Medical practice management software

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 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.

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-04 forms (formerly the UB-92 which use of was discontinued in 2007). 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. Some practice management system vendors will update CPT/ICD-10 codes in the Practice Software on an annual basis. Some, especially smaller firms, leave it entirely up to medical practices.[2] 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. Such clearinghouses commonly maintain connections to a large number of payers and make it easy for practices to submit claims to any of these payers. Instead of creating a connection to every payer, the practice user or software vendor must only connect to the clearinghouse.

Once a claim is adjudicated by the payer, some sort of response is sent to the submitter. This usually comes as a paper Explanation of Benefits (EOB) or an Electronic Remittance Advice (ERA). These describe the actions that the payer took on each claim: amounts paid, denied, adjusted, etc.

In cases where a patient did not have proper insurance, or where insurance coverage did not fully pay the charges, the practice will usually send out patient statements. Practice management software often contains ways for a practice to print and mail their own statements (or other correspondence), and may even contain a way to interface to third-party patient statement printing companies.

Almost invariably, the process of running a medical practice requires some introspection, and practice management software usually contains reporting capabilities to allow users to extract detailed data on financial performance and patient financial histories. PMS often has both pre-setup reports and allows users to design their own, ad-hoc reports. In some cases, the reporting functionality of PMS interfaces with decision support systems or has similar functionality built-in.