Your office's practice management system is more critical to your business success than ever, so it's worth the time to make sure you're fully versed on just what the system can do for you. It might also be worth a call to your vendor. It's likely you and your staff got initial training, but maybe everyone could use a refresher. Over time and with successive software updates, there may be treasures in your system that
got lost. Focus on functions that enable you to:

1. Set criteria properly.
Allscripts Inc. offers a built-in feature that allows a physician's office to preset group or certification number criteria--the number must be eight alpha-numeric digits, for example, using no 0s or 3s--specific to individual payers, says Debbie Williamson, director of sales in the West for Chicago-based Allscripts.

"If set up properly, the system will scrub claims up front to make sure they meet the criteria and go out the door the first time," Williamson says. And when a payer changes its number criteria, a screen in the software allows the physician's office to update everything simply and intuitively, she adds.

2. Fill out claims correctly the first time.
Watertown, Mass.-based athenahealth Inc. gives its software away and takes a cut of collected revenue as payment. Built from about 40 million different information requirements culled from various insurers' claims rules, the software doesn't allow a claim to go to CIGNA, say, unless all the claim form elements required by CIGNA are present, reports John Hallock, manager of public affairs and corporate communications.

It also prompts real-time updates when a patient is onsite. "Say the patient has switched jobs and has a new carrier," he explains. "The software will say to the office staff in real time, 'Stop now and get such-and-such additional information for the new claim form.'"

3. Track changes that insurers make.
"Say we see a denial pattern with a particular carrier," Hallock says. "We can find out what the story is and, if it relates to some kind of reimbursement policy change, our staffers will craft a new rule and fire it out to every doctor on the system that same day."

4. Stop insurance denials before they happen.
"You can reduce denials and improve payment times by running a batch eligibility check each evening on all patients scheduled for the following day," reports Rick Mullins, vice president at Sage Software in Tampa. "That ensures you have accurate information for each patient--and it gives you the opportunity to make necessary corrections prior to the patients arriving in the office."

5. Minimize the impact of the denials that slip in.
"The biggest headache for any practice is tracking and managing insurance denials," Mullins says. "Using automated denial tracking systems allows you to eliminate stacks of paper and hundreds of sticky notes. Those systems allow you to assign denials, forward them and monitor results automatically."

6. Minimize lost revenue due to scheduling.
Some systems can help when a patient can't schedule a three-month follow-up before leaving the office on the current visit. "I was in a 12-physician primary care practice recently where the scheduler didn't realize that if a patient elected not to schedule the follow-up appointment, the practice management system could attach a reminder to the file and generate a mail reminder each month," says Judy Capko of Capko & Co., a Thousand Oaks-based consultancy.

"The problem often lies in staff training," Capko says. "Usually, [system insights] are passed on from one user to another once a system has been implemented. After a few turnovers of a position, the user is likely to take advantage of less than 50 percent of the system's capabilities."

7. Fill in a wait list.
If you can avoid it, you don't want to lose any revenue on cancellations, so having an active wait list is essential. "Our system will allow you to easily put a patient on a wait list when he or she calls in for an appointment," Williamson says. "When you enter a cancellation, the screen can pop over to the wait list and tell you how to contact the first patient who asked for that time slot if it became available."

8. Maximize coding.
"Physicians typically only look at month-end reports of charges, receipts and adjustments and, perhaps, the aged receivable analysis," Capko says. "That's a good starting point, but how about checking out your evaluation and management coding practices?" It only takes a short time to run those reports and examine trends, she notes. "I was recently at a practice where all the initial consultations were high-level codes and the return visits were minimal codes," she says. "That was an irregular pattern that suggested they needed to review how the doctors were coding visits."

Physicians and staff need to stop thinking of practice management systems as tools for billing and scheduling only, Capko emphasizes. "There is a lot of power in practice management systems," she says. "They hold a lot of data that can help you manage both the business side of your practice and your patient care. The opportunities to use those systems are limited only by your desire and your imagination."