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 |
| 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 | |||||||||||||||||||||
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 |
| 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 |