1. Enterprise RCM Feature Highlights
2. Complex Billing Scenarios
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Setup multiple legal entities, each with its own Group NPI and Tax ID |
Multiple locations, Multiple Providers, and Specialties each with its own Group NPI/NPI and Tax ID |
Setup Group NPIs and Tax IDs where individual providers have their own NPI and Tax ID |
Setup multiple individual Provider NPI/Tax ID (SSN) combinations |
Setup multiple Billing Provider NPI and tax ID combinations |
Setup secondary, non-NPI insurance-specific PINs |
Setup referring provider with supervising provider billing scenarios |
3. Patient Record Management
Comprehensive, Robust, 360-degree view of patient information |
Incomplete Patient Flag. Cannot create charges on incomplete patient data. Reduces claim errors |
Upload Patient Pictures |
Make patient record Active or Inactive for archiving |
Attach multiple primary, secondary or tertiary insurances |
Attach multiple financial classes or billing cases |
Exempt from Meaningful Use Reporting feature |
Quick access to statement history, ledger, eligibility history, authorization history, recall history, payment history |
Quickly print labels, custom letters, demographic sheets and others |
Placeholder to reference other systems — PC Ref# |
Access patient’s complete Note History (Billing, Scheduling, Patient, Collections) |
Scan and Attach documents to patient record |
Attach multiple guarantors to patient – Individual / Organization |
Track Patient by Referring Provider or Other External Referral sources |
Patient Alerts |
4. Powerful, Flexible Scheduler
Simple and easy Scheduler interface |
Color Code Appointment by Status and Appointment type |
Predefine Appointment time slots: e.g. 30 Minutes for new patients, 15 minutes for follow-up, etc. |
Built-in Eligibility Verification |
Single click option to view weekly or daily schedule |
Search patient appointments |
Multiple appointments in the same time slot |
Keep multiple appointment screens open while you navigate to other areas of the application |
Easy to set follow-up and recurring appointments |
Ability to generate forms, superbills, patient labels or patient demographics from scheduler |
Instant access to patient’s financial summary |
Instant access to patient ledger, statements, etc. |
Block single, multiple, or recurring appointment time slots for a specific Provider |
Block single, multiple, or recurring appointment time slots for the whole Practice/Entity |
Customize appointments by name for multi-provider practices with supervising physician |
5. Resource Scheduling /First Available
Flexible and robust multi-resource scheduling |
Extremely useful for multi-provider visits (Surgical Centers, OB/GYNs etc.) |
Create sequential and/or simultaneous resource schedule paths |
6. Financial Class/Case Management
Ability to setup multiple Cases for patients by Financial class, Coverage type or Contract |
Auto Case creation matches patient with insurance, saving time on data entry |
Easy access to Case information from the Patient Ledger or Charge screen |
Quick and easy to move charges from one Case to another Case |
Defaulting Case values auto populate charges |
Case Summary: View total charges, balances and last billed/submitted information |
7. Charge Management
Keyboard driven for fast data entry |
Instantly create charges from EHR |
Color code charges for a visual view of charges posted, submitted, new and missing, and charges by appointment |
View patients seen and their superbill status by color. Enter charges for these patients and/or other charges |
Optional print, claim override |
Convenient access to Patient, Payments and Patient Payment Information |
Repeat last charge feature |
Ability to Void saved charges (no delete) |
Charge Summary Report |
Unbilled Charges Report |
8. Instant Eligibility & Authorization
Real-time Eligibility and Batch Eligibility |
Electronic Authorizations (available through Emedeon) |
Easy access to complete eligibility verification history |
Activate responses to be given by Provider’s specialty or type of service |
Detailed responses showing active coverage, copay, annual deductible & Co-ins for various type of services |
9. Appointment Reminders
Send Email or Text reminders to patients with appointments |
No separate email access is required as customers can use their current email host settings to set up the reminder function |
Setup a generic message template or use separate templates by appointment type/ appointment status |
Message transmission method is easy to setup and is selected on the patient information |
10. EHR Superbills
