Do You Know the Capabilities of Your Practice Management Software?

August 16, 2017


Most organizations have a Practice Management system for appointment scheduling, billing and reporting. Are you utilizing all of the capabilities of your software system? Are you familiar with your systems functionality and reporting?

One of the major challenges of utilizing all of the capabilities of PM software systems is the time required to determine which features are most important to your practice. Most offices will state that the appointment scheduling function is a priority – and an efficient billing module is paramount. Most current billing systems have a function that many offices do not utilize properly, if at all. This is the Insurance Verification module that is available in most current PM systems. If your software has this function and you are not using it, you are potentially losing out on thousands of dollars a year in insurance rejections.

The health insurance industry has become exceedingly complicated and almost impossible to navigate for both providers and patients. Unfortunately, too many practices still do not verify health insurance coverage for their patients, or they utilize tools that are sometimes outdated. This leads to unpaid medical claims with very little recourse except to bill the patient, who does not realize they are going to be held responsible for the visit costs.

One of the patient groups having a great deal of difficulty navigating and understanding their health insurance coverage is the Medicare population. Patients are often unaware that when the choose a Managed Care Medicare plan that they are stepping away from the traditional Medicare coverage and benefits, and must adhere to the policies and guidelines of a different medical insurance carrier. An educated staff and proper insurance verification procedures, will allow a practice to manage the healthcare of this patient population, while ensuring appropriate reimbursement.

Another example of a difficult patient population to manage are those with Blue Cross coverage. There are literally hundreds of networks and plan specific guidelines that both patients and practices are unaware of. Some fine print on an insurance card can mean the difference in receiving payment or not. Aside from verifying if a Blue Cross plan is active or not, the practice must know which specific plans the practice/provider is contracted with. The time spent in verifying both coverage and contracts will pay off in the long run.

Many software programs perform eligibility directly from the schedule. Of course, staff training is required to ensure the patient demographics and insurance information has been entered correctly. The program only works properly based upon the integrity of the data entered.

If your software has the capability of insurance verification and you are not utilizing it, consider researching this module and system functionality. There are usually costs involved which can be negotiated based upon the usage volumes. The benefits will greatly outweigh the costs, if used appropriately.

By Susan Genrich, CMM, CPC.

Consultant, RR Health Strategies