MedSymPM: Multispecialty supports a more resourceful office and staff, meaning you can focus on what truly matters the most: your patients.
The PM module is the practice management segment of the MedSym Multispecialty Management System.
The Front Office – Physician Schedules
Our Practice Management System gives the receptionist the ability to manage multiple physicians’ schedules.
Personal patient information:
- Patient insurance information
- Electronic version of the insurance card via scanning
- The insurance validation feature is used to confirm the validity of a patient’s Blue Cross/Blue Shield insurance, check co-payment amount, and whether or not a patient has met their deductible.
- MedSymPM: Multispecialty offers a streamlined check-in system. Once the patient is checked in electronically, the system notifies the nurse that the patient is ready to be seen and the record transmits in real time to the EHR
- PM also helps make the patient check-out more efficient. Once the nurse and physician have completed their part in the patient’s encounter, the receptionist is alerted that the patient is approaching the check out window. At this point, the receptionist is ready to begin the check out process
- The receptionist can review the patient’s demographics, insurance records, and the electronic super bill
- The receptionist collects the co-pay and posts the payment to the system
- Next, the receptionist checks the patient’s assessment and plan created by the physician earlier. If the physician has indicated a follow-up visit, the receptionist schedules the appointment, gathers any prescriptions printed by the physician, clicks to print the patient a receipt and details of the next appointment, and hands that documentation to the patient. The patient’s encounter is complete
- As the patient leaves the office the receptionist indicates to the system that the encounter is complete. This will give the billing specialist notice that a patient’s insurance claim is ready to be reviewed and filed
- PM electronically notifies the billing specialist that check out is complete.
The Business Office
Once the billing specialist is notified when a patient has been checked out, PMS creates a complete insurance claim with all the diagnosis, procedures and services (including codes) for review. After reviewing and editing the claim it is ready to be filed either by mail or electronically.
Billing Department Workflow
The creation and preparation of insurance claims. Claims are created in two ways:
- Automatic: Claims are created and completed during the course of the patient’s encounter. The billing specialist simply needs to review the claim and set it up to filed.
- Manual: There are cases when a claim needs to be created where the patient’s encounter is at a different location (Hospital Visits, Nursing Homes, etc.). This is partially automated. When you open a new claim you are required to select the patient, physician, and date of service. When the claim opens, the demographic and insurer information is already filled in. The billing specialist uses the same coding system that the physician uses to help guide in the selection and linkage of the diagnosis, procedure, service, etc. Once completed, the claim is ready to be filed.
Transmission of claims. Insurance claims can fall into two general categories:
- Government: Direct-transmission to Medicare, TennCare, Blue Cross for Tennessee and Medicare, Medicaid and Blue Cross, for Alabama, etc.
- Commercial: (Aetna, United Healthcare, Cigna, etc). Most commercial insurance claims can be transmitted electronically through a clearinghouse. For those that can’t, the clearinghouse will “paper-claim” in exchange for a per claim charge. To avoid the charge for the paper claims, some offices create paper claims locally. Since we are fully integrated with the insurance processors, the process of sending a batch is, in most cases, only one to three “clicks” of a button away.
Follow-up of claims and patient accounts:
- Insurance claims: The follow up on electronic claims is simple, requiring only a “click” or two. The audit report will provide information regarding total claims transmitted, accepted, rejected and then a detailed report for rejected claims. There is also the capability to produce an aging report that identifies outstanding payments in categories of 0-30, 30-60, 60-90, 90-120 and >120 day intervals. Once identified the user has the option to re-print or re-submit electronically these outstanding claims.
- Patient Accounts: MedSymPM: Multispecialty has the ability to follow up on patient accounts by providing reports identifying patients who have neglected to pay their bills. Once patients are identified on the report, users have various options available to help manage the accounts such as to send the final statement, collection agency report, account write-off, and other options.
Posting and balancing of claim and patient payments:
- Electronic Posting: Large volume providers, such as BlueCross and Medicare, offer electronic posting of explanation of benefits [EOB] or remittances. A click of a button usually downloads and posts most payments from the electronic EOBs.
- Manual posting:
- Patient payments, co-pays and mail, offers a “distribute” functionality that allows the users to distribute large patient payments over several encounters, oldest to newest
- Payments from insurers who do not provide electronic EOBs are quickly manually posted
- Balancing: MedSymPM: Multispecialty offers several reports to balance both daily patient payments and daily insurance payments, so the user can make sure that the cash drawers and computer totals match. These reports can also be used for end-of-month balancing and end-of-year balancing when reconciling bank statements.
- The user selects some initial criteria, clicks a button, and the system generates a list of patients whose insurance has reconciled and who have a balance greater than a specified amount. No more need to send a statement for a 10¢ bill when a stamp costs more than four times as much. Statements can also be transmitted electronically to bulk mailing houses.
MedSymPM: Multispecialty also provides numerous reports to manage accounting details associated with practice, charge, payments disallowed, write off, patient payment, etc, and can be broken down by Facility, Insurer, Physician, and Procedure Code, etc. These reports offer date range options for date of service, file date and post dates.
