Here are 3 steps to help you manage claims denials at your medical practice and start receiving timely reimbursements.

1. Ensure that all patient demographic and insurance information is entered into the EHR accurately.

Correctly capturing patients’ demographic and insurance information is the first step to successfully billing claims and avoiding denials. Insurance companies will check this information against their records during the claims reimbursement process and may deny claims if demographic or insurance information is incorrect. Train front desk staff and registrar personnel on how to capture and enter this information as accurately as possible.

2. Obtain prior authorizations when required by insurance carriers.

Insurance payers often require prior authorization for high-value services and drugs. Obtaining this prior authorization information from the carrier prior to billing the claim will help ensure that the claim has all of the information it needs to be paid and will reduce the chances of a claim denial. Implementing a streamlined process among your billing team to obtain prior authorizations is an important consideration to manage prior authorizations.

3. Proactively identify and review denials.
   

Implementing a process to proactively identify and work denials is critical in the denial management process. Request that a member of your billing team run denials reports and check claims statuses frequently to ensure denials are worked and resubmitted in a timely manner. It is important to make sure denials are worked quickly so payments can be received as fast as possible for maximum reimbursement.

There are a number of steps you can take to reduce claims denials and get paid for the services your practice renders. iPatientCare’s efficient billing workflow makes it easier to identify and work denials to maximize reimbursement potential for practices. Our expert revenue cycle management team is also available to manage all aspects of billing, including denial management and follow-up.

If you would like to see how iPatientCare’s Practice Management software and or Revenue Cycle Management services can help your medical practice schedule a demo or contact us today.

From appointment scheduling to billing and claim management, a robust PMS can reduce administrative tasks and help providers focus on patient care rather than billing operations. A practice management system can simplify the way providers do business, allowing them to improve cash flow, increase appointments, automate essential tasks, and transition to a paperless practice.

Basic Components of a Practice Management System Include:

1. Appointment Scheduling: A scheduling component allows providers and staff to quickly book and schedule appointments. It enables real-time monitoring of each provider’s availability across multiple facilities, which allows them to instantly identify potential scheduling conflicts and availability for specific appointment types. Additionally, text or email appointment reminders can be sent to patients, helping to reduce no-shows and cancellations, ensuring patients keep appointments and increasing revenue opportunities for the practice..
2. Patient Demographics Capture and Updates: A practice management system allows for clean entry of patient demographics and insurance information and permits easy updates to that information. Capturing patient demographic information as accurately as possible in the PMS is critical to successful reimbursement by payers because payers will reconcile the patient demographics they have on file with those entered into the PMS.
3. Claims Management: A PMS system creates electronic claims from captured charges and sends claims to the clearinghouse for transmission to payers.  Many practice management systems have built-in claims edits to ensure that claims are billed as accurately as possible the first time to help ensure maximum reimbursement as quickly as possible.

Benefits of a Practice Management System for Providers Include:

• Clearer documentation of patient demographics resulting in fewer claims errors and denials
• Improved scheduling processes that can reduce no-shows and cancellations
• Improved billing processes such as eliminating manual charge and payment entry
• Electronic submission of claims to speed up the claims adjudication process and reduce time in A/R
• Reduction of administrative tasks so providers can focus on quality of care

Moving from a paper-based management system to an electronic practice management system can improve efficiencies throughout the practice, leading to greater efficiencies and maximum reimbursement potential for practices of all sizes. Learn more about how iPatientCare’s practice management system can help your practice achieve your revenue goals today.

We invite you to view our free demo today.

This is where the PM software comes in and changes the entire system by digitization. From keeping the follow-up track, to allocating the resources through the practice, to scheduling patient appointments etc., is all at the liberty of practice management software.

The practice management system today, has tools that helps medical office staff focus on the task at hand with flexible views, filters and sorts options and helps your team members to create and save custom views to save time on repetitive tasks. It is more appropriate to say that practice management helps in keeping the practice’s non-clinical operations running in every situation.

What are components of Practice Management Software?

