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The Power of Medical Payment Software

The Power of Medical Payment Software

Prior to implementing a practice management (PM) system that automated its billing operations, the staff at Tri-County Eye Physicians and Surgeons in Southampton, Pa., often waited weeks before learning that a claim had been denied due to mismatched diagnosis and procedure codes. Since going electronic, the practice has not only eliminated that wait but prevented errors from occurring in the first place.

"We know if a claim would get denied before it goes out the door," says Vivien Werner, information systems analyst at Tri-County Eye, a 12-physician practice with a second office in New Britain, Pa. "Our claims are going out cleaner and our payments are coming back faster."

Most practices have been concentrating on getting EHRs up and running in order to qualify for CMS incentive payments for meeting meaningful use objectives. With the Stage 1 reporting deadline now passed, many practices are shifting their priorities.

"Over the past year, our clients were focusing on clinical applications but now we're cycling back to business applications," says Bradley M. Boyd, vice president of Culbert Healthcare Solutions, a healthcare management and information technology consulting firm based in Woburn, Mass. "Now those practices are looking at the benefits of using a billing system to go with their EHR."

Purchasing and implementing a practice management system to automate billing and other business operations can be costly and time-consuming for small to mid-size practices but the investment eventually pays off in increased efficiency and revenue. According to the AMA, the average practice can cut its claim submission costs alone by more than 55 percent by switching to electronic filing, while automating prior authorizations can reduce transactions costs by upwards of 80 percent.


"The practice management system defines how your practice works with itself," says Derek Kosiorek, principal consultant specializing in information technology with the Medical Group Management Association. "It affects every part of your office and defines your work flows."

Kosiorek and other consultants and practice managers offered the following advice on selecting the best system for your practice and taking advantage of the features that can help boost efficiency and revenue.

Choosing a system

If you already have an EHR, find out if your vendor also offers a PM product, experts say. Although interfacing PM and EHR systems can work, it's easier to have everything under one umbrella.

"With interfaces, the systems still talk to each other but there are limitations," says Lynn M. Anderanin, senior director of coding compliance and education at consulting firm Healthcare Information Services in Park Ridge, Ill. "When the products are from the same vendor, you can pull transactions from the EHR into the practice management system automatically but with two products we have to use another interface or middleman to accomplish the same thing."

Premier Dermatology in Joliet, Ill, for example, purchased an EHR system from e-MDs last July and has plans to install the PM portion this summer rather than stay with its current billing system.

"We looked at dermatology-specific systems without a practice management component but we decided that having an integrated system was a key issue for us," says Corky Bellile, senior administrator and chief operating office at Premier, which has six offices and eight physicians. "And we didn't want to toggle back and forth between our existing practice management system and the new EHR."

There is immense benefit to having your billing software as one function among a suite of products that includes your EHR, says Kosiorek, so that charts can pass directly from the exam room into your billing software.

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