Web-based practice management system can streamline your operations

MGMA Connexion, Jul 2004 by Enos, Nancy M

Practice managers face enormous demands for technological change - and a wide array of products, services and delivery options.

Administrative simplification mandated by the Health Insurance Portability and Accountability Act (HIPAA) has forced us to evaluate our needs for a practice management system (PMS), particularly if existing software does not comply with the standard electronic data interchange (EDI) claims format. The number of clinical functions related to the PMS has led practice administrators to demand compatibility and accessibility to meet many goals with a single solution. That solution should yield accessibility, efficient workflow, lower overhead expenses, increased revenue and more satisfied employees.

Accessibility

A Web-based PMS can improve front-office operations by unifying clinical and business workflows. When electronic medical records (EMR), e-prescriptions, electronic charge capture, lab-order systems and others are stand-alone applications, the administrator must struggle to integrate them to avoid duplication. Integration may involve costly programming, ongoing downloads and information technology staff.

For example, a PMS handles patient registration. Once a medical practice purchases an EMR, employees need to enter patient insurance changes into both systems. This can lead to an accounts receivable nightmare if they don't update information accurately.

Practice-management applications that use the Internet can ensure that patient information is accessible at any time from any location by physicians and appropriate staff. Groups with satellite locations must consider the cost of communication among sites to a client-server PMS within the organization.

A Web-based PMS allows physicians on call to log in over the Internet wherever they are to obtain patient records or review medications, orders and test results. The administrator can review staffing allocations right from home.

Workflow

Technology innovation is where a leading medical practice shines. From the first point of patient contact - scheduling and eligibility verification - through closure - prescriptions and order management - a rules-based PMS manages patient encounter workflow.

Lower expenses

Payroll makes up the highest cost in any medical practice. Technology can help reduce staff by automating routine tasks and freeing personnel for patient care, colleetions and follow-up of unpaid claims. HIPAA has increased practices' monthly claims clearinghouse fees. A Web-based PMS that offers e-claims:

* Cuts out those fees;

* Enables the back office to send HIPAA-compliant claims directly to payers;

* Can provide integrated claims-reporting data, enabling the billing manager to monitor EDI transmissions; and

* Properly translates claims into the 837 formats.

Increased revenue

A Web-based PMS allows a practice to obtain patients' insurance eligibility information online. A billing clerk can obtain a list of ineligible patients to review prior to their appointments, avoiding denials for ineligibility. Integration between the appointment schedule and payers' eligibility information can bring cost savings. A practice can also get key billing information regarding referrals and copayments.

Improvements in managing the revenue cycle maximize payments by scrubbing data and editing invalid and missing information to ensure clean claims. Nightly EDI transmissions by the PMS vendor ensure consistent cash flow. The system identifies unbilled and rejected claims instantly.

Workforce satisfaction

Traditional practice management systems are reactive. Personnel must generate reports to review missed appointments, schedule changes and overdue recalls; track missing test results and open orders; and manage unpaid claims adjustments, aged accounts, unbilled claims, missing encounters and inactive claims.

Database changes to update the tables in a client-server PMS depend on staff entering hundreds of ICD-9* changes and updating hundreds of CPT** code changes annually, as well as other data critical to claims payment.

A Web-based practice management system can provide a proactive dashboard that brings key information to employees' desktops, enabling them to take action on issues before they become problems. A common database with valid CPT, ICD-9 and HCPCS*** codes is at the fingertips (or mouse-click) of physicians and data entry staff, promoting correct and accurate coding. A comprehensive, rule-based scrubbing engine brings alerts to operators, giving them information to make decisions before validating transactions.

What are the obstacles to consider?

As with any technology change introduced in a medical practice, the learning curve and level of enthusiasm for a Web-based PMS will vary depending on the attitude and aptitude of the staff.

If the practice has a pro-technology culture and employees use the Internet at home, they'll learn quickly. However, many medical offices do not have access to highspeed Internet connections. Many medical employees lack Internet access at home or don't use the Internet at all. This segment of the population poses a significant challenge with respect to training.