The following features should be available in any practice software you may consider :
Claims Transmission - The transmission of your electronic claims should go through as few channels as possible between your office and Medicare or the commercial insurer. If your software vendor uses a clearing house for claims, you must make sure that the house is recognized by both CMS and the private insurance companies. You should have a claim editing feature that will advise you of errors in coding and provide a daily listing of your transmissions that will allow you to view the total number of claims transmitted, those accepted and any rejected claims as well. This transmission log should be examined each day and rejected claims should be carefully reviewed before the claim is re-transmitted. Store your transmission logs in a binder in your billing office and do a quarterly audit to assure that none of the commercial insurers are making an error in payment month after month. Occasionally, you should print out a paper claim for each provider to assure that their provider ID numbers are entered into your system correctly. I have seen practices who were not paid for their Nurse Practitioners for months because they were entered into the system with their social security numbers rather than the practice Tax ID. Before you transmit your first electronic claim with your new software, you must go to the data base and assure that Tax ID, NPI and insurance ID are correct for each physician in your group. You should also assure that the descriptions for certain testing or isotopes are transmitting according to CMS requirements, or these claims will be denied.
One important word of caution for obtaining your CPT and diagnosis codes for transmission. Many new systems will prompt you to use codes that they consider more appropriate for your claim and to obtain the highest reimbursement rates. This is fine if your patient's list of complaints is aligned with the coding recommended. However, if there are glaring discrepancies in patient notes or medical tests or records, you will find yourself the target of perpetual audits and may be subject to penalties when coding seems to generate from your system rather than your physicians. Use your software appropriately.
Data Change - Some of the software programs available today have glaring problems, and this is especially true with the software that is internet based. One of the more serious issues is a lack of communication between the different task modules. These internet systems are often created as a series of independent books. A book for demographics, one for coding, one for billing etc... Very often, data changes entered in one of the books does not communicate with the system as a whole requiring staff to navigate between screens to make changes in each task module. This may be especially true in systems that were developed for use by single practitioners. Make sure that the changes you need to make in your systems are noted and saved in each of your patient screens.
Multiple Location Features - In a large practice with multiple locations, you will want a system that allows you to designate the different locations by short name rather than by creating separate entities. This will allow you to enter charges and payments by location rather than making it necessary to switch entities and allows you to report your billing and demographics as one bulk or by location. Billing should be separated by location and entered under the short name.
Auto Population - Most systems will offer features to streamline demographic and billing data entry. A zip code feature will populate city and state . Guarantor information and insurance mailing address and phone numbers are also possible auto population features you may want to consider.
Report Modules - You will want a system reporting module that gives you several options for reporting practice financials. Charges and payments should be geared to report financials for any physicians, locations, or procedures and to compare these statistics each month and quarter. Better systems will allow you to plug in your own choice of desired options for reporting so that your examination of your practice is comprehensive and less time consuming. This data can then be converted automatically into an Excel spreadsheet for meetings and quarterly comparison. Accounts receivable reports should always contain the patients name, date of birth and both primary and secondary insurance coverages as well as insurance ID numbers to make it easier to communicate with the insurance providers by phone regarding aged claims.
All systems will require you to make a commitment to assure your system functions at maximum efficiency. While the software vendor will assist you in obtaining transmitted identification numbers for Medicare and the commercial carriers, you will need to make certain that each physician's information is correct. You staff will require comprehensive training and a clear understanding of each feature of your software so that its use will allow maximum performance and job description.
Tomorrow : Your Employees - the key to you success...
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