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The Practice Management System
(PMS) is used to deal with the day-to-day
operations of a medical practice. Its users can
capture patient demographics, schedule appointments,
maintain lists of insurance payers, perform billing
tasks, and generate reports using it.
A Practice Management System
(PMS) usually connects to EMR (Electronic Medical
records) Systems.
Integrated EMR In fact some of the information
in both these system overlap for example the patient
and provider information. However broadly speaking,
the main difference between the two is that while
the Electronic Medical records (EMR) system relates
to capturing the clinical charting details of
an encounter, the Practice management Application
(PMS) is used for administrative and financial
matters.
After a patient visit, a set of charges corresponding
to the particular service rendered to the patient
is entered via the practice management system.
These charges are entered using a combination
of Current procedural terminology (CPT) and International
classification of diseases (ICD) codes and has
a fee typically associated with it.
If the patient has a valid insurance policy, these
charges are then send as an insurance claim using
either the paper format (CMS 1500 form), For Hospital
charges (institutional) these charges are sent
using the UB-92 forms. Claims are also sent out
electronically using the Industry standard data
interchange standards (HL7 and ANSI X12).
Paper billing is accomplished using a HCFA 1500
form. A clearinghouse provides a service of accepting
claims from a variety of payers and then distributing
those claims to the appropriate payer.
A clearinghouse for medical claims differs from
a medical billing company. A medical billing company
provides billing, collection and accounting services.
Generally if a medical clinic uses a medical billing
company that clinic will not need a Practice management
System (PMS).
The medical billing company handles accounts receivable
and sending statements to patients. A clearinghouse
sends a claim to the payer, but does not handle
accounts receivable or collection services. In
many cases a medical clinic will need a Practice
management System (PMS) to collect the information
for submitting a claim to a clearing house and
to manage the accounts receivable after submitting
a claim. Many clearinghouses offer a variety of
services and there is overlap between the services
from a medical billing company and a clearinghouse.
A Practice Management System
(PMS) is capable of automating the office's
workflow and daily procedures. The systems perform
the essential functions necessary to effectively
manage the day-to-day operations of a healthcare
provider, including patient management, report
generation, claims processing, patient invoicing
and appointment scheduling.
The system is capable of billing claims for a
variety of medical specialties, and can process
HIPAA-ready electronic claims to Medicare, Medicaid,
Blue Cross / Blue Shield, any clearinghouse or
directly to the insurance carriers.
The Practice Management Application that will
help you automates your office at a cost effective
price. And with four versions of Practice Management
Software, you can be sure that Binary spectrums
Practice management Software (PMS) can serve your
organization, regardless of the size of your practice
or the number of locations you wish to manage.
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| Core
Functionality |
- Restricts access to data and system functions
- based on user and/or group settings - with
built-in multi-level security
- Create a variety of internal data codes,
including fee schedule, modifier, payment
and visit codes
- Reminder notes for physicians and staff
- Multiple locations can be managed as one
company or individually by easily switching
databases
- Share data with other Windows-based applications
- Multiple windows can be opened simultaneously
- Automates your patients' visits with minimal
required keystrokes, from patient check-in
to scheduling follow-up appointments.
- Streamlines many of your most time consuming
tasks through the system's integrated workflow
management - increasing office productivity
and providing a greater return on investment.
- Improves current account revenue by reducing
denied claims via the software's advanced
claim scrubbing technology.
- Generates reports that can identify your
most popular and profitable procedures, top
referring physicians, outstanding accounts
receivable and more.
- Manages a variety of critical patient data,
including demographic details, insurance information,
billing history and more.
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Data
interchange standards used in a Practice Management
System
PMS often needs to interface with the outside
world. There are a number of standards that are
used |
- HL7 — used to communicate with hospitals,
or EMR systems
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| ANSI
X12 EDI transactions, including |
- 270 — eligibility & benefit inquiry
- Is the patient an insured of this payer?
- 271 — eligibility & benefit response
(response to 271) - A yes or no response that
the patient is insured.
- 276 — claims status inquiry (follows 837
submission)
- 277 — claim status response (response to
276)
- 835 — claim payment/advice (follows 837)
- 837 medical claim is paid, and amount of
payment and the patient's financial responsibility
- 837D — claim submission for dental claims
- 837I — claim submission for institutional
claims
- 837P — claim submission for professional
claims
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Benefits
Medical
Billing Manager or Practice Management
Medical Billing Manager or practice management
supports you to automatically claim medical bills
from insurance companies, ensuring minimized efforts
and accelerated reimbursement. All claims verification,
processing and interchanges are processed using
EDI standards to ensure information reliability
and security.
Patients’
Eligibility Verification
Patients’ eligibility for different treatments
and procedures according to their health plans
can be verified to ensure that only those services
are provided for which the patients are entitled.
Super Bills
Creation
The super bills for patients can automatically
be generated that include the charges for diagnosis,
services, treatment and procedures of patients.
Automatic Code Generation
Standard codes for diseases and procedures are
generated to ensure industry compliant medical
coding. The system is regularly updated to use
standard codes in conformance to ICD, CPT and
HCSPC.
Automatic
Claims Processing
Medical Bills can be claimed automatically from
insurance companies and swiftly reimbursed.
Payment Records
Payment records of patients can be maintained
and monitored. The payment history of patients
can also be viewed. Accounts Receivable (co-payment,
insurance) can be identified and their payment
can be claimed accordingly.
Better
Collections
The better Practice Management
(PM) or integrated EMR/PM systems on the
market feature dynamic accounts receivables reports
which enable the biller to drill down on each
line item on screen to re-bill, access patient
information, and access insurance information.
These features alone will cut in half the time
your staff spends on collections. These highly
accurate reports provide valuable information
on everything that is outstanding, the number
of days that the claims have been out and which
insurance companies are the slowest to pay, including
how much each one owes.
Control Over Practice
With new database technology and practice management
systems that are linked to EMRs, you’ll be able
to run a number of different practice management
reports to help keep you in control of your practice.
There are a number of quick reports that can be
printed out daily that tell practice owners things
like the number of patients seen on a specific
day, total collections, new patients compared
to old patients, reschedules, cancellations, etc.,
etc., all on one screen.
Practice
Automation
The total automation of the front and back offices
will drastically cut down on labor costs. Scheduling,
super-bill creation and management, document management,
and integration with the EMR, will save your office
hours each day.
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- Achieve 100% HIPAA compliance
- Faster payment entry
- Improve front desk and back office efficiency
- Receive payments for payers quicker
- Flexible, feature rich, easy to use
- Scalable and adaptable
- Streamlined workflow
- Increased productivity
- Reduced errors, risk & lost charges
- Accurate statements & claims
- Increased revenues, compliance, treatment
protocols, outcomes, physician effectiveness,
patient care& patient loyalty
- Faster sharing of vital information
- Impressive Return on investment
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| Features |
- Patient/Insurance billing
- Patient/Resource scheduling
- Multi-provider scheduling views
- Electronic billing
- Electronic insurance eligibility checks
Patient letters
- Advanced accounts receivables management
- EMR integration
- HL7 compliant
- HIPAA compliant
- NPI number ready
- Data Analysis (Outcomes, Quality, Process)
- Electronic Claims Submission
- Electronic Payment Remittance Scheduling
- Document Completion
- Dictation/transcription
- Report Generation, Referral Management
- Wireless Technology/Mobile Solutions, Fax
Capability
- Online Interactive Support
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