Paid
Allowed
Copay
Co-ins
Deductible
Other PR
Code
Adjustment
Code
Totals
Totals
05/22/2013
1199213
79.00
79.00
60.50
60.50
77.16
77.16
0.00
0.00
15.43
15.43
0.00
0.00
0.00
0.00
0.67
1.17
1.23
3.07
CO-45
CO-237
CO-223
N545
Patient:
Provider
Service Date
POS
Proc/Mods
Billed
Paid
Allowed
Copay
Co-ins
Deductible
Other PR
Code
Adjustment
Code
11 11 11 11 11
92585
93040
95816
95930
95957
126.00
325.00
149.00
374.58
98.76
10.98
254.30
116.82
293.67
14.00
988.58
775.05
126.00
14.00
325.00
149.00
374.58
938.58
0.00
0.00
0.00
0.00
0.00
0.00
25.20
2.80
55.00
29.80
74.92
197.72
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.02
0.22
5.20
2.38
5.99
15.81
CO-223
CO-223
CO-223
CO-223
CO-223
MA01
Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require
another individual that did not process your initial claim to conduct the appeal.
CO
Contractual Obligations
223
Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code
can be created.
PR
Patient Responsibility
2
Coinsurance Amount
05/22/2013
05/22/2013
05/22/2013
05/22/2013
05/22/2013
22
N545
Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.
MA18
Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them.
MA01
Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require
another individual that did not process your initial claim to conduct the appeal.
CO
Contractual Obligations
45
Change exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability). This
charge effective 7/1/2013: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use only with Group Codes PR
or CO depending upon liability).
237
Legislated/Regulatory Penalty. At least one Remark Code must be provided {may be comprised of either the NCPDP Reject Reason Code or Remittance
Advice Remark Code that is not an ALERT.}
223
Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code
can be created.
PR
Patient Responsibility
2
Coinsurance Amount
06/19/2013 23:55 FAX 7323491690 COLTS NECK NEUROLOGY 0002/0005
File Name:
IN04X_06122013F3NK1P_NJMCR.835
Date of Creation:
05/29/2013
NOVITAS SOLUTIONS, INC.
PO BOX 890031
CAMP HILL, PA 170890031
Payee No.:
97349857923
Date:
06/29/2013
Check/EPT No.:
885584722
Patient:
Provider
Service Date
POS
Proc/Mods
Billed
Paid
Allowed
Copay
Co-ins
Deductible
Other PR
Code
Adjustment
Code
11 11 11 11 11
92585
93040
95816
95930
95957
126.00
325.00
149.00
374.58
98.76
10.98
254.30
116.82
293.67
14.00
114.00
87.87
126.00
14.00
325.00
149.00
374.58
112.08
0.00
0.00
0.00
0.00
0.00
0.00
25.20
2.80
55.00
29.80
74.92
22.42
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.02
0.22
5.20
2.38
5.99
0.21
1.71
1.79
CO-223
CO-223
CO-223
CO-223
CO-223
05/03/2013
05/03/2013
05/03/2013
05/03/2013
05/03/2013
1196120
05/03/2013
C0-45
CO-237
CO-223
N545
1,102.58
862.92
1,100.66
0.00
220.14
0.00
0.00
19.52
Totals
Claim automatically crossed over to HORIZON BCBS OF NEW JERSEY
23
Provider
MA01
Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require
another individual that did not process your initial claim to conduct the appeal.
CO
Contractual Obligations
223
Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code
can be created.
PR
Patient Responsibility
2
Coinsurance Amount
06/19/2013 23:55 FAX 7323491690 COLTS NECK NEUROLOGY 0004/0005
File Name:
IN04X_06122013F3NK1P_NJMCR.835
Date of Creation:
06/12/2013
NOVITAS SOLUTIONS, INC.
