If you’re looking for greater efficiency, effective operations, and increased billing, practice management systems (PMS) are proven to meet those requirements.

But not all solutions are the same. If you’re shopping for a PMS, make sure you get the functionality that truly makes your practice better by looking for these 10 characteristics:

1. Eligibility:

You should be able to check a patient’s insurance coverage in real-time—on the spot, providing active coverage details for any date and place of service.

2. Multiple billing accounts:

A patient may be identified just once in a PMS but could still be seen in the practice for different diagnoses attached to multiple guarantors. Make sure the solution enables more than one billing account for each patient.

3. Fee schedules by payer:

Your PMS should be able to maintain a fee schedule, contracted or not, for any or all insurance payers of interest.

4. Claim scrubbing:

The ability to scrub claims prior to transmission to the clearinghouse will result in a higher first-time acceptance rate and faster claim turnaround.

5. Drilling down:

A robust PMS system will enable the ability to drill down through the data, allowing users to quickly access and retrieve needed information without having to open and close multiple forms.

6. Practice messages:

Information is essential to an efficient practice. Identify a PMS that gives you the ability to quickly disseminate messages to all system users.

7. Flexible reporting and exporting capabilities:

Yes, reporting tools are a must have, but those tools should also be flexible enough to group, filter, and format on the fly and easily export to a third-party reporting tool.

8. HL7 interface:

Interoperability is a must to enable connectivity with hospitals, nursing homes, and labs.

9. Payments/adjustments posted on date of service:

The PMS system should post all payments and adjustments for a specific service date, not just to an account balance. Services should be managed by date so that each service rendered during a visit can easily be billed, re-billed, and released.

10. Automated RCM for patient A/R:

The ability to move accounts receivable through an automated revenue cycle management (RCM) tool is essential. Users should be able to view collection activity by the age of the receivable and payment criteria and automate the collection process with notes and letters to the patient.

You can probably find PMS systems out there with more functionality than this set of core capabilities. But with each added bell and whistle, the price goes up. Remember that the goal is to find a solution that improves practice efficiency and billing; at a certain point, more functionality tends to overwhelm the user and detract from the very things the system is intended to enhance.

Balance your practice budget with the functionality you want and can afford, but make sure these 10 must-haves are included in chosen solution.


This post was first posted on May 3, 2016 on Medsphere. It has been republished with the author’s permission.

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