What is a practice management system and how do I choose one?

A practice management system is software that is used for scheduling patients, billing and running reports on the numbers in your practice. For a overview of the billing cycle read this post. Why should you care about the ease of the practice management system? Because you want to get paid with the least amount of data entry as possible!

The purposes of the practice management system are to:

1. Enter patient demographic data and insurance information. If your PM system is compatible with your EHR, the information you enter transfers over to your EHR. Here’s my post on how to choose a EHR.

2. Verify patient eligibility and financial responsibility (if there is a deductible and how much has been met, or what the copay or coinsurance is)

3. To post charges (for each patient seen, the ICD 10 and CPT codes). You definitely need to get a PM system that is compatible with your EHR so the codes automatically transfer over, which saves a ton of manual labor as well as reduces room for error).

4. To view confirmation reports from your clearinghouse (where charges are sent from the PM system, before the clearinghouse transmits them to insurance companies) to make sure charges are accepted.

5. To be able to print paper claims (on CMS 1500 forms) for payers that don’t accept electronic charges

6. To post patient payments

7. To post insurance payments. These come as EOBs (explanation of benefits). If they come on paper then you have to look up the patient and manually enter in four or five different items for each patient. If you get EOBs electronically, they are called ERAs (electronic remittance advice) and with the click of two buttons or so, all of the patients on the EOB have their payments post.

8. To look up delinquent accounts, preferably you can choose accounts over 30, 60 or 90 days and sort them by amount outstanding and whether it is patient or insurance responsibility.

9. To print out statements to send to patients for monies owed after insurance adjudication of claims.

10. To print reports so you can analyze your practice- monthly reports of charges and collections (to keep track of your revenue), revenue per patient (this is called benchmarking and we’ll have a separate post on it later), breakdowns by insurance company, how many OCTs you did last year, your revenue from OCTs, which zip code or insurance most of your cataract surgery patients come from, etc.

So how should you choose your practice management system? First of all, it will probably be driven to a great extent by your EHR. A lot of cloud programs are two in one software, meaning that if you pick the EHR, you pretty much have to go with the practice management system. I’ve heard of folks getting nickeled and dimed after the fact- fees to send out extra number of faxes, fees to generate reports, different tiers of pricing with what you would EXPECT out of a practice management system at the highest and most expensive tier. So if the price for your EHR looks low, the company might make it up by overcharging you for the practice system. Typically the cost ranges from $300-600 per month, sometimes this is for both the EHR and practice management system.

If you are server based, you usually have more choices. My EHR is compatible with several practice management systems, and has two or three partners at the highest level of compatibility. So when I chose my system there were basically two choices. Ho Sun went with the first company and absolutely hated them, so I went with the second company. I never test drove the software simply because I didn’t even know what to look for back then, but spoke with several ophthalmologists who kept their billing in house to make sure it was easy to use. I’m still happy with mine even though customer service can sometimes take a while, but Ho Sun just switched his software this week, eight years into practice. My software cost about $8000 up front with about a $3300 annual support fee. With a cloud based app you can log in from anywhere at anytime, but with a server based system you can still do billing from home if you use teamviewer or similar software.

Finally, if you use a billing company, often times they require you to use their practice management software (or they say they’ll give it to you for free). The drawback with this is that it may not be compatible with your EHR, thus creating more work for you in data entry for ICD and CPT codes, compared to if you posted your payments yourself. If you used a cloud based system, they often advertise a “complete RCM (receivables collectible management)” package where they do billing for you. Don’t bite; many on our thread have found that the folks doing billing were clueless and lost them money until they brought it in house.