Purpose and Advantages of Software Solutions for Medical Practices

Purpose and Advantages of Software Solutions for Medical Practices



Healthcare services are one of the most fundamental and primary services needed in every society to maintain people's health and quality of life. Medical practices and hospitals are open 24/7, and every day throughout the year as anyone can get sick or injured and require immediate care.

But the question arises as to how medical practice can sustain and manage the entire cost of dispensing healthcare services that includes

  • Scheduling numerous appointment of patients
  • Diagnosing and treatment of acute or chronic illness that includes medicines, or use of medical equipment
  • Payment or reimbursement to healthcare providers such as doctors, surgeons, nurses, consultants, lab technician, and therapists for their timely services
  • Payment of overhead costs such as rent, utilities, repair, insurance, legal fees, and taxes.

Medical practice needs to manage its financial resources to ensure all the tasks are efficiently done and on time. Most of the population relies on insurance plans that allows them to get proper medical care in emergency and without the worry of financial constraints. In return, the medical practice provides the necessary treatment to patients and then bill the amount to insurance companies to collect the payment for the rendered healthcare services.

In these tough times, with the ongoing Coronavirus pandemic, the medical organizations are overburdened and understaffed and require all the resources and tools to treat and care for patients diagnosed with different ailments effectively. To manage business aspects and medical insurance in play, a regular accounting system is no good, and medical practices need a professional approach.

Medical revenue cycle management (RCM) software is essential for a medical practice to streamline its tasks, schedule appointments correctly, ensure accurate medical billing and coding so that claims can be processed and payments are collected on time without any objection.

Every day numerous patients enter a medical practice, and it can be a problem to keep pace with all the billing requirements, which can be complicated due to

  • Insurance policies and plans which differ with each insurance provider
  • Intricate coding systems which need to be updated to ensure claims are processed correctly
  • Problems may arise as to whether the insurance provider will pay the entire amount or the patients themselves.

The numerous challenges that an efficient RCM software can address are

  • The slow and mundane task of manually billing that effects payment collection and revenue flow
  • Huge numbers of claim denials or rejection due to incorrect billing and coding
  • Inability to monitor the claims process and solve the errors instantly
  • Compliance with HIPAA (Health Insurance Portability and Accountability Act) and HL7 (Health Level) rules
  • Inaccurate and slow claims scrubbing that increases the chances of claim denials

The healthcare revenue cycle begins with the patient's appointment and ends when the payment is collected from the insurance company, and the healthcare providers are reimbursed. The RCM software allows the staff to schedule the day and time of the visit and check the insurance status saving precious time and effort.

The Electronic Medical Record (EMR) / Electronic Health Record (EHR) is a software and vital part of every medical organization to store all the patients’ medical records and automate clinical workflows. Through EHR, the patient information is generated quickly; reporting is fast, which ensures timely diagnosis. Once the patient details and medical history is entered, there is no need to take the details every time a specific patient visits the hospital. The implementation of EHR software depends on the size of the medical practice.

In times of global pandemic such as Covid-19, it can be quite challenging for nearly every big and small medical practices to find, recruit, and train qualified individuals who can manage the crucial medical billing and coding process.

The advantages of implementing sophisticated RCM software are

  • The considerable time required in manual paperwork is reduced and shifted to automated program with all the necessary value-added features
  • Easy integration with EHR/EMR software system
  • Patient’s insurance information is checked and verified
  • Proper codes are configured depending on the type of visit, diagnosis, and treatment
  • No need to remember complex and difficult ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes which are already added and the coder has to simply select them
  • Monitoring and managing the rejected and denied claims
  • Entering correct amounts based on the copay policies
  • Tracking the patients’ visits and ensuring every time correct bill is made and processed
  • A portal system integration that allows easy scheduling and updates information of patients
  • Numerous payment options such as Credit cards, debit cards, and online transfers
  • The major and minor errors are removed, which reduces the chances of claim denials.

The medical billing and coding software is necessary to optimize the claim process and maximize medical practice efficiency to collect full payment from insurance companies without any claim denials. The billing software solution deals with multiple aspects, from verifying insurance status to ensuring proper coding to posting payments and generating reports.