The practice management software comes with automated applications that perform scheduling, insurance claims, billing, and accounting functions within the practice. The Different types of medical practice management software are designed for the use of by small to mid-sized offices or third party billing agencies. Below are some important features of iPatientCare Practice Management Software:

• Patient Appointment Scheduling: Your practice can increase arrival of patients and reduce no-shows. The automated feature of appointment reminder uses phone, text, and emails to gently remind the patients of upcoming scheduled visits. There are even family messaging options that stores multiple appointments for a household on the same day into single automated appointment reminder call.This particular feature reduces no-shows and reduces expenses too as there is no cost for mailing patients. There is no need for staff to call manually to each patients for upcoming appointments. Appointment reminder system gives surety that your messages are delivered accurately, inexpensively, and quickly.
• Patient Data: There is a seamless front-end graphical user interface and a powerful database that input, stores, and retrieve data very quickly that is offered with great efficiencies by this medical billing software. The medical administrators can verify in real-time whether patients are eligible for insurance benefits or not depending on the type of system available whenever the new patients submits their insurance and demographic data items like – first name, last name, phone numbers, physical addresses and email addresses etc. This leads to fewer surprises for patients during their visit and for the billing staff during the billing process afterwards.
• Insurance Claims: Top practice management software makes the claim submission process much easier. This gives the office staff ample time to thoroughly answer patient questions and take care of their other needs. The greater level of transparency is given among patients, office staff and insurance companies.

Some medical billing software’s have basic reports available for insurance companies and patients pertaining to billing. On the other hand, there are software’s that can be customized to report capabilities that permits billing staff to compile financial and other patient data into useful information. So different level of this practice management software offers better level of simplicity among providers, medical administrators and patients.

After a patient visits a practice, the practice management system software allows the staff to generate a claim for the services provided, apply discounts and add additional charges. When it comes to billing, the charges are usually entered using codes. Medical practice management system when integrated with an Electronic Health Record System automatically transfers the claim information and thus helps in faster processing. Whenever submitting to various insurance companies, based on the pre-defined rules, the system makes sure that the process goes smoothly by assigning special billing codes for variety of procedures. Every system has a unique design and structure to meet the needs of patients. This system is created to work on an array of configurations, including networks connected to the internet, desktops, and client services.

This software has permitted the providers to maintain connectivity between the front office and back office on their own, without hampering their productivity. One has to thank the evolving technologies in healthcare IT for the number of advantages that the cloud based ambulatory EHR systems provide by keeping the information safely and easily available. The medical billing system has turned to be the most cost effective and giving efficient solutions, that are available to the providers.

With better-organized patient records, bookings, treatment processes, and improved efficiency in billing, the profitability of practice is enhanced. With EHR technology becoming more popular, a lot of vendors have started integrating Practice Management Software to expedite medical billing in their practices.

However, the providers must realize that medical billing software is bringing about a new change in the healthcare industry. The rate of claims being denied or delayed is decreasing significantly due to the latest technology like Claim Scrubber. Some other features of medical billing software that can contribute to increasing the practice’s efficiency are:

Access to Patient information makes the physicians run background checks on patients’ medical and insurance eligibility. Now it is easier to access patient information from anywhere and it helps speed up the billing process avoiding claim errors.

Reducing claim denials is another problem faced by the practice. The mistakes are inevitable as the practices have to deal with several claims directed towards different insurance companies at a time. But with the help of billing technology, it has become easier to identify errors and correct them before sending the claims out. This way around 90% of the claims pass through submission on the first go.

An increase in cash flow is observed by the practices after adapting to the electronic billing software. It helps to increase cash flow and increase the rate of claim submissions. It also helps the providers re-claim their fee early by reducing payment time. The software has the capability to auto-generate modifications through which providers can follow up on their claims through regular reports and tracking.

In short, the billing software increases the first pass resolution rate that improves the speed of collections and decreases work for in-house staff. It is sometimes impossible to keep track of every payer contract. So there is no way to know when your practice is being underpaid. The software automatically compares the actual payments received with the payment specified in each contract and sends an alert if discrepancies occur.

Make a thorough assessment before switching your Medical Billing Software

The billing software system helps to make the best decisions for your practice. It allows to schedule customized reports to be created at certain intervals for ongoing analysis, as well as generate custom reports, thus making the tedious manual process automatic. The optimization can be done by creating easily understood reports for better decision making, reducing staff requirements and increasing productivity, and finding mistakes and underpayments.

