Medical Practice Management Software
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Medical practice management

Most practice management software contains applications 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.

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).

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. 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.

For comparisons of different medical software products, download the free Medical Software Selection Kit.