The PM has other features that include auto re-file so you can set dates to automatically re-file insurance that has not paid. All reports have a unique feature allowing the user, with the click of a mouse, to go directly from a follow-up report into the claim needing attention, correct the claim, resubmit and then, with another click, quickly start back at the last place in the report. All reports can be sorted by column heading. For example, quickly sort patients with the largest account balances to the top of the report.
Account Receivables and Reporting Management
- Comprehensive patient information including demographics, insurance, appointments, contacts, referrals, notes, case management details are fully integrated with the MedSym Multispecialty Management System
- Fast patient registration with alert messages including duplication warnings
- Case specific records: insurance plans, hospital stays, A/R classes
- Patient and guarantor account retrieval by numerous search criteria including patient and/or guarantor name, date of birth, social security number, account number, transaction number, medical record number, and user-definable fields
- Procedure and diagnosis code tracking specifically designed for oncology care plan, etc.
- Patient and insurance company balances displayed in every patient-related view
- Custom fields available for user-defined information
- Easy viewing of managed care issues such as referral tracking, copayments, number of allowable visits, utilization and outcomes
- User-defined reports generated by procedure, A/R class, location, referring doctor, date range, service or posting date, insurance, department, provider, credit type
- Patient referral tracking warns when patients approach referral service limits
- Next post-procedure date for reimbursement
- Comprehensive transaction information with easy mouse click drill-down capabilities
- Accounts receivable and collection activity: complete computation, tracking, and reporting
- Insurance and HCFA forms: automatic generation and recreation
- Recording of check numbers with the associated procedures for easy posting reconciliation
- Dynamic formats and flexible customization features
- Full audit trail
- Open item posting: automatic disallowance, withhold calculation, automatic write-off
- Multiple statement formats
Robust System Reporting:
- Transaction listing
- Aged trial balance (user-defined patient/insurance aging categories by date range for itemized charges)
- Recall report (selected by patient name, account number, birth date, provider, recall reason, last service date, or procedure selection)
- Demographics reports
- New patient listing
- Reports may be sorted/filtered by any combination of A/R class, department, insurance, provider, plus date range (daily, weekly, monthly, quarterly, annually, and for any date or date range)
- Screen-preview and printing of all reports, statements, receipts, immunization record, insurance forms, encounter forms, and letters
- Laser Forms Software (optional module) for patient statements and receipts, encounter forms, HCFA 1500 forms
- Built-in word processing, seamlessly integrated with other system modules
- Mail-merge for automation of single letters or letters to groups of patients, providers, insurance companies, attorneys, etc.
- Letter creation based on: date of service range, diagnoses, procedures, birthday letters, operative reports, dunning and pre-collection letters, request for insurance information, patient labels, referring physician labels
- Free-form letters and documents supported, both stand-alone or generated by merging information from the system database
- Mail-merge label printing
Customization, Personalization, Security:
- Choice of ledger column headings and their sequence
- On-screen patient summary
- Insurance plan billing order
- Procedure and diagnosis code linking
- Linked procedure code posting
- Customized billing cycles
- Aging categories
- Dunning messages
- Administrator-defined access permissions and customizations
- Multiple security levels: read-only, add, modify, delete; access assigned per user, per group, per module
Appointment Scheduler Module:
- Numerous views and reports available including schedule printouts by provider/room, daily/weekly schedule report, no-shows
- Effortless modifications to existing appointments in one or two mouse clicks
- Extensive customization: customized screen settings, user-defined appointment types, appointment durations, overbooking features, time slot intervals by provider/room, etc.
- Separate office and surgical schedules
- Wave scheduling
- Charge slip and label printing for chart preparation
Patient and Insurance Billing:
- Detailed insurance plan information screen
- On-screen insurance claim status (insurance claims pre-submission report, insurance unpaid claims report, automatic claims re-submission and claims tracking)
- Procedure-diagnosis code linkage: helps ensure claim acceptance by automatically verifying that an accurate and appropriate diagnosis code is attached
- Automatic cascading: sequential billing of an unlimited number of carriers per patient
- Automatic claims resubmission (user definable by insurance carrier)
- Unlimited insurance-specific fee schedules
- Multiple insurance holders per patient
- Multiple insurance coverage and effective dates
EDI – Electronic Billing & Reconciliation:
- Fast and flexible electronic claims submission and Electronic Data Interchange (EDI) can handle the most sophisticated billing requirements
- Quick reimbursement on electronically submitted claims
- Eliminate the need for paper forms, HCFA and other forms
- Dramatically reduced insurance company rejections due to error-free electronically submitted claims
- Electronic reconciliation for automatic posting of payments, eliminating the need for manual keyboard entry
Medical Practice Management Reports Module:
- User-defined reports including:
- Practice analysis report
- Procedure analysis report
- Referral analysis report
- Insurance aging report
- Diagnosis analysis report
- Transaction summary report
- Reports may be sorted/filtered by any combination of A/R class, department, insurance, place-of-service, provider, referring doctor, plus date range (daily, weekly, monthly, quarterly, annually, and for any date or date range)
- All reports are fully customizable
- Customized report parameters can be saved for easy reuse
- On-screen preview available for all reports
- Reports are produced without interrupting other system operations