Built-in electronic superbill. Instantly post superbill to billing |
One single system, one database. No HL7, No bridging. |
Auto populate diagnosis, procedure codes, modifiers and units from clinical to billing. |
EHR superbills are colored coded with a NEW status for easy identification and billing |
Perform bulk on EHR superbills |
11. Bulk Charges
For large volume practices that send electronic superbills, easily review multiple charges on one screen rather than individual charge review, select and submit all charged reviewed in one click |
Auto-processing facility available for bulk charges |
Available for PracticeSuite EHR and other EHRs linked with PracticeSuite Billing Software |
12. Claims Validation/Edits
System Alert when attempting to save charges against an incomplete patient record |
Defaulting value through Financial Class to ensure required items are always automatically entered |
Built-in rules to validate rudimentary claim gotchas! |
13. Claim Edits through Clearing House
Optional integration with Third party to validate LMPR, CCI, Local and National Edits. Available as an external interface through Charge Entry Screen |
14. UB-04 Billing
Built-in Facility Billing. |
User friendly! UB04 screen resembles the look and feel of an UB04 form. |
Works for Rehab, PT, Home Health, Long Term Care and others. |
HL7 interface available from external systems. |
Many built-in rules to auto-populate UB04 fields. |
15. ONC Certified EHR
ONC Certified for Meaningful Use | |||||||||||||||||||||||
In use by +61 medical specialties and sub-specialties | |||||||||||||||||||||||
e-Prescribing to over 70,000 pharmacies nationwide | |||||||||||||||||||||||
Single-screen design for all charting and patient documentation | |||||||||||||||||||||||
A cloud-based, whole practice solution | |||||||||||||||||||||||
Clinical Dashboard/Doctor’s Dashboard
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Efficient Charting
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Flowsheets | |||||||||||||||||||||||
–Tracking timely metrics for any specialty | |||||||||||||||||||||||
–Graphical Visualization of FlowSheet Data for enhanced interpretation and analysis | |||||||||||||||||||||||
E-Prescribing
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Integrated Labs and Order management
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Immunization
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MIPS/Clinical Quality Measures
TeleMed
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16. Online Patient Portal
Secure. 256 bits encrypted. HIPAA Compliant |
Fully integrated portal seamlessly integrates with scheduling, billing, EHR |
Online Patient Registration with the ability to enter insurance data |
Appointment requests both for new and existing patients |
Manage appointments: Cancel or reschedule an appointment |
Confirm patient appointments automatically or queue for staff to confirm |
Online patient communication via secure email and instant message |
Request communication from staff, lab results, Rx refills, referrals, etc. |
Share clinical summary, plan of care, CCD, and patient education |
Online EHR self-assessment form. Easy to customize form auto-populates subjective patient notes into EHR |
Patient balances are prominently displayed. Easy access to statements |
Online payment processing: Quick pay without login. |
Kiosk access with self-check-in. |
17. Front Desk KIOSK
Enable patient to complete EHR Self Assessment form/ follow-up summary sheet and others |
User-friendly and easy-to-build forms through EHR encounter sheet |
Form auto-populates patient encounter notes in EHR |
18. Meaningful Use Monitoring
Meaningful use dashboard |
Real-time alerts during patient encounters with compliance flags |
Computerized physician order entry (CPOE) |
Physician Quality Reporting System (PQRS) |
Clinical Decision Support System (CDSS) |
Evaluation Management Coding (E&M coding) |
ePrescribing through +71,000 pharmacies nationwide |
Exception and compliance ratings |
19. Inter-Office Messaging
Inter Office Messaging |
To-Do Functionality |
Provides a convenient communication mechanism between Providers, Practice users, and billing office users |
Easy access to both To Do items and Inter-Office messages and viewable on the front screen of the application |
Pending tasks are flagged for user attention |
Ability to view or monitor the status of the assigned To Do items |
The ability for users to reply, forward, or delete Inter Office messages |
20. Claims Workbench
Single, comprehensive Dashboard with an easy tabbed interface for batching, submitting, printing claims, and printing batch log reports |
