Research EHR and Practice Management Software. What are the features for each? What are the ...

Research EHR and Practice Management Software.

Practice management software is one among a variety of healthcare software that is primarily concerned with the daily operations by allowing users to schedule appointments, generate reports, perform billing tasks, keep insurance payors and get data relating to patients demographics. Electronic Health System is mainly an electronic form of patient’s medical history under the care and maintenance of the provider at the time. (EHR) includes medications, problems, notes on the patient’s progress and the patient’s demographic. Offices require the two systems since EHR records patient’s data while practice management software handles the day to day operations.

Explanation of Benefits

The Preferred Provider Organization (PPO) model allows individuals the benefit of not needing to have a primary care physician. Any healthcare professional inside or outside your network can be visited.  Moving outside your network carries higher out of pocket costs compared to the smaller copays when staying within your network. The health maintenance organization (HMO) enables individuals to choose a primary care physician who handles all their healthcare related services. A referral is required for one to see another professional healthcare provider except in the case of an emergency.  Insurance does not cover any professional healthcare outside your network. This system ensures general lower healthcare costs and less paperwork.

The managed care scheme refers to healthcare payment system which mainly endeavor to contain the costs by regulating the level and type of healthcare services. This is done by emphasizing on the preventive aspects and early intervention rather than critical care after an illness. Subscribers pre-certify specific treatments, procedures and costs afore the insurance declaring them covered.  Individuals get specialized referrals from their primary care physicians selected during enrollment. Network providers are guided on the testing, prescription, and care administration by guidelines to ensure unnecessary costs are prevented.
In choosing a healthcare provider, patients need to factor in the cost of the various schemes, networks that their specialists and primary care physicians are in, the nature of the prescription coverage, where the care will be received and the quality of the care.

Fraudulent Practices Research

1.   Billing patients for health care services or procedures they never received.
2.   Billing the patient for more services than they received.
3.   Double charging by submitting a double claim to an insurance provider.
4.   Service unbundling where procedures are separated and billed separately producing a higher invoice.
5.   Self-referrals where a physician may encourage a test they themselves will perform and get compensated.