Practice Management Software

Electronic Claim Submission

Manual claim processing often results in unnecessary errors. Electronic claims mitigate those errors and enable medical practices to use software to transmit corresponding data to payers for processing and reimbursement. By electronically submitting them, practices can track and monitor claims and better understand what’s being done to get them paid.

Claim Denial Management

Claim denial occurs when a claim is processed and then repudiated by a payer. The purpose of denial management is to investigate every unpaid claim, uncover a trend by one or several insurance carriers, and appeal the rejection appropriately according to the appeals process in the provider contract. The denial management process seeks the root cause for the denial as well as the coded cause.

Management and Financial Reporting

Quick and easy access to necessary reports and documents is an essential part of the management of financial reporting, which helps optimize practice operations by identifying revenue cycle trends and proactively addressing them. This type of reporting also is utilized for customized decision support and advanced denial management processes.

Patient Scheduler

Electronic scheduling gives providers the option of sending secure, HIPAA-compliant, paperless intakes to patients. This eliminates the need for patients to complete the time-consuming task of filling out paperwork when they arrive for their appointment. It also can be used for scheduling procedures and combined with appointment reminders for improved patient communication.

Appointment Reminders

Missed healthcare appointments cost the United States an estimated $150 billion annually. When patients schedule their own appointments, though, they're more likely to show up. Automated appointment reminders allow physicians’ practices to easily communicate with patients, saving time and money while also reducing cancellations and decreasing no-shows.

Patient Eligibility, Insurance, and Copay Management

PrognoCIS Practice management software aids in streamlining payment processes and facilitating quicker reimbursement. Providers can electronically view and verify patients’ demographics and allowable health benefits, including access to insurance, deductible, co-pays, and other vital billing information. This task can be completed when the patient’s appointment is scheduled, thereby improving efficiency in managing patient eligibility.

Billing Code Sets (ICD-10, CPT)

A code set is defined by the Centers for Medicare & Medicaid Services (CMS). This shared list of codes is used in place of longer names or explanations. The World Health Organization (WHO) created the International Classification of Diseases, a diagnostic tool utilized globally for epidemiology, health management, and clinical purposes. ICD-10 consists of more than 70,000 procedure codes and 69,000 diagnosis codes. Current Procedural Terminology (CPT) refers to a set of medical codes used by physicians, allied health professionals, non-physician practitioners, hospitals, outpatient facilities, and laboratories to describe the procedures and services they perform.

Scanner Interface

PrognoCIS practice management systems includes multiple interfaces to improve interoffice communication and collaboration. This type of interface eliminates the need for manual data entry and reduces errors by interfacing with QR code scanners.

EHR Integration

EHR Integration improves clinical efficiency by allowing physicians to have a comprehensive overview of their patients' conditions. It also helps reduce over-utilization of services and redundancies, resulting in lower healthcare costs for patients and physicians.

Clearinghouse Interface

A clearinghouse interface helps verify patient eligibility in real-time and offer advanced search options for data access. Aligning an intuitive interface with the clearinghouse reduces training time and allows the billing processes to run smoothly.

Benefits for Practices

Using practice management software, the practice staff can focus on patient care. The software offers them an organizational environment where patient care is the number one priority. Designed to work with a practice’s workflow, it offers increased productivity, improved patient flow, automated billing, and strict compliance with ever-changing healthcare industry regulations and requirements. Additional advantages include:

• More Efficient Front Desk and Back Office Workflow
  Effective practice management software creates efficient workflow and processes. To optimize staff performance, it reduces data entry errors, eliminates redundancies, decreases patient wait time, and serves as an early reporting system for potential scheduling, compliance, billing, or staffing issues.
• Improved Accuracy and Efficiency
  By integrating with billing and insurance processes, practice management software minimizes errors. The software allows updated user data and information to be entered in a single input and accurately updated across all programs. This increases office efficiency by freeing up time and resources without sacrificing quality or progress. Plus, the integrated access to patient records, reports, insurance, and billing information expedites the reimbursement process by eliminating the multiple exchanges of information typically required between medical practices and billing entities.
• Increased Revenues and Quicker Payment for Services
  The streamlining of insurance verification when a patient schedules an appointment enables speedier payment processes and quicker reimbursement. More efficient revenue streams are achieved through optimized scheduling features. Revenue is increased by eliminating errors and redundancies through real-time error alerts and automatic insurance verification and eligibility assurance.

