What is Practice Management Software and Why Do You Need It?
Written by: Cheryl Reifsnyder, PhD
Running a fast-paced medical practice can be a complex, stressful operation. In a single day, practice staff may deal with administrative, regulatory, financial, and technological tasks as well as patients. The knowledge that patients’ health and well-being depend on the practice’s smooth operation only makes it more stressful.
That is the reason for Practice Management (PM) software. It streamlines practice operations by automating many essential daily activities. The software’s multiple functions combine to help keep your practice running smoothly and effectively.
What is Practice Management software?
PM software is a collection of computerized solutions used by healthcare providers (HCPs) and their administrative staff to streamline many of the practice’s essential day-to-day tasks. It exists to improve practice efficiency and, as a result, improve the quality of patient care. PM software can be used by practices of all sizes, including both generalists and specialists.
PM software usually focuses on financial and administrative tasks. In most cases, it integrates with the practice’s electronic health record (EHR) system, allowing information exchange between patient profiles in the PM system and the EHR. Some PM systems have EHRs included as part of their functionality.
Common features
Although each PM system is unique, most have several features in common.
Scheduling
PM software generally provides an appointment booking process that is more efficient and less stressful for patients and practice staff alike. Most PM systems allow staff to customize their appointment booking screens, to organize and display data according to individual requirements. Many systems enable patients to book appointments online, which can increase appointment requests. PM systems also often provide automatic appointment reminders. Text or emailed reminders decrease the number of missed appointments, which can also increase revenue.
Together, these features make the scheduling process go quickly and easily. This leads to shorter lines in the waiting room and less time required from staff—freeing them to spend more time on patient care. This results in an improved visit experience for both patients and staff.
Patient information management
A good PM system can further decrease administrative burden by providing patients with free online check-in. Online check-in enables patients to complete customizable intake forms online. Patient information can then be imported directly into the patient’s chart, eliminating the need to enter data manually into the EHR.
Insurance eligibility checks
PM software also enables staff to check the insurance status—including whether patients will be provided coverage at your specific medical practice—of several patients simultaneously . Eligibility checks also allow providers to review whether specific procedures will be covered by patients’ insurance prior to ordering.
When required, an eligibility check can return a real-time response, helping patients spend less time at the reception desk while staff verify their insurance.
Billing
PM software frequently includes electronic billing, which automates and streamlines the practice’s billing operations. Electronic patient billing includes collection tools that track patient transactions and balances. It can automatically deliver reminder notices and collections correspondence as needed. These tools eliminate the need for practices to track down overdue payments individually. Automating numerous billing department tasks can save staff time while increasing cash flow.
Flexible payment options are also included in many PM systems, which improve the patient experience by making the payment process more user-friendly. Not only that: Experts advise that more payment options offered by a practice increase the chances of payment.
Management of electronic claims submissions and denials
One primary reason for increased adoption of PM systems is that they enable more rapid submission and adjudication of insurance claims. The American Medical Association estimates that inefficient claims management systems lead to about $210 billion in unnecessary expenses annually. Using an electronic system to manage claims submissions and denials can alleviate significant loss of time and money on faxes, phone calls, and snail mail.
A PM system is designed to capture all the relevant information from patient encounters, information that is required to obtain reimbursement. It then performs tasks such as:
- Generating claims for reimbursement requests
- Tracking claims status, payments, and denials
- Automated claims appeals process
- Creating patient statements
- Creating business correspondence
Coding tools
Some PM systems also provide coding tools containing information such as:
- International Classification of Diseases, Current revision, clinically modified for use in the U.S. (ICD-10-CM) diagnostic codes
- Current Procedural Terminology, fourth edition (CPT-4®) and Healthcare Common Procedure Coding System (HCPCS) codes
Coding tools make it easier and more efficient to identify the correct codes for submitted claims in accordance with federal mandates and deadlines. This optimizes calculating reimbursements to which the practice is legally and ethically entitled, while simultaneously helping avoid fraud or abuse fines for improper coding.
Reporting function
The ability to generate various report types is critical for helping a practice move toward its goals and objectives. The right reports can give a practice better understanding of its operations. They can enable practice administration to analyze trends and implement improvement strategies based on their findings.
PM systems generally provide customizable financial reporting. Users can also apply analytics to the financial data to gain a clearer picture of key financial indicators.
PM systems can generate other custom reports as well. For example, a report on HCP utilization or personnel productivity might be used to improve practice efficiency. Alternatively, reports might be generated for identifying patients who regularly fail to show up for appointments; gaining insight into how vaccination rates correspond to the frequency of patient reminders; or comparing turnaround times between claims submissions and payments for different payers.
Benefits of using PM software
PM software can help you optimize your practice’s operations by:
- Reducing paper-based workflow, helping streamline patient check-in and other administrative tasks
- Automating tasks for administrative staff, billing, and collections, saving staff time while increasing cash flow
- Helping staff and HCPs better coordinate administrative, logistical, and financial operations, increasing overall practice efficiency
- Helping the practice gain a better understanding of its operations at multiple levels through generation of customized reports
- Streamlining communications, helping improve coordination among staff and HCPs
PM software, particularly software that includes risk assessment and built-in compliance safeguards, also makes it easier to maintain compliance and regulatory standards. Automatic updates occur as regulations change and can automatically track necessary internal data, helping to prevent errors. In addition, customization features mean that individual PM systems can be tailored to accommodate specific practice needs.
The automation PM systems supply helps free time for both providers and staff—time that can be used to focus on patient needs. This, in turn, increases patient satisfaction.
Make the most of your practice’s resources
You can bring this broad range of productivity tools to your practice to improve both your financial and operational performance using Veradigm’s Practice Management. Veradigm Practice Management is a comprehensive revenue cycle management system available for practices of all sizes and specialties.
Veradigm Practice Management can help improve practice productivity and efficiency with features such as:
- Flexible scheduling
- Guided scheduling that uses artificial intelligence to optimize physicians’ schedules
- Intuitive Quick Pay dialog screen that provides front desk operators with a guided workflow to improve the collection rate and check-in process
Veradigm Practice Management can help optimize financial resources with:
- Automated, customized claims management workflows
- Tools to help verify insurance eligibility and increase patient collections during office visits
- Real-time reporting to enable access to real-time payment, claims, and coding information to help measure financial performance
Veradigm Practice Management can also enable you to:
- Create rules for updating vouchers before claim creation as well as delivering the ability to qualify items based on voucher-specific criteria
- Create “tasks” based on voucher-specified criteria and assign qualifying vouchers to a Tasking Queue to assign to designated staff for review prior to submission.
Contact us to learn more about how Veradigm Practice Management can help you improve both your practices’ financial and operational efficiencies and productivity.