Thus, it is becoming more essential for medical practices to get a hand in the process of efficiently collecting money due to the escalated complications of healthcare revenue cycle management. For the medical practices, it is making it more important than ever to get a handle on the process to efficiently complete the collections on time. Use this billing software technology to your advantage. By utilizing the up-to-date billing software, practices have the opportunity to determine whether claims are likely to be accepted or denied, and also the software has the capability to update the ever-changing rules of the healthcare system regarding Medicare and Medicaid. This helps the providers to know about new trends in denials and work toward increasing the amount they can collect for the clients. Communication with the patients about the following details becomes easier if a medical billing software is implemented:

• Insurance requirements
• Upfront payments
• Co-payments
• Billing procedures

By having the above terms of payment easily visible to patients there will be no confusion. Clearly, there are many ways for a medical billing practice to become more efficient and effective.

What should a Practice Management Software Do?

• A success rate on the first attempt Clearinghouse Claims.
• Concurrency checking to ensure there are no overlaps in billing times.
• A must-have feature – the base unit being linked to procedure codes for accurate results every time.
• Variable unit pricing is based on insurance for quick reimbursement (reduces stalls by payors).
• Claim tracking and denial management.
• System-produced or offsite patient statements.
• Ability to handle multiple Tax IDs.

PMS features should allow the staff to easily register the new patients and be able to maintain the check-in and checkout of the other patients. Some of the important features are:

• The demographic information should auto-populate and must keep track of all modifications using built-in HIPAA compliant audit trials.
• Ability to scan and store multiple insurance card images and maintain a complete history of patient’s past insurances; also be able to take patient’s picture and scan insurance cards.
• Use digital pads for the patient’s signature.
• Easy check-in and check-out, using a self-check-in Kiosk.
• Should collect co-pays/past payments using credit cards and print receipts.

After registration, scheduling appointments is equally important. The PMS software should have the following features so that the staff can operate easily and efficiently:

• Should be able to schedule appointments for the providers at multiple locations along with color-coding (based on reason and status).
• The duration should be automatically marked as per the appointment reason.
• Should provide a customized view of scheduler chart to group providers.
• Should have the ability to block specific time slots for specific appointments.
• Must have waitlist and recall list management.
• Automated verification for all scheduled appointments, also rescheduling of appointments using easy-to-use drag/drop.
• No-shows can be reduced by sending automated reminders through either phone, text, or emails.

Keeping all the above features in mind, also know that the longer the vendor is utilizing the software, the better chances are that it will always be updated. Train the staff well so that they can take advantage of this timesaving software. The integration of PM with the EHR system is vital in order to implement a better billing system. The EHR enables a clean transmission of the data from it to the best practice management software so that the claims can be quickly submitted.

The billing software has a workflow to bring-in efficiency in all areas of operations of your practice. Documentation, submitting claims, and managing collections are all linked together, providing streamlined communication, time efficiency, and an effective tracking mechanism. Evaluating, assessing, and comparing different software vendors can be overwhelming. Be cautious in selecting your Medical Billing Software, and ask detailed questions to determine the expertise of the software before moving ahead.

Feel free to get in touch with us in order to get any specific guidance you are looking for. Fill up the form and our experts will set up a quick call as per your availability.

Ground Reality: A larger portion of patients walks out of the provider’s office without paying a dime. This trend is soaring on the higher side because of the inability to determine what you can collect. Co-payments are a given sure shot, but will your payer contracts allow you to capture coinsurance and unmet deductibles?

To handle these un-toward incidents update practice policy to collect these monies at the time of service and require patients to sign such financial agreement forms.

Correct Approach: Time-of-Service collection(s) starts right before the patient even arrives at the provider’s office. When patients call for appointments, set and establish the right expectations and make them aware of their current standings by reviewing the account ledger. Give a gentle reminder of your policy by saying: “We do expect payment at the time of service, Ms. Gomez.” and/or saying “Ms. Gomez, I notice that you have a balance.”

Automation Tool: iPatientCare Patient Payment Estimation is a contract-based advanced estimation tool with the ability to produce estimates of patients’ medical costs. Patient Payment Estimator allows your staff to give patients written estimates of their expected out-of-pocket responsibility after payment by their insurance carrier based on their plan coverage.

iPatientCare Patient Payment Estimator analyzer shares the provider’s negotiated contractual reimbursements; the historical, procedural information along with the charge description master information; and patient-specific, year-to-date benefit data to arrive at the most credibly defensible estimates of the patient’s out-of-pocket financial responsibility.