Flexible filters on batching, submission, and print/reprint screens |
Pending batches/ claims are listed in a separate tab for quick access |
New paper and electronic separately listed for easy review and print |
One click direct batch upload to clearinghouse |
Automated/Scheduled batching and submission available to select clearinghouses |
Ability to void or hold both electronic and paper claims |
Quick & convenient access to the clearinghouse portal for claims tracking |
Single report to track claim submission status |
Paper claims can be exported to either a lined or an unlined format, or Print image format |
Easy adjustment to align claim forms |
21. Payment Posting – Manual
Easy payment posting screen with the look and feel of an EOB |
The payment log screen shows the posted payment on the current check |
Quick and easy payment entry |
Complete line history of the entire activity on that line available on the same screen |
View patient balance information while posting insurance payment at line level |
Convenient access to posting screen from Scheduler, Charge Entry and Payment screens |
Ability to default information to posting screen field(s) from payment header for quick posting |
Auto transfer to next responsible party based on patient insurance |
Easy to reverse or refund payments |
Easy to capture withhold, overpayment etc. |
Click to access payment history at line level |
Quick options for adding notes, patient statement remarks, denials entry, COB claims |
Quick access to the charge screen |
Flagging of underpayments and denials with follow-up action. This action gets transferred to the Collections Workbench for collector follow-up |
Ability to add multiple adjustments and reasons |
Validations are in place to prevent manual posting errors. Option to force an override of the posting validations whenever necessary |
22. Bulk Patient Payment Posting
Post multiple patient payments in one stroke, save time, no need to post individual payments |
Simple and easy interface with one click listing of patient lines and posting |
Quick options for adding notes and remarks |
Easy access to view detailed charge information |
23. Payment Posting – ERA
User friendly! Posting screen resembles the look and feel of an EOB |
ERA auto-post facility available |
With one click, download ERAs from the clearing house |
Upload external ERAs |
Save posted ERAs for future reference |
Fully functional, robust, and flexible auto-post. Multiple manual overrides to handle unusual exceptions |
Segregate Processed and Unprocessed ERAs |
Comprehensive information on the ERA screen includes payment information and denial remarks |
Filters to exclude closed lines, duplicate claims, and prior posted claim lines |
Option to export ERA data to a spreadsheet or print to PDF |
Flag all the matched and unmatched claims and their totals |
Ability to select and exclude claims for posting |
Ability to make any manual overrides on the posting screen |
Medicare auto-forwarded claims are auto-flagged as COB |
Auto-flags unpaid/denied claims on the posting screen |
Auto-post denials |
Instant reconciliation report to review posted and unposted items. |
24. Aging Claims Reporting
Aged claims reporting: |
– Insurance: Detailed and Summary |
– Patient Detailed and Summary |
– Aging by Financial Class – Aging by Provider |
Running AR Report: Build an AR snapshot at any point in time in the history |
Aging by Location or Legal Entity |
Aging by location-specific provider. A provider that sees patients at two different locations. |
25. Collections Workbench
Unique and powerful follow-up management features |
26. Follow Up Management
Work Queue Assignments-Configure workflow assignment to user groups. |
–Clearly defined work allocation with time expiration based on the configured assignments. |
–Work automation – no human intervention is required for the daily provisioning of work. |
One-click to resubmit one claim or multiple claims for the same error/category |
Eliminates paper tracking of unpaid claims; comprehensive workbench for managing all unpaid claims |
Robust and flexible filters to list outstanding claims |
All pertinent information necessary to complete a follow-up with insurance payers on one single-screen |
Claims grouped by insurance or denial codes |
Add follow-up notes that are accessible from the charge management screens |
Ability to add reminders for outstanding claims to be followed up later |
Ability to assign a follow-up task to users that can be seen on their To-Do screen when they login |
Move worked claims to appropriate status or sub-status |
Ability to customize status and sub-status lists from lookups to effectively manage or organize followed-up claims |
