Practice management
Encyclopedia
Practice management software (PMS) is a category of software that deals with the day-to-day operations of a medical practice. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payers, perform billing tasks, and generate reports.
In the United States
, most PMS systems are designed for small to medium-sized medical offices. Some of the software is designed for or used by third-party medical billing companies. PMS is often divided amongst desktop-only software, client-server software, or Internet-based software.
The desktop variety is intended to be used only on one computer by one or a handful of users sharing access. Client-server software typically necessitates that the practice acquire or lease server equipment and operate the server software on that hardware, while individual users' workstations contain client software that accesses the server. Client-server software's advantage is in allowing multiple users to share the data and the workload; a major disadvantage is the cost of running the server. Internet-based software is a relatively newer breed of PMS. Such software decreases the need for the practice to run their own server and worry about security and reliability. However, such software removes patient data from the practice's premises, which can be seen as a security risk of its own.
PMS is often connected to electronic medical records (EMR) systems. While some information in a PMS and an EMR overlaps — for example, patient and provider data — in general the EMR system is used for the assisting the practice with clinical matters, while PMS is used for administrative and financial matters. Medical practices often hire different vendors to provide the EMR and PMS systems. The integration of the EMR and PMS software is considered one of the most challenging aspects of the medical practice management software implementation.
connection.
(HCPCS) or its subset, the Current Procedural Terminology
(CPT). The diagnoses are indicated using International Classification of Diseases
(ICD) codes. Each charge will typically have a fee associated with it.
If the patient carried a valid private or public insurance policy at the time these services were provided, the charges are then sent out as an insurance claim. The process of sending charges may happen on paper, usually with the use of the CMS
-1500 form. This form lists the provider who performed the service, the patient, the services performed and the related diagnoses. For institutional (typically hospital) charges, claims may also be sent out on the UB-04 forms (formerly the UB-92 which use of was discontinued in 2007). Claims may also be sent out electronically using industry-standard electronic data interchange standards.
In most cases, electronic claims are submitted using an automated software process. Some practice management system vendors will update CPT/ICD-9 codes in the practice software on an annual basis. Some, especially smaller firms, leave it entirely up to medical practices. While a lot of insurance payers have created methods for direct submission of electronic claims, many software vendors or practice users use the services of an electronic claim clearinghouse to submit their claims. Such clearinghouses commonly maintain connections to a large number of payers, and make it easy for practices to submit claims to any of these payers. Instead of creating a connection to every payer, the practice user or software vendor must only connect to the clearinghouse.
Once a claim is adjudicated by the payer, some sort of a response is sent to the submitter. This usually comes as a paper Explanation of Benefits (EOB) or an Electronic Remittance Advice (ERA). These describe the actions that the payer took on each claim: amounts paid, denied, adjusted, etc.
In cases where a patient did not have proper insurance, or where insurance coverage did not fully pay the charges, the practice will usually send out patient statements. Practice management software often contains a way for a practice to print and mail their own statements (or other correspondence), and may even contain a way to interface to third-party patient statement printing companies.
In some cases, the reporting functionality of PMS interfaces with Decision Support System
s or has similar functionality built-in.
systems are under development. PMS usually costs about $100 to tens of thousands of dollars to license and operate.
Operating system
compatibility:
In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, most PMS systems are designed for small to medium-sized medical offices. Some of the software is designed for or used by third-party medical billing companies. PMS is often divided amongst desktop-only software, client-server software, or Internet-based software.
The desktop variety is intended to be used only on one computer by one or a handful of users sharing access. Client-server software typically necessitates that the practice acquire or lease server equipment and operate the server software on that hardware, while individual users' workstations contain client software that accesses the server. Client-server software's advantage is in allowing multiple users to share the data and the workload; a major disadvantage is the cost of running the server. Internet-based software is a relatively newer breed of PMS. Such software decreases the need for the practice to run their own server and worry about security and reliability. However, such software removes patient data from the practice's premises, which can be seen as a security risk of its own.
PMS is often connected to electronic medical records (EMR) systems. While some information in a PMS and an EMR overlaps — for example, patient and provider data — in general the EMR system is used for the assisting the practice with clinical matters, while PMS is used for administrative and financial matters. Medical practices often hire different vendors to provide the EMR and PMS systems. The integration of the EMR and PMS software is considered one of the most challenging aspects of the medical practice management software implementation.
