Designed for multi-location, multi-provider, or multi-group practices
Identify and confirm patient insurance benefit eligibility level and copay quickly
Implement your choice of the many clearinghouses that our software integrates with
Receive patient payments faster with integrated online patient payments
Customize patient statements generation by Locations, Business Units, Rendering Doctors, or Attending Providers on a specific day of a month
Post EOBs/ERAs quickly and efficiently
Streamlines communication, simplifies administrative and financial tasks, and enhances physician and staff productivity
Time-proven implementation methods for successful Practice Management software transition
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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 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.
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.
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.
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.
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.
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.
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 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.
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.
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Medical Practice management represents everything that goes into the practice of managing the finance and administration of a doctor's office or an office of a medical professional. It consists of financial management and business operations, information technology and medical practice management systems, patient management, compliance, quality control and risk management, human resources, and organizational operations.
Change occurs in every industry, and healthcare is no exception. New technologies, trends, regulations, and research continually shape the industry. The implementation more than a decade ago of the Affordable Care Act and the move from fee-for-service to value-based care have impacted patient care and the way physician practices operate.
Although doctors have administrative tasks in addition to their focus on patient care, it’s almost impossible for them to manage their practice without assistance. That’s where practice management comes in.
According to the American Academy of Professional Coders (AAPC), the role of a practice manager is to manage all aspects of a medical practice, including financials, human resources, information technology, compliance, marketing, and operations. Their goal is to enhance patient care, ensure day-to-day operations of the practice run smoothly, and alleviate administrative burden on the physician(s).
The key component to running a successful physician practice is proficient financial management. Even if a clinician provides excellent care to his or her patients, the practice isn’t going to be sustainable without the necessary revenue.
Myriad facets are necessary to achieve and maintain streamlined financial operations, and many of them fall into the category of revenue cycle management (RCM).
RCM is defined as all administrative, financial, and clinical functions that contribute to the capture, billing, collection, and management of patient service revenue.” Some of these functions include:
One metric many practice managers utilize to accomplish these functions is relative value units (RVUs). Through a cost analysis based on RVUs, physician practices are able to establish productivity-based compensation, evaluate and renegotiate payer contracts, evaluate procedures and services, and set practice fees.
Two key functions that should be included in financial management of a practice are medical billing and coding audits. By auditing and analyzing past results of your practice, you achieve an in-depth review of your practice’s performance and identify what improvements might be needed for optimal efficiency.
Focusing on patient care should be the goal of every physician. As noted by MGMA, patient-centered care refers to the ability to create an environment and develop processes that support the best possible patient encounters. A practice manager can assist in that endeavor by performing care coordination, striving to ensure patient safety, and optimizing office workflow to promote patient satisfaction.
Patient satisfaction can be increased through patient engagement because those who are fully engaged in their care are more likely to maintain treatment plans, track their health and ask their providers questions. Technologies such as patient portals, automated appointment reminder systems, check-in applications, telehealth, digital payment options, and data analytics have been found to have profound impacts on both patient engagement and practice workflow.
Another role of a practice manager in patient management is supporting and overseeing quality initiatives and measurement activities. There are three types of quality measures in healthcare: structural, process, and outcome. One such measure is the Institute for Healthcare Improvement (IHI) Triple Aim of healthcare, which is designed to improve the patient experience of care and the health of populations and reduce the per capita cost of healthcare.
It takes a skilled team of physicians, nurses and support staff to run a successful practice. Most functions of the office that center on these employees are the job of a practice manager. However, human resource management is not solely about recruiting, hiring, retaining, and dismissing staff members. It’s about handling the scheduling, processing payroll, conducting clinical and administrative training, developing personnel policies and procedures, performing staff evaluations, and more.
Developing and administering compensation and benefits programs for practice employees is essential in human resource management. Processing payroll is just one part of this process. A practice manager has to have knowledge of different physician compensation models, ensure compliance with federal, state, and local employment laws and regulations, and which benefits best assist in recruiting and retaining staff members.