The unbilled claims or rejected claims are tracked regularly, and any error is instantly reported and resolved. The modern billing software offers many valuable options such as cloud hosting and medical billing and coding specialist working remotely. The innovative billing software automates every revenue cycle function, such as integration with EMR, scrubbing claims, automatic alerts, and advanced reporting.

PETTIGREW is one of the prominent companies in the healthcare industry, offering a complete suite of billing, coding, and staffing solutions. The innovative and sophisticated RCM and billing software are ideal for

  • Integrated Suite Buyers which consists of medical practices that want to manage their entire practice, including scheduling, claim processing, EMR interfacing, and analytics.
  • Inpatient care providers involve hospitals, clinics, and nursing facilities that process and submit the claims on UB-04 (Uniform Billing) forms.
  • Outpatient care providers include private medical practices that submit claims on CMS-1500 (Center of Medicaid and Medicare Services). These private practices mostly submit online claims to insurance companies, so they need flexibility in claim processing and payment structure.

The use of digital technology is imperative everywhere, from our personal lives to businesses. The healthcare industry has evolved significantly with the involvement of digital solutions. The EHR/EMR systems have provided a smooth operation in collecting, recording, submitting, and updating patient information. The modern software solutions have allowed integration of EHR/EMR with billing and coding system with all the CPT and ICT codes.

The integration allows front desk support staff of medical practice to add the patient details in a file, and when the file entered in the system, the data will correlate, and the billing process will streamline directly. The patient information includes name, gender, age, current medications, while the patient medical history consists of a history of illnesses and treatments and a list of chronic ailments in the patient’s family.

From the doctor or physician’s perspective, the most important task is not only diagnosing and treating the patient correctly but filling forms and charts to document everything from diagnosis to treatment to post-treatment. The latest EMR systems have many dynamic features, such as customizable charts, voice recognition, dictation option, and machine learning.

The customizable chart helps a medical practice, and medical practitioners configure the charts according to their needs and requirements. The artificial intelligence allows systems to automatically recognize data patterns and streamline the process and saving precious time. The EHR/EMR software ensures proper record keeping of patients and reduces the billing and coding errors significantly.

PETTIGREW has a diligent and technically proficient team that designs and develops RCM software solutions that can ensure seamless coordination and operation, enable compliance with health regulations, customize payer policies, and reduce claims denials.

The biggest advantage is removing labor-intensive tasks such as mundane paperwork, filing claim forms, payment posting, filing appeals, and correspondence to unpaid or rejected claims. According to the American Medical Association (AMA), the number one cause of claim denial is patient insurance eligibility issues.

The RCM software solution can also integrate audit tracking service, which is important to record and track every transaction. The revenue collection is optimized from scheduling to eligibility verification to copay collection. The medical coding software translates all the diagnosis, treatment, and medications into ICD codes that can help accurate billing process.

Many of the companies offering RCM solutions usually focus on billing and coding, but only a few emphasize the significance of reporting and analytics on the long-term sustainability of revenue management for a medical practice. The analytic tools include financial data reports and enabling performance metrics for examining critical financial and clinical data

PETTIGREW medical business services includes ‘accelARate,’ an innovative software that can integrate with a particular medical practice management system. It digitizes the entire billing process and streamlines doctors' and physicians' encounters with patients and easy access to file storage, retrieval, verification, and submission to improve efficiency. A medical practice can

  • Analyze and view the performance according to individual patients
  • Monitoring individual payment for any provider
  • Detailed view of all the billing entries and payments for any date and time

The ‘Payer Connect’ feature helps a provider or medical practice to join a payer or health insurance company’s network. The process is called ‘provider enrollment’ and involves sending a request to join a payer network, submitting documents, completing credentialing requirements, and signing a contract with the payer.

Payer enrollment is necessary to ensure that healthcare providers reimburse correctly for rendering their services. The insurance companies do not accept claims or pay medical organizations that are not part of the payer’s network. The payer enrollment services allow a medical practice to correctly fulfill the requirement of different payers and keep pace with enrolments about to end. The rapid technological advances have allowed the development of cost-effective coding and billing solutions that can completely be customizable to fit a medical practice’s particular needs and requirements.