Medical practice management software

Software to help medical practices manage their offices has been around for decades. However, today’s medical practice management software (MPM software) bears only the most basic resemblance to its older counterparts Medical software today allows staffers to track patient demographics, visits, and diagnoses; collect, transmit, and track billing information and insurance payments; manage appointment scheduling; and generate a variety of reports.

By taking on such a wide range of tasks, MPM software can improve the efficiency of an entire practice: from physicians and nurses to clerks and billing specialists, everyone in your office will be affected by the choice of software.

The much-maligned Health Insurance Portability and Accountability Act (HIPAA), which among other things set standards for electronic patient data, is a driving force behind many MPM decisions. Most of those shopping for medical practice management software are upgrading from older software that are not capable of complying with HIPAA regulations

There are hundreds of MPM software packages available today, targeted at every type and size of practice. This BuyerZone.com Buyer’s Guide will help you ask the right questions to evaluate both the software and the vendor so you can choose the best solution for your practice.

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Benefits of medical billing software

While the health care industry has traditionally been slow to adopt new software, that is changing. In addition to HIPAA compliance, there are several important benefits to be gained from the right medical software:

• Improved staff productivity – easy-to-use software improves efficiency
• Increased patient and customer satisfaction – more flexibility in scheduling and better access to personal information
• Faster payment from insurers – paper claims usually take 30 – 60 days, electronic claims are usually paid in 10 – 14 days instead
• Fewer errors in billing and insurance – correct and resubmit in hours, instead of weeks

Most practice management software will also bring you into compliance with the sections of HIPAA that specify increased security standards, ANSI billing formats, and more. Note that we say “most” – some software may provide only partial HIPAA compliance. You should quiz vendors carefully about the HIPAA compliance of any software you are evaluating, particularly around electronic billing and security measures.

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How to investigate medical software

Since MPM software will affect everyone in your office, it is important to involve multiple people in the evaluation and purchasing decision. Physicians, office managers, receptionists, and billing managers will all have different viewpoints and important concerns: taking any major steps towards a purchasing decision without involving every role is likely to lead to problems down the line.

If you have started looking, you have probably noticed that there are an overwhelming number of software providers to choose from. One way you can quickly narrow the field is to see what practices like yours are choosing. Find offices similar to yours in size and specialty and visit their offices to see the software in action. While this may seem like an obvious tactic, it is highly effective.

One reason there are so many different types of medical management software is that many are targeted towards specific types of practices: small family practices have considerably different needs than large hospital staffs, as do orthopedic practices and dentists. Other medical businesses such as medical equipment companies and medical billing services, have even more specific needs. Try to find software that matches your specialty and office size by asking these types of questions:

• Does the system handle scheduling quirks unique your practice?
• Does the system recognize all the procedure and diagnosis codes your practice uses?
• Can the system handle multiple offices and multiple doctors?
• Can information be accessed from multiple locations?
• Do you need inventory tracking or the ability to manage several separate accounts?

It is also essential that you see the software in action first-hand. In-person demos are preferable, but live online demos are almost as good. Many vendors allow you to log in to a sample account or will send you a sample CD to let you try the software yourself: take advantage of these opportunities. Have all the interested parties from your practice go through their most common activities to get a sense of how easy the software is to use – watching “canned” demos does not give you the same in-depth look at the products.

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Medical software features

Comparing specific features across multiple medical software packages can be a challenge. You will see the same features come up in one application after another, going by slightly different names or with slightly different options. This is where you should fall back on your initial research: make sure you pay the most attention to the features your staff has decided are important. It helps to be a bit of a cynic: if you can avoid letting yourself be “wowed” by cool features that you are unlikely to use, you will be able to stay focused on evaluating the features that are important to you.

You are likely to hear quite a bit from salespeople about how much they can customize their product for you. This is another instance where you should be skeptical. If the application does not do what you want it do off the shelf, find another that does. But unless you are buying for a hospital with very intricate reporting and functionality needs, the software you choose should already include all the basic features you need.