PO BOX 890031
CAMP HILL, PA 170890031
Payee No.:
97349857923
Date:
06/12/2013
Check/EPT No.:
885630361
Patient:
Service Date
POS
Proc/Mods
Billed
Paid
Allowed
Copay
Co-ins
Deductible
Other PR
Code
Adjustment
Code
Totals
Totals
05/22/2013
1199204
170.00
170.00
133.23
133.23
170.00
170.00
0.00
0.00
34.00
34.00
0.00
0.00
0.00
0.00
2.72
2.72
CO-223
Patient:
Provider
Service Date
POS
Proc/Mods
Billed
Paid
Allowed
Copay
Co-ins
Deductible
Other PR
Code
Adjustment
Code
11 11 11 11 11
92585
93040
95816
95930
95957
126.00
325.00
149.00
374.58
98.76
10.98
254.30
116.82
293.67
14.00
988.58
775.05
126.00
14.00
325.00
149.00
374.58
938.58
0.00
0.00
0.00
0.00
0.00
0.00
25.20
2.80
55.00
29.80
74.92
197.72
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.02
0.22
5.20
2.38
5.99
15.81
CO-223
CO-223
CO-223
CO-223
CO-223
MA01
Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require
another individual that did not process your initial claim to conduct the appeal.
CO
Contractual Obligations
223
Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code
can be created.
PR
Patient Responsibility
2
Coinsurance Amount
05/22/2013
05/22/2013
05/22/2013
05/22/2013
05/22/2013
24
REM
ITTA
NC
E A
DVI
CE
Oxford
48 Monroe Turnpike
Trumbull, CT 06611
Vend
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ame:
TIN
: 532
2100
33Ve
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ID#:
G
4740
548-
P47
4055
0
C
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Num
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2304
2164
Mem
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3252
5245
3453
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Pr
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53
2210
033
Mem
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G47
4054
8-P4
7405
50
Prov
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ID:
23
0421
64Pa
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Acc
t #: 2
3453
453
C
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#:
34
5235
252
Serv
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Des
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Bill
ed A
mt
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131.
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00
Mem
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ame:
3252
5245
3453
4
Pr
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er N
ame:
53
2210
033
Mem
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D:
G47
4054
8-P4
7405
50
Prov
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ID:
23
0421
64Pa
tient
Acc
t #: 2
3453
453
C
laim
#:
34
5235
252
Serv
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ode
Des
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QTY
Bill
ed A
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With
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25
Brain Health Evaluator
RENUA MEDICALTM BRAIN HEALTH EVALUATORSPECIFICATIONS
Record and Train Anywhere• Small profile amplifier
• Bluetooth technology
• Tablet or laptop data streaming
• Wi-Fi data upload to server
• All items fit in lightweight durable carrying case
• Rapid assessment protocols
Multiple Modalities• Simultaneous EEG, ERP, ECG recording
• Full head topography EEG and ERP
• Neuropsychological testing suites (optional)
• BCI and HRV biofeedback
High Quality Data• Latest electrophysiology chip technology
• Research & Medical grade EEG/ERP data
• 16+ hours battery life
• Real-time data quality tracking for signal integrity
Advanced Analysis
• QEEG, ERP and ECG/HRV data analysis
• Simple HIPPA compliant web-portal data upload and credit card purchase system
• Independent Component Analysis
• EEG and ERP source localization technology
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Characteristic BHE System
parametersClass 2.0
PowerAmpli�ier
25 pin Electro Cap25
Multiterminals
MeasurementResolutionBandwidth 0
rejection >90dB
Ω
ImpedanceΩ
Noise μ
None
–humidity
0 °noncondensing
EMI perform
noncondensing
Weight oz.Dimensions
FREQUENTLY ASKED QUESTIONS
Is the Brain Health Evaluator FDA registered?Yes, the Brain Health Evaluator is FDA registered.
What is the Renua MedicalTM Neuroscience product?• State-of-the-art hardware and software systems for brain and heart electrophysiological measurement
& training.• Robust data analysis & report services with the highest per-report value in the industry.• A system that provides clinically relevant quantified patient data that improves differential diagnosis,
tracking of treatment success, available treatment options for brain & heart health and improved patient communication and understanding of their condition(s).
What is included in the package?We provide you with everything required. No need to seek out multiple outside vendors.
1. Hardware and Software as well as all disposables required to collect EEG, ERP, HRV data and provide bio-feedback.
2. Hardware includes; laptop computer, eVox amplifier, patient response button, USB Charging cable, EEG recording caps (2) and ear buds.