Benefits for patients

• Reduced Wait Times
  Through a standardized system developed to maintain peak performance and minimize errors and redundancies, practice management software helps practice staff members operate smoothly and efficiently to reduce patient wait times.
• Improved Patient Security
  Practice management software lets providers store and capture patient data quickly, securely, and intuitively. Data and information transfers are encrypted to ensure protected health information (PHI) is shielded from cybercrime, including malware, viruses, spyware, and ransomware. The software should be defined by strict access levels to ensure only authorized users have access to confidential, protected records.
• Enhanced Patient Satisfaction
  For patients, the ability of a physician to instantly access their records and make informed decisions with the benefit of their medical history at his or her fingertips is a key benefit and driver of patient satisfaction. Patients also want to know their data is secure with a medical practice that follows HIPAA guidelines.

Implementation Options and Strategies

As with any new process or solution to maximize practice management benefits, the selection and implementation processes of practice management software must be well-defined, carefully planned, and based firmly on research-based practice management systems best practices. Systems can be implemented in practices of all sizes. The technology is scalable. Its storage and processing capabilities are not limited, like a traditional physical storage room. Although the prospect of implementing a new technology solution and training staff on its various functions might initially be overwhelming for some, the benefits far outweigh the challenges.

Integrated vs. Standalone

Because practice management and EMR software initially should work together seamlessly, selecting a fully integrated system is recommended. The combined capabilities offer

• easy access to patient data and billing information with one secure login
• improved workflows for better data flow
• uncomplicated sharing of information, schedules, and claims data among the office staff

Some providers prefer to keep their practice management and EMR systems separate, but that can cause numerous problems because the two don't always work well together. A breakdown in communication may occur even among programs designed to work in sync.

Server-based vs. Cloud-based vs. Desktop-based

Practices that choose to implement a server-based practice management solution must invest in expensive servers, infrastructure, and backup systems and provide the necessary maintenance and security to store and manage the data. Plus, they need dedicated space to house their servers.

Desktop-based practice management software is sometimes less expensive, but it’s typically used on just one computer accessed by only a few people.

Cloud-based practice management software can easily be scaled to meet the needs of a growing physician’s practice and doesn’t require the purchase of new servers or complex backup systems. That not only reduces your costs but decreases your physical footprint. This software also eliminates or reduces the need for costly in-house IT support and allows upgrades and software patches to be applied automatically after the critical operating window.

Cloud-based Practice Management Software

Because of advancements in technology and the benefits of cloud-based technologies, most applications based on client-server technology have been migrated to cloud technology. This makes it easy for practices to store, create, share, and track digital patient data, including billing and scheduling information.

Integrated EHR and Practice Management Software

By integrating EHR and practice management software, physicians’ practices streamline their operations and achieve better management of and easier access to electronic health records. This combination also makes it easier for practices to adapt to numerous regulatory changes and address reimbursement challenges.

Telemedicine Integration

Telemedicine has revolutionized medical practice by allowing both patients and providers to benefit from more personal, cost-effective, safe, and reliable methods of healthcare delivery. By integrating telemedicine services with practice management software, providers can give better quality care because they have access to a more comprehensive picture of the patient’s health and medical conditions beyond a single visit. This interoperability provides faster, more accurate diagnoses, improved efficiency in care coordination, quicker treatment, and more.

Mobile Support

When using practice management software, documentation can be completed using a mobile device at the patient’s bedside or the point of intervention. The ability to instantly document, chart, or code minimizes errors that may otherwise occur when lags exist between the point of care and documentation. Many clinicians want to access patient data remotely. Practice management software systems optimized for mobile use gives them the option of electronically sending patients secure, HIPAA compliant information, scheduling appointments and procedures, and communicating important insurance and billing information.

Patient Portal Interface

A patient portal allows providers and patients to communicate with each other safely and securely over the internet. Physicians utilize the portal to set up automatic reminders for preventive healthcare checkup reminders and procedure due dates and electronically send patient statements and lab results. This creates a competitive advantage for practices by saving time and money by reducing unnecessary provider face time, staff time, and patient follow-up calls.