THE FUTURE OF

surgical booking

A Surgery Center Software Scheduling Solution That Does Everything Simply and Easily

Are you looking for a patient surgery scheduling solution specifically designed for surgery centers? If so, PreferredMD has the software scheduling solution that will automate your process.

Scheduling a patient for surgery requires the coordination of over 70 unique elements that need to be tracked and updated, right up to the day of surgery. As complex as scheduling a patient for surgery is, scheduling is typically done through email, fax and phone calls. If a necessary item is missed, like an authorization, PAT, or clearance, the procedure often must be canceled and rescheduled. This represents a significant inconvenience to the patient, and loss of income to the surgeon, staff and facility.

HIPAA Compliant Surgery Center Scheduling Software

PreferredMD Surgical Scheduling software is the first and only HIPAA Compliant Surgical Scheduling Software platform that fully automates the surgical scheduling software process. PreferredMD Surgical Scheduling software is based on intuitive digital forms and available on any device which will allow you to seamlessly communicate and collaborate between surgeon’s offices and multiple surgical facilities.

PreferredMD Surgical Scheduling software is easy to learn and use. It is a centralized location for all data pertinent to the procedure scheduling software; it comprehensively captures every required element and workflow task needed to schedule a patient for a surgical procedure. Because our surgery center scheduling software is fully digital and integrated, all information is immediately and simultaneously available to all stakeholders.

Features and Functions Unique to the PreferredMD Surgical Scheduling Software Platform:

Shared patient scheduling software forms that display updates and track changes in real-time. The built-in alert system dramatically reduces the potential for case cancellations. Easy patient communication accurately obtains and stores patient medical history, consents and all documentation including Covid guidelines and pre-op/post-op instructions.

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  • An integrated calendar can be used to auto-populate patient demographics. Customizable procedure templates can be created and selected to efficiently populate a surgical scheduling software form eliminating the need to create multiple photocopied templates. These features allow for a surgical scheduling software form to be created and shared with a facility within minutes on any smart device.
  • Real-time live chat professional support at any time. Every PreferredMD Surgical Scheduling software form has a recorded chat function. You never have to wait for information or answers. Everyone works more efficiently and effectively.
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  • An embedded change log on each form tracks any changes made to any fields and by which member of staff for complete transparency and accountability
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  • Customizable email and text alerts plus interactive messaging with patients. Now you can communicate with your patients using mobile devices to provide a level of patient care that has never been available until now. Fully integrated into the PreferredMD Surgical Scheduling software platform, these communication features are easy to set up and use immediately.
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  • Easiest and most comprehensive patient data capture – PreferredMD Surgical Scheduling software patient data forms are user-guided. They auto-populate with data from the integrated office scheduler. Requisite patient and surgical scheduling software data sets and workflows are baked in so that no details are ever overlooked. Your surgeon’s customized procedural templates can be archived and accessed easily. They are editable and configurable allowing cases with specific instructions or inclusions to be booked in minutes.
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  • Using the integrated calendar feature a surgical coordinator can drill down and review any of the pertinent information about the patient, physician or supporting resources. This feature integrates and presents every detail of the surgical procedure planning. Everyone involved in the process has access to the complete set of detailed information.
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  • Insurance Benefit Verification and Pre-Authorization Undoubtedly, Undoubtedly, verifying insurance eligibility and benefits verification is one of the most difficult and time-consuming tasks for both medical professionals and patients. PreferredMD streamlines this task and takes all the guess-work out of benefit verification and pre-authorization. Designed by medical benefit professionals with hundreds of years of experience, the PMD rule-based system can evaluate a patient’s In-Network and Out-of-network coverage and generate a report in minutes.
  • As part of the PreferredMD Surgical Scheduling software platform, physicians and surgeons can create a profile which allows patients to schedule appointments online directly from the physicians website. Patient demographics information can be seamlessly be imported into the surgical scheduling software form.
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One Streamlined System that Organizes Patient, Benefit, and Resource Information

HIPAA compliant, easy-to-use yet comprehensive, the PreferredMD platform accurately automates every aspect of the verification and workflow tasks necessary to authorize and schedule a surgical procedure. This level of accuracy and seamless integration ensures that clients get the best medical treatment and experience, facility resources are optimized, and profitability is maximized; the three pillars of a well-run surgical practice.