Components of practice management software
Most practice management software contains systems that allow users to enter and track patients, schedule and track patient appointments, send out insurance claims and patient statements as part of the collection process, process insurance, patient and third party payments, and generate reports for the administrative and clinical staff of the practice. Typically, using a PMS also involves keeping up to date large sets of data including lists of diagnosis and procedures, lists of insurance companies, referring physicians, providers, facilities, and much more.Patient demographics
The capture of patient demographics often starts when a new patient fills out a patient information chart. This information includes the patient's name, address and contact information, birthdate, employer, and insurance information. Practice staff typically enters this information into the software. The software may automatically verify the patient's eligibility for receiving benefits with the insurance company using a standard electronic data interchangeElectronic Data Interchange
Electronic data interchange is the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents or business data from one computer system to another computer system, i.e...
connection.
Appointment scheduling
Practice Management systems often include a calendaring or scheduling component that allows staff to create and track upcoming patient visits. Software is often differentiated by whether it allows double-booking, or whether it uses a scheduling or a booking model. Schedules are often color-coded to allow healthcare providers (i.e. doctors, nurses, assistants) to easily identify blocks of time or sets of patients.Claims and statements
After a patient visit, the PMS is used to enter a set of charges. Each charge usually corresponds to a particular service that was performed on the patient, and is usually associated with one or more diagnoses. Most charges are entered using a code or codes from the Healthcare Common Procedure Coding SystemHealthcare Common Procedure Coding System
The Healthcare Common Procedure Coding System is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology .-History:...
(HCPCS) or its subset, the Current Procedural Terminology
Current Procedural Terminology
The Current Procedural Terminology code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among...
(CPT). The diagnoses are indicated using International Classification of Diseases
ICD
The International Statistical Classification of Diseases and Related Health Problems is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease...
(ICD) codes. Each charge will typically have a fee associated with it.
If the patient carried a valid private or public insurance policy at the time these services were provided, the charges are then sent out as an insurance claim. The process of sending charges may happen on paper, usually with the use of the CMS
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
-1500 form. This form lists the provider who performed the service, the patient, the services performed and the related diagnoses. For institutional (typically hospital) charges, claims may also be sent out on the UB-04 forms (formerly the UB-92 which use of was discontinued in 2007). Claims may also be sent out electronically using industry-standard electronic data interchange standards.
In most cases, electronic claims are submitted using an automated software process. Some practice management system vendors will update CPT/ICD-9 codes in the practice software on an annual basis. Some, especially smaller firms, leave it entirely up to medical practices. While a lot of insurance payers have created methods for direct submission of electronic claims, many software vendors or practice users use the services of an electronic claim clearinghouse to submit their claims. Such clearinghouses commonly maintain connections to a large number of payers, and make it easy for practices to submit claims to any of these payers. Instead of creating a connection to every payer, the practice user or software vendor must only connect to the clearinghouse.
Once a claim is adjudicated by the payer, some sort of a response is sent to the submitter. This usually comes as a paper Explanation of Benefits (EOB) or an Electronic Remittance Advice (ERA). These describe the actions that the payer took on each claim: amounts paid, denied, adjusted, etc.
In cases where a patient did not have proper insurance, or where insurance coverage did not fully pay the charges, the practice will usually send out patient statements. Practice management software often contains a way for a practice to print and mail their own statements (or other correspondence), and may even contain a way to interface to third-party patient statement printing companies.
Reporting
Almost invariably, the process of running a medical practice requires some introspection, and practice management software usually contains reporting capabilities to allow users to extract detailed data on financial performance and patient financial histories. PMS often has both pre-setup reports as well as allow users to design their own, ad-hoc reports.In some cases, the reporting functionality of PMS interfaces with Decision Support System
Decision support system
A decision support system is a computer-based information system that supports business or organizational decision-making activities. DSSs serve the management, operations, and planning levels of an organization and help to make decisions, which may be rapidly changing and not easily specified in...
s or has similar functionality built-in.
Practice management software and commerce
Practice management software has traditionally been commercial; few viable free practice management systems exist, though a few open sourceOpen source
The term open source describes practices in production and development that promote access to the end product's source materials. Some consider open source a philosophy, others consider it a pragmatic methodology...
systems are under development. PMS usually costs about $100 to tens of thousands of dollars to license and operate.