General

Every salesperson will tell you their software is easy to use. You need to decide for yourself what “easy to use” means, but here are some examples.

• How many clicks or screens do you have to go through to make an appointment?
• How easy is it to search for patients or unpaid claims?
• How easy is it to customize your doctors’ names, length of appointments, billing cycles, and fee schedules? Can you customize the features you want?
• Do you get good summaries of information on top-level screens, or do you have to drill down to see details?

Scheduling

Creating, changing, and viewing appointment schedules may be one of the most mundane but essential features of a practice management application. Some key attributes to look for:

• Will the scheduler accommodate additional doctors or offices if your practice expands?
• Can you double- or triple-book appointments?
• Some applications offer instant eligibility verification: while you are making an appointment over the phone, you can check the patient’s benefits through their payer, making sure that their coverage is up-to-date and includes the procedure being booked. This can be a huge timesaver for practices that deal with many Medicaid patients who have to renew their coverage on a constant basis.

Billing

One of the most common reasons practices upgrade their software is to move to electronic transmission of claims. Not only is this part of HIPAA compliance, but it can also dramatically improve the speed of payments and reduce the number of rejected claims.

• What kind of error-checking does the billing application do? Good “scrubbers” catch basic errors like missing information, as well as less obvious mistakes such as invalid policy numbers or mismatched diagnosis and procedure codes.
• How are claims processed? Some applications process all claims through a clearinghouse. Others allow you to submit claims directly to Medicare, Medicaid, and use a clearinghouse for all other claims, while still others sell add-on modules that allow you to submit claims directly to any insurer you choose. The catch there is that you need a good volume of claims to those insurers each month to make the additional cost worthwhile.
• How is financial information handled? Some systems include full accounts receivable tracking, with claims reminders, collections tracking, revenue reports, and more. If accounts receivable features are not included, look for an export format that matches your existing accounting software – Quicken, Peachtree, etc.

Reporting

It is easy to be impressed by the amount of reports offered by MPM systems: some come with hundreds of reports. However none of them matter except those you will use and act on. Make sure the software you choose can produce the reports you want.

Some examples of valuable reports that you may not be familiar with:

• outstanding claims, by date, payer, and patient
• diagnosis and procedure codes used, by doctor or location
• billing reports, by doctor and location
• efficiency reports that detail your staff’s activities

Many programs also allow you to create your own reports. If you have specific reporting needs, investigate how easy it is to create new reports or export data to a third-party report writing application.

Security

The application you choose should include security measures that meet HIPAA standards and ensure patient confidentiality.

• SSL is a standard method for communicating securely over the Internet. It is a HIPAA requirement as well as a good idea.
• Multiple access levels give you the ability to allow different staffers varying amounts of access: billing clerks, for example, could be allowed view-only access to diagnoses and procedures.
• Change logs keep track of what information users access and/or edit, which can be essential if security is compromised.
• For even greater security, some online systems allow you to restrict access by time of day or IP address, meaning only certain computers would be allowed to access the data at all.

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Electronic medical records

Deciding whether to implement an electronic medical records (EMR) system is another critical purchasing decision for medical practices. EMR applications move patients’ charts online: they store physicians’ notes, x-rays, prescriptions, and any other information usually found in paper charts. This allows doctors to access patients’ information remotely, makes searching and retrieving data easier, and improves office efficiency and accuracy.

Both MPM and EMR are major purchasing decisions costing many thousands of dollars. Because of the magnitude and expense, it is usually advisable to purchase and install one at a time. However, to get the most out of both systems, it is important that they work well together.

The industry-standard HL7 protocol allows health care applications to share data with each other, so make sure both your EMR and MPM software use it. For truly seamless integration, you should not have to export batches of data from one and import them into the other – they should communicate in real time.