Before hiring a new physician, a practice manager must perform medical credentialing. Also referred to as provider or physician credentialing, it’s an extensive process that examines and reviews a provider's qualifications and career experience and is required to be completed before he or she is hired. Areas covered during medical credentialing include education, certification, training, and licensing.
According to the American College of Medical Practice Executives (ACMPE) Guide to the Body of Knowledge for Medical Practice Management, additional human resource management skills are:
Utilizing technology in healthcare can reduce costs by automating administrative tasks for more efficient use of physicians’ time, lowering staffing costs by using scheduling apps, reaching more new patients with targeted digital marketing, improving claims processing and collections, and optimizing the supply chain for value-based care. Most of these solutions are designed to help physician practices streamline workflow, reduce administrative burden, and improve patient care.
Managing IT in a physician office entails assessing the need for and selecting medical practice software and other solutions that securely integrate clinicals and financials, offer comprehensive reporting features, include broad vendor support, promote adherence to compliance regulations, and streamline revenue cycle functions. It also consists of planning and conducting employee training on technologies used in the practice and ensuring staff members know how to optimize the capabilities.
One of the primary technologies used in physician practices is an electronic health record (EHR) system. A well-designed EHR should be customizable for your practice’s specific needs and automate time-consuming administrative tasks, allowing you to focus more attention on patient engagement and experiences. It also must provide secure, real-time access to patient health information at any time and from any location.
Following the numerous guidelines of HIPAA, MACRA, OSHA, the Stark Law, CMS, and the HHS Office of Inspector General, and others is part of the responsibilities of a practice manager. They’re also tasked with establishing and monitoring quality standards, ensuring highest levels of data encryption, mitigating all possible emergency situations, and addressing potential legal issues all while ensuring compliance with state and federal regulations.
Practice managers and the physician(s) for whom they work can avoid significant personal and entity liability by:
Risk management also is essential to sustain a financially-secure physician practice. The skills of a practice manager in mitigating risk include continually assessing potential medical practice risks to prevent malpractice suits, loss control issues, and government claims of abuse; communicating consistently to medical practice staff via most appropriate media the commitment to minimize risk and maximize compliance to ensure high-quality patient care; investigating all claims against the practice and its physicians and staff to ensure patients and staff are treated correctly; and negotiating contracts (including capitation agreements) with payors, contractors, vendors, and other outside resources to eliminate risks for the practice.
In addition to managing the daily operations of a physician practice, developing and administering policies and procedures to establish office standards and ensuring quality customer services encompass only part of a practice manager’s role. Operations management objectives also encompass implementation of an effective business plan; process improvement; purchasing and asset management; identification of outsourced business services and external expertise; communications, marketing, and community relations; and creation of physician conduct and performance expectations.
Key business and clinical operations skills a practice manager should utilize are:
Practice Management Software or Practice Management System (PMS) is a medical management program used by healthcare providers and medical practices to automate manual and effort-intensive financial and administrative tasks (like appointment scheduling, medical billing, etc.) and replace them with standardized electronic transactions and workflows. In addition to enhancing the efficiency of physicians’ clinical workflow, the right practice management system enables practice staff to accomplish the following:
Practice management systems are a critical linchpin to the success of a medical practice and achieving its goals of driving down costs and improving quality.
There are a variety of tangible and intangible benefits associated with implementing practice management systems in clinics of all sizes. Outlined below are 12 of the key benefits providers will realize by implementing medical management software.
The most valuable, and most widely reported, benefit of medical practice management software is added efficiency; specifically, in regard to workflows and processes. In a fast-paced, dynamic care environment, adding efficiencies and streamlining processes has a direct impact on throughput and the clinic’s ability to achieve quality patient outcomes.
