How an Intelligent Medical Practice Management System Produces Maximized Revenue, Productivity, and Engagement

First, let’s point out how the phrase “practice management” (PM) is a misnomer because - as alluded to in our own heading above - “PM” encompasses operations, EDI, finance, analytics, workflow, scheduling, and engagement.

So, let’s explore how a robust, rules engine-driven PM platform can have a positive impact on your own administrative costs, especially since a recent report by the Annals of Internal Medicine showed how the healthcare industry in the United States spends over $812 billion annually. 

To that end, on the financial side, the PM system should support:

• Eligibility verifications on scheduling appointments and again as often as desired in advance, preferably in automated batch mode through the scheduler
• Out-of-network alerts on scheduling and an ability to select in-network providers, if any
• An automated prior authorizations option eliminates this extremely time-consuming requirement
• Access to a patient responsibility estimator and a display of copayments while scheduling to control patient A/R 

• Interactive appointment reminder texts to dramatically reduce no-shows
• A pre-submission Denial Preventer empowering you to edit claims likely to be denied before submitting them
• E/M coding alerts for maximizing revenue, and NCCI editing alerts when multiple claims for a patient should be bundled
• HCFA, UB, Workers Comp, and No-Fault claims with a nearly 100% success rate on first-attempt clearinghouse submissions 
• Claim tracking in real-time to ensure claims are being processed
• An on-the-fly denial manager for quickly editing/resubmitting any claims not detected in advance 
• Automated EOB reconciliations ensuring A/R is accurate to the minute
• Hands-free claims to secondary and tertiary payers, if any
• Patient balance-due reminder texting and/or email statement options both with online payments; offsite paper statements production/fulfillment if preferred
• An accurate Insurance Discovery option when coverage information is fully or partially missing 

On workflow, the PM system must support a patient portal with online payments that enable patients to self-serve on any number of levels such that when they arrive, much of their intake has already been handled.

A kiosk option would further expedite intake as would a scanning mechanism for quickly inputting insurance and driver's license data. That same mechanism should capture those back/front images and automatically attach them to the patient’s record.

On analytics, you’ll want a user-friendly/user-defined ability to compile financial and operational reports, KPIs, dashboards, and analytics. They should be exportable to Excel, and be able to be saved and compiled automatically at user-specified days/times.

Back to the $812+ billion mentioned above.

It includes all administrative expenses, a sizeable portion of that cost is in filing and processing claims for medical and laboratory services reimbursements. So, whatever enterprise networks, medical groups, and laboratories can do to increase the accuracy and efficiency of the claims they submit will directly impact their revenue and profitability.

What Types of Entities Can Benefit from Practice Management Automation?  

Whether you’re part of a hospital or health system, a large medical group in any specialty or multiple specialties, a laboratory, an imaging center, or a behavioral health/substance use disorders setting, you’ll want an intuitive, intelligent, hands-off platform as described above to maximize revenue and productivity.  

MedicsPremier from ADS supports everything described, and more. It can be deployed on our cloud or implemented on your local server. And if preferred, MedicsRCM (ADSRCM) is available for outsourced RCM, billing, and staffing.