Interfaces and dependencies
PMS often needs to interface with the outside world. There are a number of standards that are used:- HL7Health Level 7Health Level Seven , is an all-volunteer, non-profit organization involved in development of international healthcare informatics interoperability standards...
— used to communicate with hospitals, or EMR systems - ANSI X12 EDI transactions, including:
- 270 — eligibility & benefit inquiry - Is the patient an insured of this payer?
- 271 — eligibility & benefit response (response to 270) - 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
Comparison of PMS software solutions
Basic general information about major software solutions: creator/company, license/price etc.| Creator | Latest stable version | Cost (USD United States dollar The United States dollar , also referred to as the American dollar, is the official currency of the United States of America. It is divided into 100 smaller units called cents or pennies.... ) |
Software license | Website | |
|---|---|---|---|---|---|
| NueMD | Nuesoft Nuesoft Nuesoft Technologies, Inc. is a health care software as a service company headquartered in Marietta, Georgia, USA. The company develops and sells practice management software for physician practices, university health centers, and medical billing companies... |
3.10 | $350 per month for one provider | Proprietary Proprietary software Proprietary software is computer software licensed under exclusive legal right of the copyright holder. The licensee is given the right to use the software under certain conditions, while restricted from other uses, such as modification, further distribution, or reverse engineering.Complementary... |
Website |
| Centricity Centricity Centricity is a brand of 31 healthcare IT software solutions from GE Healthcare, a division of General Electric. It includes software for independent physician practices, academic medical centers, hospitals and large integrated delivery networks... Practice Management |
GE Healthcare GE Healthcare GE Healthcare is a division of GE Technology Infrastructure, which is itself a division of General Electric . It employs more than 46,000 people worldwide and is headquartered in Little Chalfont, Buckinghamshire, United Kingdom. GE Healthcare is the first GE business segment to be headquartered... |
9.2 | Proprietary Proprietary software Proprietary software is computer software licensed under exclusive legal right of the copyright holder. The licensee is given the right to use the software under certain conditions, while restricted from other uses, such as modification, further distribution, or reverse engineering.Complementary... |
Website | |
| Medical and Practice Management Suite | LSS Data Systems LSS Data Systems LSS Data Systems , is a Minnesota-based medical software and service company that develops products for the physician practice community. LSS was founded in 1982, and since that time has been a partner of Medical Information Technology, Inc. developing physician practice management and ambulatory... |
5.6 | ONC-ATCB 2011/2012 Complete EHR Certified; CCHIT Certified - HIPAA Compliant | Proprietary Proprietary software Proprietary software is computer software licensed under exclusive legal right of the copyright holder. The licensee is given the right to use the software under certain conditions, while restricted from other uses, such as modification, further distribution, or reverse engineering.Complementary... |
Website |
| Medisoft / Clinical EMR | McKesson Corp | V17 | CCHIT Certified - Direct Purchase: $5480 for first doc, $3400 for subsequent | Proprietary Proprietary software Proprietary software is computer software licensed under exclusive legal right of the copyright holder. The licensee is given the right to use the software under certain conditions, while restricted from other uses, such as modification, further distribution, or reverse engineering.Complementary... |
Website |
| PeakPractice | Allscripts Allscripts Allscripts Healthcare Solutions, Inc. is a publicly traded American company that provides physician practices, hospitals, and other healthcare providers with practice management and electronic health record technology, including electronic prescribing, care management, and revenue cycle software... (Formerly Eclipsys) |
Current | CCHIT Certified - Monthly fee; Direct Purchase: $10,000 for first doc, $5,000 for subsequent | Proprietary Proprietary software Proprietary software is computer software licensed under exclusive legal right of the copyright holder. The licensee is given the right to use the software under certain conditions, while restricted from other uses, such as modification, further distribution, or reverse engineering.Complementary... |
Website |
| Dr. Chrono Professional | Drchrono.com Drchrono.com drchrono provides a patient care platform that consists of an iPad based EHR , an iPad based patient portal and a web based practice management and medical billing system. drchrono was a member company of the Winter 2011 Y-Combinator program and is based in Mountain View, CA... |