Medical practice management system offers a standardized system for maintaining peak performance – minimizing errors and redundancies to help staff operate smoothly and efficiently and reduce patient wait times. The software’s monitoring and reporting capabilities also help in the early identification of issues for troubleshooting and proactive interventions.
By systematically organizing medical practices, practice management systems allow providers to focus on quality care rather than burdensome, administrative tasks. This benefit is achieved by assuming and automating processes such as scheduling, billing due dates and patient tracking. As the documentation required by the Centers for Medicare and Medicaid Services (CMS) increases, this function will become increasingly important to providers.
Medical Practice Management Systems better leverage staff time by automating standard tasks. For example, PMS is often capable of automatically sending appointment reminders and maintaining sufficient supply inventories, which are triggered to automatically re-order when inventory is low.
Medical management systems streamline payment processes and facilitate faster reimbursement. This added efficiency is achieved through the system’s ability to verify insurance eligibility early in the process when the patient’s appointment is scheduled. PM software also provides billers with critical access to patient records and reports, which can be searched to address questions and fill in critical gaps in claims information. Such access greatly expedites the reimbursement process by minimizing the “back and forth” between practices and billing entities that can often result in costly delays.
Medical practice software can produce and send electronic bills and an e-commerce component allows providers to collect payments online. The software can even proactively identify claim errors that could potentially delay payment so that proactive measures can be taken.
As healthcare technology evolves, digital systems for medical documentation have become the norm. This transition to paperless record keeping combined with a growing emphasis on documentation – both within Medicare standards and insurance practices – has established appropriate documentation as a priority within all claims and billing processes.
Enhanced documentation is a key benefit of practice management software, as the technology provides a standardized system that effectively reduces errors compared to hand-written provider notes. Documentation can often be done via mobile device, such as a tablet, at the patient’s bedside or at the point of intervention. The ability to instantly document, chart or code further helps minimize errors that may otherwise occur when lags exist between the point of care and documentation.
Virtually every PMS solution is designed around healthcare mandates and regulatory requirements, such as the Health Insurance Portability and Accountability Act (HIPAA) rules, the HITECH Act and various provisions of the Patient Protection and Affordable Care Act.
Maintaining compliance is a constant priority for medical practices, and implementing medical practice software can help ensure that all facets of your clinic are in full compliance.
By streamlining and automating processes and administrative tasks, medical management systems allow providers to focus on the most important factor in the care equation – the patient. The less practitioners have to worry about standard tasks and processes, the more time and energy they are able to devote to the patient, which in turn yields better outcomes and fosters an environment in which quality care – and not documentation, scheduling or various other considerations – is the top priority.
Practices nationwide can attest to the fact that practice management solutions take the pain out of scheduling both patients and staff. Intuitive scheduling and calendar tools allow medical personnel to input appointments and make calendar adjustments without fear of double-booking or scheduling during a time slot when a given provider is otherwise unavailable.
The scheduling module in many systems also includes alerts, such as patient balance due or authorization, which helps proactively address potential patient issues prior to the appointment and lessens the burden on front office staff.
Through the aforementioned billing and scheduling features, practices have the ability to quickly and easily update patient records and information. From direct links to update contact information in appointment reminder emails, to intuitive programming that auto-corrects erroneous entries by staff, medical software is a trusted tool to ensure patient information is accurate and up-to-date.
The fact that practice management systems are integrated with insurance and billing processes ensures that changes made in one system are reflected in the other components “talking to” the PMS as well.
As demonstrated by the aforementioned features and benefits, medical office software is equipped to manage a range of practice functions and challenges. In addition, the barriers to entry for implementing a PMS solution are few – generally all that is required is a networked system of computers and a reliable internet connection.
Medical management systems can be implemented in practices of all sizes – solutions are available for small, midsize and large offices alike. The technology is also scalable, as its storage and processing capabilities are not limited like a traditional, physical storage room. Systems exist capable of accommodating even the largest and most demanding practices with the help of massive databases and unlimited storage.