3. Software includes the BHE software, which can perform EEG, ERP and ECG data collection for analysis and EEG and HRV biofeedback.
4. Disposables include; electro-conductive gel, syringe, blunt tip needles, alcohol swabs, ECG sensors, skin prep, Q-tips.
The provided disposables allow for approximately 15-20 subject recordings.
Billing & Payments• On average clinics profit is between $675 – over $1000 per BHE run. • Billing is done by the clinic directly to the patient or insurance provider.• Additionally, clinics can charge fees for biofeedback training performed using the Renua MedicalTM
system (no fees are charged by Renua MedicalTM for clinics use of the biofeedback training programs)
How is payment handled?• Renua MedicalTM receives payments from your clinic at the time report credits are purchased via
check or Credit Card.• Credit package discounts are available for volume purchases. Credit prices are independent of clinic
charges and reimbursements. • Renua MedicalTM provides an example CPT code PDF document as a guide. This guide is based on
what other clinics have reported to Renua MedicalTM regarding insurance submissions, reimburse-ments, ICD-9 and CPT codes. This is meant to be assistive only and was created to try and help clinics. Renua MedicalTM does not recommend or endorse any particular type of billing or payment mechanism.
• Renua MedicalTM does not handle payments from patients as we are not a clinic and do not see or interact with patients directly.
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RENUA MEDICALTM BRAIN HEALTH EVALUATOR
TESTIMONIALS
“Having EEG, ERP and ECG easily accessible allows me to confirm diagnosis and guide treatment protocols. The data analysis is extremely important clinically and from a patient perspective, giving them an opportunity to understand their own course of treatment.” - Dr. Paul Buongiorno, MD (Psychiatry)
“The new report format is absolutely excellent! My patients love it. I love it. It helps me help them to make deci-sions regarding doing one of the [Renua MedicalTM’s] valuable interventions, biofeedback. In addition, it vali-dates the biomedical procedures they are doing which are really important to their child’s overall picture on his or her road towards recovery. - Thanks Guys!” - Dr. James Neubrander, MD (Internal Medicine)
“I started using Renua MedicalTM Neuroscience BHE testing only recently. The results so far helped me tremendous-ly in confirming my diagnosis. Most importantly, it has helped in planning medical intervention. I have a patient diagnosed to have ADD and was given Aderral without improvement. In fact, the patient became more anxious. Her Renua MedicalTM brain mapping showed diffused fast activity. Based on that, giving her GABA improved her symptoms.” - Dr. M. Alhambra, MD (American Board of Psychiatry & Neurology)
“I know the smell of death and how it feels to have the weight of a fellow Marine’s severed limbs in my hands … I self-medicated, but [then] entered a downward spiral. ” In Treatment, “I liked seeing the patterns of brainwaves because it felt like the results were tangible.” “I [now] have a very healthy, productive outlook on life and it’s directly because of the therapy.” - Master Sgt., US Marine Corps., PTSD & TBI patient
“Wow. This is a fantastic report that is beyond anything I’ve seen. It is incredibly rich with information that could cap-ture all the possible parameters that could affected by a concussion, whether a serious blast or motor vehicle injury or a significant sports hit. I really like the way it has cardiac, full EEG and EP/ERP data.” - Dr. R.L. Conder (Neuropsychologist)
“Renua MedicalTM brain scan has been extremely useful to me - measuring EEG brain waves to provide an early indicators of dementia or other memory problems. I also now use it with issues such as chronic anxiety, depression, insomnia, PTSD, fatigue, autism, ADHD and other learning disabilities, to determine which areas of the brain are being affected and specifically, what brain supplements or meds might be useful in helping to repair these areas. We have now been able to track changes in brain function over time to see if a specific treatment plan should be contin-ued or modified.” - Dr. S. Ashley, MD (Internal Medicine)
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NOTES:
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Renua Medical™ A Health First Technologies, Inc. company777 E. William Street, Suite 210Carson City, Nevada 89701p: (877) 885-1258 [email protected]
A unique and unprecedented integration ofmultiple technologies in a single medical device.
For more information: