medical practice management (MPM) software

Medical practice management (MPM) software is a collection of computerized services used by healthcare professionals and administration to streamline day-to-day tasks within a medical practice and improve the efficiency of operations and quality of patient care. MPM software can be used by both general practice organizations and specialized service providers; it is most common in small to medium sized businesses. While the software generally focuses on financial and administrative tasks, it can also be combined with electronic medical records (EMR) if the organization expresses the need. However, this is an especially challenging task for IT professionals.

Medical practice management software controls large sets of data, including lists of:

  • Insurance companies
  • Medical facilities
  • Procedures
  • International Classification of Disease (ICD) codes
  • Other physicians and providers in the health care system

Some common capabilities found in MPM software include:

  • Entering and tracking patients in the system.
  • Scheduling patient appointments.
  • Documenting patient demographics.
  • Executing electronic billing procedures.
  • Sending insurance claims.
  • Managing patient, insurance provider and third party payments.
  • Creating reports for medical staff members.

In addition to enhancing operations and patient care, MPM software can also help ensure healthcare organizations -- such as hospitals and clinics -- comply with industry, state and federal regulations and requirements. As a result, public health officials may find beneficial information and uses of MPM software. Third party payers who need access to billing information also benefit from the streamlined information provided by MPM software.

Requirements of medical practice management software

An Internet connection and simple computer network is all that is required for MPM software to run. It can be deployed as a desktop-only software, client-server software or Internet-based software.

As desktop-only software, it can only be utilized on a single computer and access is limited to a few people. When deployed as client-server software, multiple users can share data as well as access an external on-site server that must be bought or leased by the healthcare practice. If the MPM software is Internet-based, then users can access the system over the Internet, thus removing the necessity of buying a server. However, in this case, patient data is kept outside the practice office.

Effective medical practice management software requires four main features:

  • Patient scheduling
  • Insurance eligibility
  • Management of claim submissions and denials
  • Financial reporting

The scheduling feature is important because it facilitates a more efficient and less stressful appointment booking process for both the staff and the patient. The scheduling feature in MPM software allows the staff to customize the screen to best fit and organize data in a personally beneficial way without impacting the work of others. Since the scheduling process is made easier and accelerated, there will be shorter lines in waiting rooms and the staff will be able to focus more on patient care, thus improving the overall experience for the patient as well as the staff.

The insurance eligibility feature enables an organization to instantly review the insurance status of multiple patients and whether or not they will receive coverage at that specific medical establishment. A real time response is provided when needed, thus allowing patients to spend less time at the reception desk and also improving the scheduling process on both ends.

The management of electronic claim submissions and denials feature is the key to accelerating a medical practice's revenue cycle. An electronic claim submission refers to the process of digitally requesting reimbursement or payment from a health insurer for medical services with a paperless form generated by the MPM software. A claim denial is the refusal of the health insurer to pay for the acquired medical services.

The claim management feature also helps protect a medical practice from any mistakes made by staff while filing claims. If the system detects an error in the claim, it will immediately display the issue so it can instantly be resolved and resubmitted, wasting minimal time. Additionally, electronic claims promote faster processing rates, accelerated turnaround time and quicker payment of claims.

The financial reporting feature allows medical practices to generate reports that are customized to each stakeholder's requirements. This feature allows the practice to spend less time creating these reports in time for regular meetings because they are readily available through the software. Furthermore, analytics can be applied to the data in the MPM software in order to provide a more complete visualization of key financial indicators.

Other components of medical practice management software

The various other components of medical practice management software include:

  • Numerous billing code sets, such as the Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT) code and the most recent ICD.
  • Access control allows administrators to customize the different levels of access for each specific user.
  • Automated electronic reminders sent to patients via text or email, notifying them of any upcoming appointments. This can increase revenue by helping to decrease the number of missed appointments.
  • Patient demographics confirmed by all registered insurance providers.
  • A card scanner interface to be used by the front desk to swipe or scan medical insurance cards, thus reducing the danger of fraudulent claims.

The ability to integrate MPM software with electronic health record (EHR) systems is another beneficial component that can greatly improve record management. Many practices computerize their workflow with EHR systems before deploying the MPM software. The EHR system allows doctors and nurses to swiftly set up new patient records and easily add information using the EHR speech recognition feature. Therefore, in order to best treat patients and improve efficiencies, medical practices should employ both EHR systems and MPM software.

Benefits of medical practice management software

MPM software benefits for healthcare organizations include:

  • Automation of tedious tasks required by the billing department saves times and increases cash flow.
  • Front desk staff can scan health insurance cards, making their job easier and protecting patient information.
  • The insurance eligibility feature allows physicians to confirm a specific procedure is covered by the patient's healthcare insurer before ordering it, thus saving the organization money on wasteful costs.
  • The software's ability to streamline all administrative activities that are necessary to run a practice enables healthcare providers to spend more time focusing on and treating their patients.

MPM software benefits for the patient include:

  • Providing an explanation of benefits to anyone who is confused by or uncertain about their insurance coverage.
  • Easy access to account balance and billing information.
  • Improved waiting room experiences due to the increased efficiency of the organization's administrative tasks.
  • Better attention and care from healthcare providers increases patients' levels of comfort and improves their experiences at the practice.

Overall, medical practice management software makes administrative tasks and processes more efficient, thus leading to an increase in revenue. The automation of some processes and enhanced ease of others allows attention to be taken away from tedious activities and placed on areas that really matter and can greatly improve patient care and the organization as a whole.

This was last updated in August 2019

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