Choosing a New PMS? Consider its Impact on Medical Billing

May 17, 2016 by Antonio Arias, MBA, CHBME

Topics: Practice Management, Medical Billing Company

Upgrading from a legacy practice management system (PMS) to a more modern solution can be hugely rewarding for providers, but it’s not without its challenges. Like all technology purchases, selecting a PMS vendor is a time-consuming process that can be riddled with system limitation issues and frustrating negotiations.

But the key to successfully choosing a new PMS is understanding – up front – what you need and want from a new system. There are a million factors to consider and questions to ask: Can it integrate with your electronic health record system and/or patient portal? Does it require a lengthy installation process? Does it offer check-in functionality or other administrative features?

One particularly important question (that those on the clinical side of a practice may fail to consider) is this: How will a new PMS impact medical billing? If you opt to handle all of your back-office efforts in-house, rather than outsource to a medical billing service, an efficient PMS is a huge asset to your revenue cycle success.

Claim errors are one of the most common reasons for payer denials. According to the American Medical Association’s National Health Insurer Report Card, $43 billion could have been saved from 2010-2013 if commercial insurers consistently paid claims correctly. The problem for payers, however, is that providers rarely submit clean claims in a timely manner.

How bad is it? Bill Heitman, a healthcare efficiency consultant, recently told Healthcare Finance that up to 70 percent of provider-submitted claims have incomplete or incorrect data – such as missing ID numbers or non-matching names.

Yet in 2016, it’s silly to even be making those errors when so many PMS tools can fix them before they happen. Most PMS offerings today utilize automated billing rules to catch potential mistakes proactively and flag them for staff members to correct prior to submittal.

Staff members can also use PMS software to respond to denials, rejections, and overpayments –  the last of which is now a more pressing practice issue than ever: Thanks to Medicare’s new 60-day rule, providers can be subject to the False Claims Act for failing to return any undue payments in a timely manner). In addition, they can utilize tracking and monitoring functionality to generate financial reports or stay abreast of any troubling trends, such as high no-show rates or recurring scheduling gaps.

Along with a diligent staff, a streamlined practice management system can help increase the amount of claims that are accepted by payers on the first pass. According to a 2015 practice profitability index (PPI) study, 40% of physicians surveyed place billing and collections as their top target area for improvement. Investing in a high-quality PMS can be the first step toward hitting that target (and boosting practice revenue in the process).

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