Practice management software is the business side of a clinic's record: the appointment book, the billing, the payments and the reports on how the clinic is doing. It is often shortened to PM, or PMS. It is usually sold together with the clinic's ambulatory EHR, so that the two share one list of patients. Most such products are sold to private practices in the United States. A practice is a clinic owned by one doctor or a small group of doctors.
The EHR holds the clinical side: what is wrong with the patient, and what the doctor did. Practice management software holds the business side: when the patient comes, who pays, and how much.
Billing in the United States is complicated, because most visits are paid partly by an insurer and partly by the patient. Each insurer has agreed a fixed price with the clinic for each kind of visit. This price is called the allowed amount. The patient pays a fixed part at the visit, called a co-pay. The insurer pays the rest of the allowed amount. If the clinic has signed a contract with that insurer, it cannot charge the patient the difference between its own price and the allowed amount.
Here is how one visit is billed at a skin clinic in Florida. A patient comes for a 9:30 a.m. appointment about a rash. At check-in, the software shows a co-pay of $40, and she pays it by card. The clinic's own price for this kind of visit is $180, and the software sends a claim for it to her insurer. Her insurer's allowed amount is $150. So the insurer pays $110: the $150 allowed amount minus her $40 co-pay. The software records the remaining $30 of the clinic's $180 price as a contract adjustment, money that the clinic agreed not to collect.
At the end of each day, the software reports how many patients came, how many did not turn up, and how much money was collected. Practice analytics tools go further. A dental practice can see, for instance, how many patients were told they need a crown but have not booked one.
The appointment book receives bookings from several places. Patients book through a doctor appointment booking app. Calls and texts are handled by a patient communication platform, which reads the same book. In a dental practice, the book also plans treatments that need equipment, such as clear aligners, which are made from a scan of the teeth, or crowns made in the dentist's office with dental CAD/CAM.
Larger practices hand the claims work to specialist software or billing firms, through revenue cycle management.