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Practice Management Software
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Better Revenue Cycle Management Through Better Technology
PracticeSuite is one of the few cloud based, complete practice solutions available today. Our affordable pricing is unmatched, but more importantly, it is quality customer care and high client satisfaction that sets us apart.
What Is Practice Management?
We believe Practice Management is a who as well as a what
Practice Managers manage medical offices and clinics and must possess a wide range of skills to do their many jobs. A well-trained staff requires a special breed of software to achieve practice wide efficiency. Practice Management is the art and science of operating a tightly run medical practice.
Over the past few years, managing a practice or clinic has become more science than art, lending much-needed support to clinical and administrative staff as they adapt to today’s healthcare realm. Robust, sophisticated practice management software provides the exact features practice managers need to keep everything running smoothly as they guide their organizations into the next healthcare phase and beyond.
The Practice Manager
Operations, HR, Finance, HIT, Compliance, Government Programs and Marketing
Practice management is the backbone of a clinical organization. It includes budgeting, contracting, benchmarking and financial forecasting, data security and risk compliance, HR, provider credentialing, revenue cycle management, oversight of government program measures and HIT. In small practices, and some medium-sized ones, the practice manager is essentially the head of administration, the CFO, and the COO rolled into one.
When Practice Management operates at a effective level, clinicians spend less time on administrative tasks and more time with patients, and money flows efficiently through the system to support key elements like payroll and purchasing.
When wearing their operations hat, a practice manager focuses on the cost of each service being provided so the practice generates a profit. This means looking at how the care-delivery process can be more efficient and looking for ways to cut costs without affecting quality. It involves data analysis, workflow analysis, and reporting to determine how effective your referral process is, whether certain functions should be outsourced, and what role technology can play in reducing providers’ administrative burdens.
The human resources role is more important than ever to the success of the practice, thanks to pandemic-related changes. Practice managers must oversee recruiting, employee scheduling, and payroll, and—most critically—team culture. A cohesive, positive culture is essential to ensuring patient satisfaction and a practice’s ability to make changes. The American Medical Association recommends the following steps to cultivate a strong team culture: diagnose the current state of your culture, discuss the results and brainstorm possible improvement, create a team compact, create opportunities for team communication throughout the day, meet regularly, strengthen the team by focusing on individual development, get to know your team members, teach leaders to me mentors rather than manager, create an environment that supports continual learning, and engage patients.
Finance is another key practice management role. Clinicians receive little or no financial education, and the third-party payment system is perhaps the most complex in the US. Practice managers must be skilled at setting up balance sheets, ensuring medical billing runs smoothly, generating clear reports for practice owners, and eliminating any wasteful systems.
Currently, the most important IT functions are integration and security. Systems that don’t communicate with each other (or must be coaxed to do so) are an enormous problem for practices of all sizes. Practice managers must have sufficient IT acumen to ask intelligent questions about all system being purchased and how they will be integrated. Data-rich health records are highly sought on the black market, so medical practices are frequently targeted by hackers; this is expected to increase. Hiring and managing cybersecurity professionals to ensure your practice’s data security is a key function for the practice manager.
Practices face a slew of regulations around patient and data privacy. Every practice manager should be well versed about compliance risks to ensure the practice is prepared for regulatory audits and does not incur fines or come up against licensing issues.
Quality Measure levels to attest for government programs must be monitored continuously throughout the year.
Overseeing marketing efforts is another important practice management function. Most marketing is now digital, so in addition to understanding branding, practice managers should have a working knowledge of search engine optimization, content marketing, and social media advertising.
Training and certification are essential to successfully managing a complex medical practice. The American Academy of Professional Coders recommends the following certifications for practice managers:
- Ability to run daily operations that lead to satisfied patients and office efficiency
- Ability to create strong compliance programs to mitigate regulatory risk
- Ability to maximize cash flow through strong revenue cycle management
- Ability to reduce costs and maximize reimbursement through strong supplier/payer relationship management
- Ability to create a robust corporate structure and a realistic financial plan
- Ability to hire and lead an IT department that can fully support the entire practice
- Ability to create value and stability for the practice owners
What is Practice Management Software?
The software to run a medical office must support operations, financial management, and revenue cycle management––and just like the Practice Manager, must be a jack-of-all-trades. The unique breed of software that’s able to bring practice-wide efficiency to a medical office is Practice Management Software. It incorporates all practice functions to increase efficiency, and should connect with a practice’s clinical EMR, but it is a distinct system with operational reporting, financial reporting, and revenue cycle management capabilities.