Easy access to Patient demographics, detailed charge information, Patient’s insurance and Case |
Ability to export all outstanding claims in the workbench to a spreadsheet |
27. Denials Management
ERA auto-posts denials and under-payments |
For manual EOB/payment, enter $0 payments with 5010 compliant denial codes |
Run Denial Reports |
Denials get posted to collectors in Collections/Follow-up workbench |
Complete end-to-end workflow to track follow-up and collection activities |
Run Reimbursement Analysis Report to compare under payments against contract schedule |
Small balances can be written off or adjusted through Mass Adjustment Module with custom-defined or pre-defined adjustment codes |
28. Write Off Management
Predefined and custom-defined write-off types |
Standard contractual v/s other write offs are entered and tracked separately |
Write-offs at line level for granular tracking |
Write-off reporting (Detailed and Summary) |
Capitated HMO claims are written off automatically after successful submission |
29. Statement Management
Generate Statements using robust and flexible criteria |
Unique identifier for each statement |
Easy access to snapshots of each statement |
Complete Statement History with details |
Print patient friendly statements |
Easy access to statement history |
Print statement from Scheduler or Patient Ledger |
Easy access to Last Statement Date and Last Payment date from Ledger |
Print Statement by Guarantor (Individual/Entity) |
Search and Post Patient Payments by Statement #number |
Complete audit trail on statements –View, Export and Print |
Multiple print formats to choose from |
30. Pre-collections Management
Ability to transfer patients to Pre-Collection status |
Ability to generate Pre-collections Letters |
Pre-Collection patients are excluded from statements cycle |
Easy access to view and print patients in Pre-Collections status |
Downloadable format for third-party printing |
Configure alerts easily |
31. Third Party Statement Support
Print statements in-house. |
Let us manage your statements at $0.74 ea. plus postage |
Outsource to a service of your choosing |
Customizable downloadable format for third-party printing |
32. Installments/Payment Plan Management
Facility for recurring installments by auto charging credit cards |
Easily schedule patient payment plans |
Easy access to View/Print payment plan activities |
Easy access to print letters to patient on payment plan screen |
Patients on Payment Plan are excluded from statements cycle |
List / View all Patients added to the Payment Plan |
Print/View payment plan details |
33. Month End Close
Flexible Soft and Hard Close Options—with the ability for the administrator to re-open if needed |
Flexible Accounting Date |
Flexible Month-end Closes Close charges yet post payments. Restrict activities by function in previous, current, or future periods (Months, Weeks, Days) |
34. Reconciliation
Unique Realtime Reconciliation Report shows 360 snapshot of all Transactions. 7 different Excel reports in one click. |
Reconcile in a Single Excel Workbook, |
– Review: Charges, payments, write-offs, adjustments, open charges, unapplied payments, posted payments |
– Reconcile by user, provider, legal entity, location, and payer |
Reconcile Unbilled Superbills: Easily identify unbilled superbills |
Reconcile Superbills on Hold: Flag Superbills/Charges as Hold with comments |
35. Financial Reporting
Complete Report Package: |
– Revenue |
– Receivables |
– Aged A/R |
– Visits |
– Procedures |
– Providers |
– Locations |
– Legal Entities |
– Payer |
– Patient |
– Denials |
– Reimbursement |
Net Change Reporting Model: Easy review of net activity |
36. Real-time KPI Dashboard
Single Screen Dashboard with many invaluable Key Performance Indicators; for your business and for your practice’s |
View Dashboard by Legal Entity, Payer, Provider |
View by Month to Date, Quarter to Date, Year-to-Date |
View summary by User: Easily monitor user productivity at the click of a button! |
Charges Summary: |
– Posted |
– Entered but not billed |
– Unbilled |
– Last Date Billed on (Charge entry backlog) |
Payments Summary: |
– Summary deposit by Insurance, by Patient. |
– Track collected by Practice v/s billing company. Payments made at practices through statements are tracked separately |
– Last Payment posted date (Payment posting backlog) |
Aging Summary: |
– Quick one-screen view of aging by Bucket |
Adjustments Summary: |
– Write Offs |
– Refunds |
– Visit Summary |
– New Patients |
– Established Patients |
– Capitated HMOs |
– Outside Visits |
– Older claims resubmitted |
– Charges submitted 15 and 30 days past DOS |
