1. Enterprise RCM Feature Highlights
Cross Practice Single Screen Multi-Practice Dashboard with financial KPIs
Single Sign-on Master Login
Practice Messaging
Document Manager: Manage superbills, EOBs and other documents in a robust, workflow-based, secure tracking system
Financial Reporting Package: Reports designed to make RCM companies shine!
Scanned documents
– Assign tickets to staff to monitor, communicate with client, or other staff
– Maintains a complete step-by-step audit trail
– Monitor open tickets and effectively manage office workload
Real-time User Productivity Monitoring and Reporting
2. Complex Billing Scenarios
Setup multiple legal entities each with its own Group NPI and Tax ID
Multiple locations, Multiple Providers, Multiple Specialties each with its own Group NPI/NPI and Tax ID
Setup Group NPI 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/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
Predefine Appointment time slots: e.g. 30 Minutes for new patient, 15 minutes for follow-up, etc.
Built-in Eligibility Verification
Single click option to view weekly or daily schedule
Search patient appointments
Multiple appointments on 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 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-providers 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 required as customers can use their current email host settings to setup 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
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. Stage III Certified EHR
Stage 3 ONC-ATCB 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
Easy to learn and adopt
Easily modify Encounter Sheets and Forms
Using the EHR resembles paper charting
An intuitive and user friendly EHR charting tool- Non template driven charting
Document multi-condition, multi-problem visits without templates
No proliferation of windows (Single screen design)
Click, Dictate, type or hand-write in the same data box
No annoying text boxes, radio buttons, drop down lists
Easy to personalize on-the-fly. Mold the system to flow like you want.
16. Online Patient Portal
Secure. 256 bits encrypted. HIPAA Compliant
Fully integrated portal seamlessly integrates with scheduling, billing, EHR
Online Patient Registration with ability to enter insurance data
Appointment request 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, patient education
Online EHR Self Assessment form. Easy to customize form auto populates subjective patient notes into EHR
Patient balances 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 encounter with compliance flags
Exception and compliance ratings
Physician Quality Reporting System (PQRS)
Clinical Decision Support System (CDSS)
Evaluation Management Coding (E&M coding)
ePrescribing through +71,000 pharmacies nationwide
Computerized physician order entry (CPOE)
19. Inter-Office Messaging
Inter Office messaging and To-Do Functionality by Users
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/monitor the status of the assigned To Do items
Ability for users to reply, forward or delete the Inter Office messages
20. Claims Workbench
Single, comprehensive Dashboard with easy tabbed interface for batching, submitting, printing claims, and printing batch log reports
Flexible filters on batching, submission, print/reprint screens
Pending batches/ claims 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 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
Payment log screen shows the posted payment on the current check
Quick and easy payment entry
Complete line history of 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/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 charge screen
Flagging of under-payments and denials with follow-up action. This action gets transferred to Collections Workbench for collector follow up
Ability to add multiple adjustments and reasons
Validations in place to prevent manual posting errors. Option to force 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
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
Flags 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 posts 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 /Legal Entity
Aging by location specific provider. A provider that sees patients at two different location.
25. Collections Workbench
Unique and powerful follow-up management features
26. Follow Up Management
Define payer threshold for unpaid claims to push to collector’s queue for follow-up
Simple, intuitive single screen for insurance follow-up
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 collections 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
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 clearing house. Avoid the nightmare of switching between clearing houses
Partner with our clearing house– 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
Define User Types
Define menu level access by users. Restrict access by users
Easily add/remove user access level. Maintain complete audit trial.
Restrict access to users during certain day and certain hour
Restrict access from a specific location. Prevent employees accessing application outside of work
Restrict access to clinical charts of certain patient. Patient that are relatives of employees should not have access to relative’s medical record.
Allow security override in emergency.
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