Because of the complexity of tasks, the many job duties, and varying roles within a medical practice, the most important feature of PM software is its ability to connect people inside and outside the office like administrative staff, care providers, and patients. And then to organize critical processes like office workflows, patient communications, and ensuring that payments are collected. The front desk uses it for scheduling and eligibility verification; the billing department uses it for charge capture, creating bills, submitting claims, and processing payments; and the practice manager can oversee everything digitally, using data driven analytical insight and business intelligence to manage cashflow and make operational decisions.
It is software that helps automate processes that were previously manual (either on paper or using spreadsheets). This not only reduces operating costs, it frees up staff for more important tasks such as pre-authorization follow-up and payment follow-up.
The practice manager also uses PM software to keep on top of compliance issues, create reports showing the health of the practice, and get a handle on HR tasks. Perhaps most importantly, this software’s ability to connect the practice’s various employees and departments leads to improved employee—and patient—satisfaction.
The next sections detail how practice software can be used to improve each area of the medical office..
Improve the Patient Experience
Your front office is akin to the triage area of an emergency department—the first chance to make patients feel cared for and properly assess a patient’s status. If the triage nurse misunderstands a patient’s condition, the ED team must play catch-up from the beginning, trying to figure out what’s actually going on. The front desk’s role in scheduling, determining eligibility, facilitating prior authorizations, guiding patients to your portal, and working with patients on payments determines a patient’s state of mind when they enter the encounter room.
Improve Revenue Through Scheduling
A well-run front office with strong scheduling software is key to preventing schedule gaps, lowering denial rates, and increasing revenue. Your front-office workers have to keep a lot of balls in the air, so they need all the support you can provide, including technology that automates processes and identifies issues early on, including the ability to batch check eligibility, double book appointments, schedule resources like MRI by “first available,” and scan and attach documents to patient records.
Boost Profitability with Enhanced Revenue Cycle Management
Medical practices aren’t boats—but they can still leak. Revenue leaks happen for a variety of reasons, and plugging them is the most efficient way to improve your cash flow and bottom line.
The first step to improving your revenue cycle management (RCM) is putting a person in charge and giving him/her the data needed to find and fix the holes. That includes a view of the entire patient-to-pay cycle: eligibility checking, co-pay collection, coding, billing, denials management, collections, and fraud prevention.
RCM software can help with this, alerting your revenue cycle manager (or practice manager) to important events before they happen or soon afterward.
These notifications will help your revenue cycle manager understand the issues and prioritize their efforts. Front office systems may need to be reworked so eligibility and co-pays aren’t missed, appointment policies may need to be rewritten to reduce missed appointments. Similarly, new systems for payment collection may need to be instituted, including payment plans.
Fixing leaks on the claims side starts with taking three months of key figures and averaging them to establish a baseline. That way, if your percent of A/R greater than 120 days is usually around 17% and you see it rise to 20% for a couple of months in a row, you know you need to dig into the numbers and current processes to find the cause of the increase.
Next, you can benchmark your averages against what the experts say is a healthy figure. For example, your electronic remittance advice (ERA) should be at 85% or above, according to the Medical Group Management Association (MGMA). If your percentage is 75, you could set a goal of raising it to 80% within three months and to 85% at the end of six months.
Finally, prior authorization is a sticking point in many practices. If your analysis shows this is the case, consider best practices like the ones here.
Create Successful Marketing Campaigns
With its wealth of information, your practice software is just the tool your marketing expert needs. For existing patients, he or she can tap into it to create an email database that facilitates patient messaging. That could mean sending an email to everyone (say, a holiday greeting or updates about services) or a select group (say, a vaccine reminder).
For external marketing, it can provide the data to assist with search engine optimization, content marketing, and social media ad campaigns.
Reduce HIPAA Risks and Ensure Compliance
Most practices have HIPAA compliance under control, but strong office software makes that task easier. Specifically, it should help the PM manage business associate agreements to ensure that every vendor fully understands HIPAA’s importance.
Cloud-based practice software greatly reduces the risk of HIPAA-related issues. The software is automatically updated when rules change, and there is no chance patient data can be accessed physically (a break-in) or electronically (hacking into on-premise computers).
With the increase in remote work from the pandemic, cloud-based systems are even more essential. A February 2022 MGMA poll found that 59% of practices shifted workers to permanent and/or hybrid work in 2021. Practices with cloud-based systems were able shift to remote operations much more easily.