Current | $99.95 per month | Proprietary Proprietary software Proprietary software is computer software licensed under exclusive legal right of the copyright holder. The licensee is given the right to use the software under certain conditions, while restricted from other uses, such as modification, further distribution, or reverse engineering.Complementary... |
Website |
| Sage Intergy | Sage Software | 6.20 | HIPAA compliant; CCHIT Certified; scheduling; billing; electronic claims; electronic prescriptions; electronic labs; EMR etc. | Proprietary Proprietary software Proprietary software is computer software licensed under exclusive legal right of the copyright holder. The licensee is given the right to use the software under certain conditions, while restricted from other uses, such as modification, further distribution, or reverse engineering.Complementary... |
Website |
| Nortec EHR | Nortec Software Nortec Software Nortec Software Inc. is a private US-based company that provides physician practices, hospitals, and other healthcare providers with healthcare technology solutions... |
7.0 | ONC-ATCB 2011/2012 Certified for Complete EHR; HIPAA compliant; CCHIT Certified; scheduling; billing; electronic claims; electronic prescriptions; electronic labs; EMR etc. | Proprietary Proprietary software Proprietary software is computer software licensed under exclusive legal right of the copyright holder. The licensee is given the right to use the software under certain conditions, while restricted from other uses, such as modification, further distribution, or reverse engineering.Complementary... |
Website |
Operating system
Operating system
An operating system is a set of programs that manage computer hardware resources and provide common services for application software. The operating system is the most important type of system software in a computer system...
compatibility:
| Client | Windows Microsoft Windows Microsoft Windows is a series of operating systems produced by Microsoft.Microsoft introduced an operating environment named Windows on November 20, 1985 as an add-on to MS-DOS in response to the growing interest in graphical user interfaces . Microsoft Windows came to dominate the world's personal... |
Mac OS X Mac OS X Mac OS X is a series of Unix-based operating systems and graphical user interfaces developed, marketed, and sold by Apple Inc. Since 2002, has been included with all new Macintosh computer systems... |
Linux Linux Linux is a Unix-like computer operating system assembled under the model of free and open source software development and distribution. The defining component of any Linux system is the Linux kernel, an operating system kernel first released October 5, 1991 by Linus Torvalds... |
BSD | Unix Unix Unix is a multitasking, multi-user computer operating system originally developed in 1969 by a group of AT&T employees at Bell Labs, including Ken Thompson, Dennis Ritchie, Brian Kernighan, Douglas McIlroy, and Joe Ossanna... |
|---|---|---|---|---|---|
| Nuesoft Nuesoft Nuesoft Technologies, Inc. is a health care software as a service company headquartered in Marietta, Georgia, USA. The company develops and sells practice management software for physician practices, university health centers, and medical billing companies... |
|||||
| Medical and Practice Management Suite (MPM) | |||||
| Medisoft | |||||
| PeakPractice | |||||
| Dr. Chrono Professional | |||||
| Sage Intergy | |||||
| Nortec EHR | |||||
| Client | Windows Microsoft Windows Microsoft Windows is a series of operating systems produced by Microsoft.Microsoft introduced an operating environment named Windows on November 20, 1985 as an add-on to MS-DOS in response to the growing interest in graphical user interfaces . Microsoft Windows came to dominate the world's personal... |
Mac OS X Mac OS X Mac OS X is a series of Unix-based operating systems and graphical user interfaces developed, marketed, and sold by Apple Inc. Since 2002, has been included with all new Macintosh computer systems... |
Linux Linux Linux is a Unix-like computer operating system assembled under the model of free and open source software development and distribution. The defining component of any Linux system is the Linux kernel, an operating system kernel first released October 5, 1991 by Linus Torvalds... |
BSD | Unix Unix Unix is a multitasking, multi-user computer operating system originally developed in 1969 by a group of AT&T employees at Bell Labs, including Ken Thompson, Dennis Ritchie, Brian Kernighan, Douglas McIlroy, and Joe Ossanna... |
See also
- List of open source healthcare software
- Electronic medical recordElectronic medical recordAn electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...
- Health informaticsHealth informatics.Health informatics is a discipline at the intersection of information science, computer science, and health care...
- Medical recordMedical recordThe terms medical record, health record, and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction....
- MedicareMedicare (United States)Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
- MedicaidMedicaidMedicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...