It should come as no surprise that medical personnel view streamlined, reliable processes as an important benefit. Standardized workflows and automated features help providers work more efficiently and effectively, which in turn improves their overall satisfaction.
For patients, the ability for 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. Providers can also be certain that the renewed focus on quality care enabled by PMS software mentioned above is noted and appreciated by their patients.
Any discussion around the benefits of a practice management system would be incomplete without mentioning electronic health record (EHR) integration. Practice management solutions can be effectively integrated into EHRs, allowing practices to consolidate virtually every function needed to manage the practice, its patients and providers under one system. An integrated solution provides a seamless user experience for both providers and office administrators.
Far-reaching regulatory shifts at the federal level combined with advancements in technology and a changing patient population are just a few factors contributing to the rapid transformation of the U.S. healthcare system. As the industry evolves, the systems and processes utilized by practices and practitioners must also evolve in order to keep pace with the demands of today’s care continuum.
In such a dynamic healthcare environment, medical practice management software is essential in order to effectively and efficiently coordinate communications, transactions and interactions between patients, providers and systems. Various organizations nationwide have implemented practice management system software and achieved measurable, positive outcomes related to both patient care and the fiscal health of their practice.
The successful launch of medical office software can only be achieved by following a sound process for evaluating potential solutions. Outlined below are 11 key considerations and best practices that providers should incorporate into their selection and implementation process.
The goal of any Practice Management System (PMS) initiative should be to better support and leverage the medical team and provide greater efficiency to existing processes and workflows. As such, the fit, practical application and effectiveness of a potential new system should be determined by the actual team members who will be utilizing and interfacing with the software. A PMS team of key stakeholders should include at least one representative from each function or discipline within the practice. While the composition of the team will vary based on office size and type, team members may include physicians, non-physician clinicians, practice administrators, registration staff, coding and billing team members.
A team-led process will help ensure the system selected is the best fit for the practice. Collaboration and buy-in from all of the practice areas impacted by a PMS also serves to expedite the process and helps avoid unnecessary costs and delays.
In order to make an informed decision regarding medical software, it is important to evaluate current patient management processes and the claims revenue cycle. This step is often best achieved by putting pen to paper – or fingers to keys – and mapping out current systems and processes. The map should include all points and interactions – from initial contact with a patient through follow-up appointments and reminders on outstanding payments.
By visually defining existing workflows, the PMS team will be able to determine what functions and processes the optimal medical office software should support.
In his renowned book, “The 7 Habits of Highly Effective People,” author and leadership expert, Stephen Covey, advises “begin with the end in mind.” Beginning the selection process for a practice management system with a clear understanding of what it should deliver for the organization is perhaps the most critical step the journey.
The PMS team should help lead an organization-wide effort to identify the essential features and components a system must offer in order to effectively serve the practice and its patients.
But in order to arrive at a list of minimum requirements and criteria, it is important to know which questions to ask. Below are the top 10 questions to ask to ensure you are choosing the right medical billing software. Be sure to check out our previous “Top 10 Questions” post for a deeper dive into the key queries for the selection process.
1. How much do you want to spend on medical billing software?
2. Will you need to make an investment in hardware or infrastructure?
3. How will it work with your existing EHR system?
4. Do you have adequate in-house IT resources to support your medical billing software?
5. Is the billing software easy to use?
6. How long will it take to implement the system?
7. What type of training is available and will the training period fit your schedule?
8. What safeguards are in place to protect the security and integrity of your data?
9. Is there a robust reporting system?
10. Can the system be customized to your unique practice requirements?
Specific questions such as those outlined above will help define a list of essential features. The list should include some of the following components:
Once the PMS team has established the checklist of “must haves,” it is time to begin researching available systems. As with any product or endeavor, a quick online search for key terms, such as “practice management solutions” will yield numerous results – some credible, and some less than capable. Thus, it is important to narrow the field and develop a short list of viable and legitimate options even before applying the criteria established by the PMS team. Ideally, no more than 10 and no less than three vendors should be selected to submit a formal proposal for the project.