Since many medical software vendors offer both types of software – or even one software package that combines the functions of both – you may be able to investigate both at the same time. Of course, the easiest way to ensure seamless integration is to buy both systems from the same vendor. However you may find that the provider with the MPM that is ideal for your business does not offer the best EMR.

Both systems are critical to the day-to-day functioning of your office, so be sure to choose them based on your specific needs, not solely on convenience.

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The online v. desktop decision

One important decision to make when choosing practice management software is whether you want the program and data to reside on your computers or on computers owned and maintained by the software vendor. If you run it in-house, the solution can be referred to as a local, client-server, or desktop system; vendor-run applications are called application service provider (ASP), remote, or online solutions. Both options provide distinct advantages: consider which are more important to you.

Local solutions

Most of the software you use today is locally hosted--the program runs on your computer and stores the data either on your hard drive or on a network server in your office. This familiar setup gives you the greatest control over every aspect of your practice management software since the data resides on a computer in your office.

Having this total control can be a drawback, though. To meet HIPAA’s stringent data security standards, your computer network will need to employ advanced technologies including Secure Sockets Layer (SSL) security, firewalls, and variable access control which grants different permissions to each user. Installing these technologies and maintaining the patient information database can take considerable expertise and effort – not to mention considerable expense for consultants and hardware. In addition, keeping the data in-house gives you the responsibility of making regular backups – preferably daily – in case of a system crash.

Proponents of desktop applications point out that MPM software is highly stable and requires little database maintenance. In addition, some vendors will handle setup and installation for you – either through an office visit or by accessing your computers remotely. And you can fairly easily create scheduled backups that copy your data to off-site computers. (Interested in remote backup services? Get a free quote today!) Plus, there is the bonus that because the data is local, overall application speed tends to be higher.

If you go the desktop route, you are more likely to pay a lump sum to buy your software outright, then a small ongoing monthly fee for support.

Online solutions

There are two slightly different approaches to online practice management software. In the most common model, an ASP, both the application and the data reside on the supplier’s servers, and your staff uses a regular web browser to access the software. A relatively new variation is a hybrid between the local and online models: client software is installed on your computer, but the critical data still resides on the vendor’s computers.

Both options provide the same main advantage: the database is maintained by IT professionals at the vendor’s office. Multiple layers of firewalls and security, uninterruptible power supplies, fail-over (instant switching from one computer to another in case of a crash) and reliable backups are all standard operating procedures for these vendors – and they combine to virtually guarantee that your data will always be secure and available.

The biggest risk of online solutions is that they require an active Internet connection, which is no small requirement. No Internet connection works 100% of the time: your internal network may fail, your ISP may experience an outage, or an Internet worm may cause congestion that prevents you from accessing your data for a while. Online medical systems offer various workarounds for this potential bottleneck – some allow you to download some patient info, work with it, then re-upload, but this is only useful if you can anticipate outages before they occur. Others work in batch mode, pulling down a whole set of data you are likely to need (that day’s patients, for example), then re-uploading it at the end of the day.

With online providers, payment is more likely to involve a small setup fee, then ongoing monthly payments based on usage.

Which is right for you?

Since both options provide secure, reliable practice management applications in almost all cases, one way to make the choice is to consider which of the potential downsides you fear more: being unable to access your data while your Internet connection is down, or losing data and time because your server crashes. If your practice has access to an immediately available IT resource, an in-house solution may be your best choice – but make sure you involve the IT staff in the purchasing decision! Smaller practices with little to no computer expertise may be better off choosing an online solution.

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Medical software vendors

In addition to selecting the MPM software, you are choosing a new partner for your practice. The application you choose will be part of your operations for years to come, so it is important that you go with a vendor who will be around to support it.

One way to help assess the stability of your provider is to choose a product with a large installed base. This ensures that the vendor will continue to upgrade and improve the product, and demonstrates that the company has an ongoing revenue stream to keep them in business.

Training and support

Training and installation is critical. Switching MPM systems is an inconvenience even in the best case: ask how the vendor plans to minimize disruption during installation. The vendor you choose should be able to import data from your current system to avoid re-entering all your basic patient data.