37. Reimbursement Manager
Unlimited fee schedules |
Flexible and robust fee master |
Setup Billed Amount, Allowed Amount, and Paid Amount |
Analyze reimbursement variance |
Setup fee schedule by: |
– Payers, or Group of Payers |
– Self-Pay |
– Standard Fee Schedule |
– Medicare / Medicaid Fee Schedule |
– Any other type of services |
Track fee schedule by any date range. Never lose historical reimbursement information |
Ability to make any line on the fee schedule Active/Inactive with Effective End-Date |
38. Clearinghouses
Keep your clearinghouse. Avoid the nightmare of switching between clearing houses |
Partner with our clearinghouse– RelayHealth |
High volume, aggressive clearinghouse pricing available |
Seamless transition from current clearinghouse to one of our partnered clearinghouses |
Send commercial claims within 72 hrs. of enrollment |
Dedicated enrollment support staff to assist at different stages of the enrollment process |
One of the industry’s largest payer list |
EDI portal provides easy search of payers and their payer IDs. Full payer list available inside our software |
Easy access to the clearinghouse portal from our application |
Simple and intuitive screens for claims tracking and listing electronic remits |
Ability to send Worker Comp Claims electronically and attach documents to the WC claims |
All unresolved claim issues past 72 hours are escalated to the personal attention of our CEO |
39. Capitated HMOs
Setup Payers as Capitated HMOs |
Setup custom fee schedule for single/group of payers as Capitated |
Submit electronic patient visit and claim information to Capitated Payers |
System automatically writes off all Capitated charges upon claim submission |
40. Easy Customization of Lookups
User define system wide drop down values (Except system controlled ones) |
Identify a unique code to each lookup values |
Control if the new codes can be edited or inactivated by users |
No DELETE. Maintain code as Active or Inactive Code or by effective end date |
41. Custom Letters
Flexible with predefined variables have the flexibility of Microsoft Mail Merge |
Group letter by types such as for – Collections/Pre-Collections/Appointment Reminders |
Generate multiple letters from patients |
42. Employee Productivity Time Card
Easy access to check in and check out options |
Independent employee time clock options for accurate reporting |
Access to Employee time card report for payroll, user system usage and productivity |
43. Interface to Accounting Systems
Completely customizable sub-ledger details |
Setup charges, payments, adjustment, A/R by accounting codes |
Setup payers, payer-type by accounting codes |
Setup providers, legal entity, financial class by accounting codes |
Detailed Sub-ledger Reporting |
Summarized Sub-ledger Reporting |
Create CSV format data dump to suit the accounting system of your choice! |
44. User Security & Segregation
45. Customer Service
Unmatched Customer Service! |
Platinum Support: Email, Instant Chat, Plus Unlimited Phone. |
Smart Phone Support |
Customer Request Tracking Portal – Real-Time Access to your support requests |
Instant Customer Satisfaction Survey |
Open Claims Issues over 48 hours are directly escalated to the CEO |
Frequency Asked Questions Diary |
Comprehensive Step-by-Step Online Video Training |
Strong Online Documentation |
Frequent releases of new features recommended by customers |
46. Access to Your Data
You are 100% owner of your data as PracticeSuite is a mere custodian of your data |
We provide data dump to slice and dice or to do analysis on your data |
Your data is safeguarded, backed and managed by professionals |
Data is stored on industry’s most robust and enterprise class database- Oracle 11g database |
We access your data to provide services to you and to improve our software usage |
A full data dump in a CSV format and a readable format is made available to client in the unfortunate event of a separation |
47. ICD10 Features
ICD9, ICD10 Dual Mode Billing Software |
Print New ICD10 Dual Mode CMS 1500 Claim Form |
ICD10: Code up to 12 Diagnoses |
Instant ICD10 lookup for ICD9 codes (GEM Crossover) |
ICD10 Claim Validator1 |
ICD10 Super-Bill Convertor3 |
48. Billing Office: Enterprise Edition Key Features
Manage Multiple Cases: Self-Pay, PI, WC, and MVA |
Connectivity to National Payer Base of Over 1500 Payers |
Instant Repeat Billing |
File Unlimited Electronic Commercial Claims |
Print Secondary Paper Claims |
Single Insurance Contract / Fee Schedule |
Charges on Hold (Charges Queued But That Require Attention) |
Aging Claims Sorted by Insurance |
Aging Receivables by Patient |
Payment & Adjustment Posting |