At the same time, such practices have turned out to be not-so-effective in terms of manpower handling as well. Thus, the leading practice management vendors these days are emphasizing preparing all-inclusive systems.

Emphasis is being given to the development of a system that can provide a complete platform for workflow. These systems basically comprise a series of services that function in coordination with different departments and clients to deliver ultimate therapeutic. Such systems are prepared in a way that can be cost-beneficial for the organization.

Modern-day price management software undoubtedly fulfills the all-encompassing characteristics talked above.

Practice Management Software Makes Modern Day Patient Management Streamlined:

What makes the price management software most effective is its all-in-one feature, which offers everything that one needs for better management. These tools are excellent for management purposes through a single vendor. It makes things easier by combining the departments, that used to be disconnected.

Such disconnected systems indeed were creating troubles in smooth management. However, Practice Management Software makes things easier through smoother data access across the departments. It makes things much faster to facilitate as well.

As a practitioner, one can have a greater focus on patient care, without being worried much about the management affairs.

Things can be even more efficient if Practice Management software functions in combination with Electronic Health Records Software.

How Can Practice Management Software be helpful in being integrated?

• Integrated Practice Management systems can let the practitioners handle their work schedule from their place. Even, a practitioner gets noticed through their devices, the moment a patient schedule is upgraded.
• It makes medical billing much more systematic than ever. A professional in charge of billing can start billing immediately, the moment a cost chart sheet is prepared. Through the process, one doesn’t need to fear missing information, revenue calculation, etc.
• Practice Management systems working in combination offer greater control to the patients regarding their schedules with the practitioner, bills, progress reports, etc.
• These systems create a better environment to connect with swiftly developing technological healthcare modes, starting from the laboratories, automated laboratory facilities, etc. A patient doesn’t need to stay in regular connection with the lab technicians; the outcomes can be forwarded through a patient portal.
• Communications between the practitioner and the patient get much more streamlined. Not just with the practitioner, though, it makes things easier for a patient to connect with the managers, managers connecting the practitioners, etc., as well get streamlined.

On the whole, a combined medical practice management system is beneficial for practitioners, corporate doctor’s houses, management professionals, etc. At the same time making it streamlined, encourages greater patient care as well.

The prime intention of the Medical Practice Management software is to minimize the time a doctor has to pay for the documentation. Through the process, the doctors become able in finding more time for the patients. Primarily, the medical practice management software helps in following medical administration tasks.

Takes care of the entire billing processes:

Medical Practice Management software (MPM software) helps the doctors in a great way for preparing patient billing statements, delivering electric bills and also with the payment related aspects. In a way it also works as a complete medical billing services module.

Automate appointment fixtures:

No need to be careful of those paper documents neither is there any need to be an expert in excel spreadsheet. MPM software also a good Medical Appointment Scheduling software can take care whole of your appointment details. At the same time scheduling new patient appointments, the Medical Appointment Scheduling software can follow the existing schedules, offer details of previous appointments, and also can send appointment reminder though ‘iRemind’.

Dealing with the patient details in a better way:

A new patient primarily has to fill out a form that asks various details like, physical address, insurance detail, contact details, etc. You can put all this information within the MPM software system. In fact, you can also transfer patient details to an Electronic Health Records Software (EHR) and even to the patient’s insurance company for proofreading.

Simplified document management:

Needless is to say that the modern day medical facilities include a huge amount of documentation steps to be followed. Hence, the likes of MPM solutions come up with functionalities to help you in arranging those documentation steps in a better way. A doctor can also scan the prescriptions, expense bills and other details into the system. Most of the systems also let the administrators generate complete reports to have a better observation on the various official functionalities.

Better check of different claims:

MPM software can be used by the doctors in editing the details of the insurance claims for services delivered, before final submission, to ensure it fits well with the national insurance claim norms. In fact, a doctor can also take the help of MPM software to submit claims electronically, have details of claim status, check the details of advantages that can be enjoyed, and get details of the unpaid claims.

