PMA Practice Management Application
PMA Practice Management Application
What is a PMA – Practice Management Application
A PMA or Practice Management Application is generally a software package or system that automates aspects of the day-to-day running of a medical practice, dental practice, or healthcare provider practice.
Medical Data Capture
In a nutshell, the PMA would allow for the capture and retrieval of patient demographics, maintain lists of medical aids, sick funds, and other payers, perform billing and claiming tasks, and generate reports.
In South Africa, most PMA s are designed for small to medium-sized independent health care practices. Extensions of the application could also be used by third-party medical billing companies or bureau.
Medical IT Configuration
Practice Management Applications is often segmented to address the following market segments: stand alone desktop software, client-server or network software, or Internet or cloud-based software.
Stand alone desktop software is generally intended to be used only on one computer by one or a handful of staff members sharing access.
Client-server or networked software typically necessitates that the practice installs a file server which will serve as a central repository, while individual operator workstations contain client software that accesses the server. Client-server software’s is most efficient in the way in which multiple users can get to share the data and the workload. Though a major disadvantage could well be the cost of running the server.
Medical Software in the Cloud
Internet or cloud-based software is a relatively newer emergent breed of PMA. Such software eliminates the need for the practice to run their own server, and removes the worry about security and reliability. This, however, comes at a price: the patient data is stored off premises, which can be sometimes be a great security risk. Also, the practice will be at the mercy of the network. If the network is down, the PMA at the practice will be non-functional, and workflow severely disrupted.
Electronic Medical Records
Though not very common in South Africa, a PMA can be inter-operable with Electronic Medical Records (EMR) systems. While some information in a PMS and an EMR overlaps — for example, patient and medical aid data — in general the focus of an EMR system is augmenting the practice’s clinical matters, while PMA is focused on administrative and financial matters.
It is often necessary for health care practices to rope in different vendors to provide the EMR and PMA systems. The integration of the EMR and PMA software is considered one of the most challenging aspects of the medical practice management software implementation.
Software for Medical Practice
Most practice management applications provide for functionality that allows users to enter and track patients, send out medical aid claims and patient statements as part of the credit control process, process electronic claims via EDI, manage patient and medical aid payments, and generate reports for the administrative staff and management of the practice. Typically, using a PMA also involves keeping up to date large sets of data including lists of diagnosis (ICD 10) and procedures (tariff codes), lists of medical aids and network management companies, and much more.
The capture of patient demographics often starts when a new patient fills out a patient information or registration form. This information includes the patient’s name, address and contact information, date of birth, employer, dependents and medical aid information.
Practice staff typically captures this information directly into the PMA. There are some advanced PMAs may automatically verify the patient’s eligibility for receiving benefits with the medical aid using a standard electronic data interchange connection.
Billing, Claims and Statements
After a patient visit, the PMA is used to capture details of the encounter. Each charge usually corresponds to a particular tariff that was performed on the patient, and is usually associated with one or more diagnoses.
Most charges are entered using a code or codes from NHRPL or a medical aid issued subset. Each charge will typically have a fee associated with it.
The diagnoses are indicated using International Classification of Diseases (ICD 10) codes.
Provided the patient is a bona fide beneficiary of medical benefits at the time these services were provided, the charges are then sent out as medical aid claim. The process of sending charges may happen on paper, usually in accordance with a statutory defined format. This format includes the provider who performed the service, the patient, the services performed and the related diagnoses.
Electronic Claims Submission
Claims may also be sent out electronically using industry-standard electronic data interchange (EDI) standards.
In most cases, electronic claims are submitted using an automated software process, and the data transporting software will be provided by an EDI routing company (Mediswitch, Datamax, Healthbridge, etc.)
Some practice management application vendors will update ICD-10 and tariff codes in the practice software on an annual basis. Others again, may elect to leave it entirely up to medical practices.
While a number of medical aids have created methods for direct submission of electronic claims, in most cases practices use the services of an electronic claim clearinghouse EDI Vendors to submit their claims.
Such EDI Routing companies commonly maintain connections to a large number of payers, and make it easy for practices to submit claims to any of these payers. Instead of creating a connection to every payer, the practice or PMA vendor only needs to connect to the clearinghouse.
Once a claim is processed by the medical aid, some sort of a response is sent to the health care practice. This usually comes as a paper Remittance Advice or an Electronic Remittance Advice (ERA). These describe the actions that the medical aid took on each claim: amounts paid, denied, adjusted, etc.
In cases where a patient is not covered by a medical aid the practice will usually send out a paper patient statements. Practice management applications usually incorporate facilities for a practice to print and mail their own statements (or other correspondence), and may even contain a way to interface to third-party patient statement printing companies.
Almost invariably, the process of running a medical practice requires some measurement and evaluation, and the PMA usually incorporates reports that allows the user to extract detailed data on financial performance and patient financial histories. retaining a history of these reports allows one to analyse and hence control what is happening inside the practice on a non-clinical basis.