Last but not least, it’s important to put a strong, organized manager in charge of compliance. That person should not only be well-educated about healthcare policies and procedures, but also understand the nature of compliance-related risks and how to mitigate them.
HR: Engage Providers and Create a Positive Culture
From a practice management perspective, human resources is all about adjusting staff schedules to match patient volume and clinic status. Understanding the overall clinic workflow and key individual workflows can lead to both provider satisfaction and stronger revenue.
Of course, having a strong grip on HR and workflows is essential during times of stress like natural disasters or public health crises like the pandemic. Practice managers had to lean heavily on their HR systems as employees moved to remote or hybrid models during the pandemic, and those models are continuing for some workers.
There’s also a scheduling component to HR, one that leads to both provider satisfaction and an improved bottom line. For example, armed with knowledge from the scheduling system, the practice manager can incent providers to fill all or nearly all their appointment slots (reducing the temptation to create open slots before lunch or at the end of the day). Similarly, schedulers can be incented to fill empty slots whenever possible, assuming the software helps them quickly find those slots (and bonuses are handed out to those most successful at filling them).
Practice Management Software Features and Benefits
We’ve already seen many critical features of strong management software in the sections above. Let’s now review a few key structural components.
Cloud based. The days of buying server-based software are over. Instead, buy a subscription that includes upgrades so your system is always up to date.
Highly adaptable. Many practice management systems don’t allow user customization, which is a problem for all practices other than internal medicine. Buying a practice management system designed for your specialty is an option, but buying a system that you can fully customize is a better decision. Newer systems allow you to easily adjust what’s on each screen, ensuring you see the items most relevant to your practice and your role in it.
Customizable dashboards. Dashboards are common in practice management systems, but many don’t allow you to choose which key performance indicators (KPIs) are included. Choose one that lets users choose which KPIs appear on their dashboard.
Robust reporting. Some PM software doesn’t let you create your own reports to show the items most important to you or export raw data to Excel to help you drill down into problem areas. Newer systems offer far more flexibility, allowing you to adjust the reporting to fit your needs and “slice and dice” your data to reveal exactly where problems lie.
Revenue alerts. Revenue cycle management can be complicated, so give your practice manager a leg up with alerts about events like failure to check patient eligibility and unpaid claims that haven’t bee followed up on. State-of-the-art RCM software provides alerts and insights that allow your practice manager to act less like a bookkeeper and more like a CFO. Imagine someone in your practice armed with the data to control every facet of profitability, including overhead, payer contracts, claim errors, accounts receivable levels, and cash flow.
Robust integration. We said at the beginning of the page that the most important feature of PM software is its ability to connect people and systems. That means strong integration with your practice’s front-end and back-end systems, including your EMR, clearinghouse, and patient portal.
Practice managers are responsible for so many moving parts—and recently added is the need to manage remote workers. However, keeping everything running smoothly is still feasible, especially with help from a full-featured practice management system. Healthcare has seen substantial changes in the past decade and is likely to see more in the next few years, so keeping a close eye on workflows and giving practice managers the tools they need is more important than ever.
Change is never easy, and healthcare has seen a lot of it. We shifted from small family practices to large managed-care operations, from a manageable number of medical codes to a plethora, and from a focus on acute care to chronic-care management and accountable care. Then the pandemic pulled the rug out from under us, forcing rapid shifts on virtually all our systems. Perhaps we need to adopt Benjamin Franklin’s attitude: “When you are finished changing, you are finished.”
Fortunately, there are systems and technologies that can help us thrive in our current circumstances and with whatever changes are coming.
- “Team Culture: Strengthen Team Cohesion and Engagement.” AMA EdHub, accessed 6 June 2022.
- “The 2020 Healthcare Cybersecurity Report.” Cybersecurity Ventures and the Herjavec Group, accessed 6 June 2022.
- “RCM Software: Time to Plug Those Revenue Leaks.” PracticeSuite, accessed 6 June 2022.
- “Claims Denied for No Prior Authorization.” PracticeSuite, accessed 6 June 2022.
- “What is Practice Management?” AAPC, accessed 6 June 2022.
We think you’ll be pleasantly surprised just how affordable the #1 rated medical practice software really is.
We understand that not all medical practices are the same. Whether it be multi-specialty, multiple locations, or complex billing scenarios, we’ve got you covered.