The vendor should also provide training for everyone who will be using the system. Many practices prefer having a trainer come to their office, but that is not always possible: web-based training can also be effective, if done properly. However it is accomplished, the training should take users through the basics of setting up, operating, and troubleshooting the system.

As with any software, you are should expect occasional problems or outages. While “guaranteed 99.5% uptime” and other vendor assurances are fine, more important is how they react when something does go wrong. Inquire about support policies: do they have live support staff on the phone during business hours? Is there a guaranteed response time?

Do a site visit

You can learn a lot by visiting one of the vendor’s current customers. Ask to be put in touch with a local practice similar to yours so you can bring your team for a visit. If you can set up a visit with the other practice by yourself, all the better – you are more likely to get honest answers without a vendor representative looking over your shoulder. During your visit, have these questions ready:

• How responsive is the vendor when you have problems?
• Does the software do everything they said it would do?
• Did the vendor provide adequate training?
• How much downtime have you experienced in the last year?
• If you were starting over, would you work with the same vendor again?
• What do you like least about the program?

Some MPM software vendors use dealer networks to sell their software. The buying process will be basically the same – you can apply the same tests described here to resellers. However if buying from a dealer or value added reseller (VAR), make sure you understand who is responsible for each aspects of the deal: installation, support, and upgrades. In some cases, the dealer will only get you set up and trained and the software developer will handle ongoing support; in other cases the VAR handles all of the ongoing support.

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Practice management pricing

For desktop MPM software, licenses start at $2,000 to $3,000 and range up to $10,000 or $15,000. Many vendors are quite willing to set up leases or extended payment schedules, turning a hefty $6,000 purchase into a more palatable $200/month commitment.

Vendors use different standards to determine exact pricing: the number of physicians, concurrent users, or computers that will have the software installed. A thorough needs assessment before you start shopping – who will use the system, and how – can make for smoother negotiation.

Online or ASP software is paid via monthly fees. Setup fees are usually less than $1,000, with monthly fees ranging from $50 to $300 or more. Many ASPs do so by charging for actual usage: $0.50 per claim, $0.75 per patient statement, and so on. Often, they have monthly minimums no matter how little you actually use the software. Note that these usage-based pricing arrangements are generally fair – typically totaling $60 to $200 per month in fees for a small practice – but they require you to estimate your average usage before you can compute the total cost.

There are a large number of additional fees to be aware of. Some providers may include these as part of their monthly fees, and some may bill each item separately. As long as you know exactly what fees you will be expected to pay, you will be able to compare vendors accurately.

• Data transfer fees – when you import existing data, vendors will often charge you for an extra step of cleaning, de-duping, and preparing the data for the new system.
• Exit fees – when you leave the service, to cover the expense of exporting your data so you can move it to a new system.
• Support fees – basic support is often included for six months or a year with the purchase of a desktop system and is usually included in an ASPs’ monthly fee. However you may encounter long hold times on the phone unless you upgrade to the “gold” or “premier” support package, which will cost extra.
• Training – As with support, basic training is often included, usually computer-based training (CBT). If you need extra administrator training, or on-site classroom training, you can expect to pay extra for those as well.

Upgrade pricing can also vary. ASPs will usually upgrade their software without charge to you, but desktop vendors may charge an upgrade fee because they have to help install the new software. Check your contract to see how often upgrades will occur and how much they will cost.

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Medical billing buying tips

• Portability of data: if you leave, how easy is it to export data to take to new app? Or how easy to export to do detailed spreadsheet analysis of financials?
• Password security: the most elaborate security available is useless if your employees keep passwords on sticky notes on their monitors, or if you use your address as the password. Make sure your staff understands the importance of basic password security.
• Build a test plan: create a script that walks through your most common office tasks, both simple and more complex. Use it when you try out each solution, and you’ll get a balanced comparison of how easy each package is to use.

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