Medical practice management software

[Note: the term Practice Management Software is now used for many other types of professional practice - in particular Accounting and Legal Practices. Probably need a dis-ambiguity page.]

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.

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 interchange 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 Health Care Procedure Coding System (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-92 forms. 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 Systems 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 source 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:

• HL7 — 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)	Software license
Automated Medical Assistant	Advanced Billing Solutions, Inc.	Current	$39.95 per month; HIPAA compliant; Browser based-accessible from anywhere; scheduling; EMR; electronic claims; Website: www.AutomatedMedicalAssistant.com; Phone: 1-800-815-BILL	Proprietary
AXEO SYSTEMS	www.axeoEMR.com	Current	PMS - $40/month per provider; PMS/EMR - $100/month per provider; cloud-based; Silverlight	Proprietary
eTHOMAS	Genius Solutions, Inc.	9.0	Direct and Subscription options available	Proprietary
ECLIPSE Practice Managment Software	wwww.galactek.com	11.0		Proprietary
MedEZ	MedEZ/ISS	6.0.4	HIPAA Compliant: Module Based and Customizable	Proprietary
MDsuite	Data Strategies, Inc.	4.1	HIPAA Compliant, CCHIT focused	Proprietary
eClinicalWorks	eClinicalWorks	8.0	CCHIT Certified - Monthly fee; Direct Purchase: $10,000 for first doc, $5,000 for subsequent	Proprietary
SequelMed	Sequel Systems Inc	7.0		Proprietary
NueMD	Nuesoft Technologies Inc.	3.07	Subscription-based pricing starting from $120 per month. Cost dependent on services required.	Proprietary
Medical and Practice Management Suite	LSS Data Systems	5.6	CCHIT Certified - HIPAA Compliant	Proprietary
Medisoft / Clinical EMR	McKesson Corp	V15	CCHIT Certified - Direct Purchase: $5480 for first doc, $3400 for subsequent	Proprietary
Impulse	MedNetwork Systems	5.5	Australian NeHTA certified	Proprietary
PeakPractice	Eclipsys	Current	CCHIT Certified - Monthly fee; Direct Purchase: $10,000 for first doc, $5,000 for subsequent	Proprietary
Dr. Chrono Professional	Drchrono.com	Current	$99.95 per month	Proprietary
Sage Intergy	Sage Software	5.5	HIPAA compliant; CCHIT Certified; scheduling; billing; electronic claims; electronic prescriptions; electronic labs; EMR; etc... http://www.sagehealth.com	Proprietary
	Creator	Latest stable version	Cost (USD)	Software license

Operating system compatibility:

Client	Windows	Mac OS X	Linux	BSD	Unix
Automated Medical Assistant (AMA)	Yes	Yes	Yes	Yes	Yes
eTHOMAS	Yes	No	No	No	No
MedEZ	Yes	No	No	No	No
MDsuite	Yes	No	No	No	No
eClinicalWorks EMR	Yes	No	Yes	No	?
SequelMed	Yes	No	No	No	No
NueMD	Yes	Yes	Yes	Yes	Yes
Impulse	Yes	No	No	No	No
Medical and Practice Management Suite (MPM)	Yes	No	No	No	No
Medisoft	Yes	No	No	No	No
PeakPractice	Yes	No	No	No	No
Dr. Chrono Professional	Yes	Yes	Yes	Yes	Yes
Sage Intergy	Yes	No	No	No	No
Client	Windows	Mac OS X	Linux	BSD	Unix

See also

• List of open source healthcare software
• Electronic medical record
• Health informatics
• Medical record
• Medicare
• Medicaid

External links

• List of Practice Management Software Products
• CMS-1500 Claim Form