Medical management software selection tips

Medical management software, or as it is also commonly known  - practice management software, provides healthcare practices the tools to carry out a broad range of administrative tasks. Common medical management software features include scheduling, billing, patient portal, ePrescribing, check-in, insurance eligibility verification, financial reporting and benchmarking, and tracking quality of care metrics, among others. 

Before discussing selection tips, it is important to briefly consider the benefits that can be attained from adopting a medical management system. One of the primary benefits an organization can attain from using medical management software rests in its management and monitoring capabilities. Most quality medical software packages will provide users the ability to examine operational data and generate reports based on a designated criterion of analysis. By examining this data, users can seek out inefficiencies and redundancies and adopt measures to mitigate them.  

The non-clinical data generated and used by medical management software offers practices, if used properly, to provide insight into several operational areas. Broadly these areas include revenue, expenses, workflows, and a variety of data concerning an organization’s patient population. More sophisticated medical management software can combine administrative tasks and data with clinical data to provide a holistic and nuanced view of an organization’s operations. Specifically, these data and tools can shed light on inefficiencies within an organization that can be corrected to provide better care at less cost. 

An example of how data sharing between clinical and non-clinical data can be found in the following example. A member of your clinical staff sees a patient. The clinician documents the encounter into the EHR. The EHR system shares the clinical data FOR THE visit with the practice’s medical management software. A claim is prepared to be submitted to the patient’s insurance provider. The claim is automatically prepared with information from clinical records to ensure the claim is coded properly. Further clinical documentation is submitted with the claim for reimbursement to ensure the claim is paid or in the case of claim submitted to CMS the risk of an audit is mitigated because supporting documentation has been submitted with the claim. 

What is considered practice management software often does not contain all these features. From a practical perspective, practices benefit from having these features fully integrated into one software package. Although many practices can function quite well without a fully integrated practice management solution there are a number of compelling reasons why one should select a fully integrated EHR and practice management solution.   

A second benefit is found in medical management software’s ability to automate standard tasks. For example, medical management software can automatically send appointment reminders, monitor supply inventories, and provide notifications when a re-order is needed. Further, many medical management systems contain billing features which allow claims to be automatically scanned for errors and submitted. Also, this software can also generate bills and allow for patients to pay their outstanding charges through a payment interface. 

Considering the benefits practices can realize from adopting medical management software, what should selection teams consider when selecting medical management software. 

One size (or type) of medical management software does not fit all

As is the case when choosing an EHR system, the selection process for medical management software will be guided by an organization’s needs. The characteristics of a practice’s patient population is an important consideration in determining what features are required from medical management software. For example, larger organizations may require medical management software capable of sharing data not only with the clinical side of the organization, but also various clinical departments. Further, larger organizations such as hospitals or large practices spread across multiple locations may require the ability to collect, monitor and analyze more complicated data. In response to the diversity of consumers being served, medical management software is commonly scalable to suit different needs. Therefore, selection teams should be mindful that a rigorous requirements gathering process will assist in making their prospective medical management software align with organizational goals.  

Choose an integrated system 

Medical management software is offered in three different deployments: standalone, add-on, and integrated. Standalone software is offered to customers as a product that can be used independent of the main EHR system. Add-on software is offered by EHR vendors as an optional add-on. Add-on medical management software is produced by an EHR vendor or by a third-party vendor who licenses their product to EHR vendors to be sold as part of their suite of EHR products. Add-on medical management software functions as if it is a feature native to the EHR system.  Lastly, integrated medical management software is included as a native feature in an EHR product. 

Given the three options available, integrated medical management software allows clinical and administrative data to be shared within the system. As such, data from different departments can be used to inform management decisions. Further, the billing and collection process can be carried out in a more efficient manner as clinical data can be used to support claims submission. 

Financial features relevant to practice needs

Financial features such as billing, spending and revenue tracking are commonly found in medical management software. Practices can avoid drains on their revenue by adopting medical management software that can offer patients an accessible option to schedule and reschedule appointments, verify patients’ insurance eligibility, pay copays and outstanding balances online, generate bills, and facilitate the claims submission process.   

In addition, to the areas referenced previously, medical management software should offer an organization the ability to track revenue and expenses in a way that can inform decision making. Often these features are classified as revenue cycle management or RCM. These features allow administrators to track and predict revenue as a way to assist in financial planning.  

In the last decade, medical management systems have become a common type of healthcare technology available to consumers. Given the wide availability of these products and their proven ability to help health care organizations make their operations more efficient, as such this software should also be considered an important part of an organization’s technology strategy.  

Jeff Green

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Jeff Green

About the author…

Jeff Green, MPH, JD works as a freelance writer and consultant in the Healthcare information Technology Space.

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Jeff Green

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