Better register management:

Any medical administrator can tell about how time taking is the stocking and medical inventory distribution tasks. However, good news is that the MPM software can simplify the entire process to a great extent. Starting from having the details of inventory orders, checking out the supply levels to handling the whole inventory storages, everything can be simplified in a great way through the MPM software.

Apart from this, such software also lets you prepare inventory reports and check the details of products delivered to the patients from your medical.

Why software?

It’s a common sense that the need for a medical appointment scheduling tool is primarily to avoid the potential issues involved with the conventional scheduling ways, conducted manually. The most important factor is to increase automation. It has been seen at many occasions that manual procedures of managing medical appointments comprise of human errors which adds loss to the medical practice at the end of the day. On the other end using medical appointment scheduling software reduces such errors significantly and adds its contribution in improving care at reduced cost.

In fact, there is every chance of misinterpretation or wrong mentions despite putting all efforts following a manual procedure. Using the software, the above aspects could be certainly solved at an ease.

Which features to expect?

It is always advised to go with comparatively simpler software rather than the one with too many-unwanted features. However, considering the contemporary demands, the advanced features like quick booking, option to modify the scheduling, availability of the schedules, off day and other notifications, reminding notifications, a brief mail about the discussed aspects in meeting, etc., should definitely be there within the tool. Moreover, people should be able in checking the availability a long before.

It is user-friendly:

The contemporary users mind the user-friendly nature of the devices the most. Hence, the concerned tool needs to be incorporating the system those can be accessed through clicks and selects. It makes the procedure quicker and transparent as well. It’s even better if the tool comes with the subscribing option. Good news is that most of the modern-day healthcare practice management software originally comes with equivalent features.

Best for emergency:

Needless is to talk about how daunting it is to find the date of a physician. On the other hand, if there will be an emergency to consult the doctor prior the suggested duration, due to certain hypersensitivity or something like this, then the software should definitely have a feature to convey the emergency. More importantly, one can add such features through the software in a customized fashion, which is extremely hectic with a manual scheduling system. In fact, the situations like this lead towards bribing.

In addition:

Apart from scheduling, practice management system can help the doctors in terms of generating reports, going through a patient’s history and for case studies as well. In short, it makes the whole scheduling systematic and transparent.

It is a known fact that these processes are quite time consuming as well as complicated procedures. However, there are multiple billing software that provides the facility to maintain admin and finance records, but most of them are the generic ones and do not specifically cater to medical billing. Thus, health care facilities are required to opt for practice management software that are specially designed to meet their specific needs in order to get qualified to earn the stimulus incentives. Practice management software is termed as “Medical industry oriented software or computer application, which manage entire billing and admin tasks in a healthcare facility”. It ensures data security and flawless maintenance of the crucial data. In addition, some medical management software also provide payment gateway interface and additional features that help in streamlining the billing workflow.

Is it enough to Have Practice Management Software (PMS)?

Though practice management software are highly helpful in maintaining admin and financial records ,however medical biller would have to manually enter the financial or insurance related data in the application in order to make it ready to perform the tasks. Thus, it becomes the need of the hour to think beyond practice management software.

What is Next?

The most ideal thing that can be done with healthcare practice management software to make it better and productive is to integrate the same with your existing EHR. The health care facility can avail multiple benefits by integrating PMS with EHR. Some of the basic advantages are listed below:

• Manual Input, Not Required: The biller is not required to input the medical and financial data manually as the system will automatically fetch the ICD and CPT codes of the patients and can complete the billing procedure.
• Easy to Connect with Insurance Company: Once the bills are generated, the executive can send them to the respective insurance company through the system itself, and can even track the ‘move’ of the insurance providers over the same.
• More Advanced Care: PMS holds the basic medical information of the patient and EHR holds the records of the care plan. Through the integrated software, the patient’s medical detail can be matched with the available care plans and hence, most suitable care plan can be assigned to the patient.
• Easy and Immediate Refills: PMS maintain the record of the medication inventory and EHR take care of the patient’s medication plans. Through integrated software, refills can be done immediately as EHR will generate an alert for the medical shortage and PMS will help in settling the shortage with immediate refills.

There can be more benefits with EHR and PMS integration if you have the most appropriate EHR and PMS system.