A few tips and guidelines for choosing quality and practice-tested systems include:
Calculating what the practice’s return on investment (ROI) will be before deciding to pursue medical office software is critical to success. Considering the ROI will help determine whether the investment of staff time, resources and money is worthwhile. A cost-benefit analysis can help make this determination by weighing factors such as:
Obviously not all returns will be directly measured in dollars and cents; as patient outcomes, satisfaction scores and other key factors should be carefully considered as well.
In today’s connected healthcare environment, system integration is critical. Medical practice software solutions must align with existing processes and procedures, and provide users with the ability to easily access and utilize data between workflows and programs. Without an integrated solution, staff members will waste time copying and pasting information and duplicating tasks.
Similarly, practice management system software must also talk to the practice’s electronic health records (EHR) system. Some medical management systems are integrated within an EHR as a component of the care platform, while others are designed to seamlessly interface. Regardless of which option your practice chooses, the ability to connect with your EHR is crucial to ensuring efficient communication both internally, and between care settings and providers.
While the selection and launch phases are vitally important, the life of the practice management solution is only just beginning at implementation. It is important to consider the ongoing maintenance and continuing service needs of the system during the selection process in order to make an informed decision and commit to an arrangement that is manageable for your practice.
A few key questions to consider include:
Customization and flexibility are important considerations for any PMS team. Every practice differs when it comes to the functionality and features of medical office software and medical billing software. Some may require specific, non-standard reports; others may request a unique configuration of the system’s interface.
Some systems may meet all of your needs out-of-the-box, but if customization is important to you, be sure to weigh this factor in your evaluations of systems and vendors. As previously mentioned, it is important to define your organization’s must-haves early in the process as this will allow you to determine if your practice’s requirements and non-negotiables are standard or custom features.
Maintaining compliance is a constant priority for medical practices, so naturally the medical practice software selected should bolster your efforts toward healthcare compliance, rather than serve as a hindrance. Most systems are specifically designed to ensure compliance with healthcare mandates and regulatory requirements, such as the Health Insurance Portability and Accountability Act (HIPAA) rules, the HITECH Act and various provisions of the Patient Protection and Affordable Care Act. Be sure to ask how the solution you are vetting can help make the compliance process easier for your practice.
Once the list of potential practice management solutions has been winnowed down to a few front-runners, it is time to create a RFP (Request For Proposal) and contact your shortlisted vendors . While the makeup of the RFP will vary based on the organization’s size, needs and other practice-specific factors, all RFPs should include key elements, such as features, timeline, training and support required. You may also choose to provide vendors with your list of “must haves” as an attachment. By comparing the responses to your RFP, the PMS team will be able to determine the best overall fit for you practice. Responses should be carefully evaluated to determine which system provides the most ROI within the defined budget.
Medical offices considering a practice management solution must carefully weigh factors such as cost, functionality and integration. But while these factors are key determinants, the importance of user experience and overall fit must not be overlooked.
Ultimately, the best medical practice management system is the one that fits best in your practice and meets your organization’s specific needs. The solution that allows you to build on the processes that are working, and add efficiencies and fixes to the areas that are not, is a solution that will position you for success.
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.
Because practice management and EMR software initially should work together seamlessly, selecting a fully integrated system is recommended. The combined capabilities offer
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.
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.
Although these two types of software appear interchangeable, they vary in numerous ways. The most significant difference is that practice management software streamlines administrative tasks, and EMR software handles the documentation and storage of patients’ medical data
Practice management and EMR software can be used individually. However, when combined, they help physicians’ practices operate with speed, accuracy, and ease and create a simplified workflow for physicians and staff members. Combining practice management with the EMR software keeps all staff members within a practice connected by providing an unbroken flow of information.
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.
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 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.
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.
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.