Surgery Center Patient Scheduling Solved!

With the addition of the PreferredMD Surgical Scheduling software Financial Projection Module your surgical facility can generate a real time estimation of the projected insurance payment (reimbursement) and patient responsibility within moments after the scheduling software form has been submitted. This built in, easy to use feature makes audit and analysis of your facility revenues easy for your financial team.

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Frequently Asked Question

How does an insurance company determine how much to reimburse an out-of-network Physician?
Benefits are determined by the out of network benefits of the plan. The reimbursement model varies from plan to plan with the highest reimbursement being the Physician's full billed reasonable and customary fee and the lowest being according to the Medicare fee schedule eg 110% of Medicare.
What does “out-of-network benefits” mean for the patient and the Physician?

Out of Network or OON is the terminology used for Physicians that choose not to participate in an insurance carrier’s network. When a Physician is contracted or In-Network, he or she is bound by the terms and conditions set forth by the insurance carrier. The in-network Physician agrees to accept the payment determined by the insurance carrier. The out of network Physician does not.

For the patient this means that the physician will submit their bill for services rendered to the insurance company and the insurance company will determine what part of that service cost is covered. The payment will be determined by one of the reimbursement schedules:

  • Usual and Customary
  • Reasonable and Customary
  • MNRP

As the insurance company will only pay part of the allowable amount, the remainder of the billed charges will be assigned to the deductible, coinsurance or not covered at all and may be subject to a balance bill.

What is a third party negotiation?
The reimbursement fee schedule for out of network claims differs to such an extent that health insurance companies frequently utilize another company such as data-site or multi-plan to negotiate a settlement for any given claim. This negotiation is based on the physician’s billed amount and the maximum amount an insurance company is willing to pay for the service. The goal of the 3 rd party negotiator is to settle the claim for a percentage of the billed amount. Once the negotiation is signed, the insurance usually pays the negotiated amount within 14 days and the physician makes no further claim to the patient. If a settlement is not reached, the claim is returned to the insurance company for further management.
What is Usual and Customary?
Usual and Customary (U&C) is the reimbursement model that insurance companies use to determine the allowable amount. This is arguably the highest value model and will result in the least out of pocket expense to the patient. It is determined by the data that has been collected by fairhealth.org which was initially set up to track billed amounts for services in distinct geographic regions. Fair health is freely accessible to patients and physicians.
What is Reasonable and Customary?
Reasonable and Customary (R&C) is the reimbursement model that insurance companies use to determine the allowable amount. The reimbursement level is anecdotally not as high as Usual and Customary (U&C) plans.Reasonable and Customary (R&C) is determined by the data that has been collected by fairhealth.org which was initially set up to track billed amounts for services in distinct geographic regions. Fair health is freely accessible to patients and physicians.
What does Medicare rated out-of-network benefits mean?
This is an out of network reimbursement model commonly referred to as MNRP. As the name suggests the medicare fee schedule is the schedule according to which physicians who are participating providers of medicare will be paid. It is this schedule which determines the amount an out-of-network claim pays the physician.
What is the allowable amount?
The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.” If your provider charges more than the plan's allowed amount, you may have to pay the difference.
What is an EOB?
An EOB or Explanation of Benefits is a written correspondence from health insurance companies to Physicians and patients. Claim details include but are not limited to: date of service, billed procedures, billed amount, paid amount and patient responsibility (i.e. deductibles, and coinsurances).
What is a deductible?
The deductible is how much you pay before your health insurance starts to cover a larger portion of your bills.
What is coinsurance?
Once your deductible is met, Coinsurance is typically a percentage of a medical charge that you pay, with the rest paid by your health insurance plan.
What is a balance bill?
A balance bill is issued to the patient by the Physician for the amount that the insurance company does not reimburse.When a provider bills you for the difference between the provider's charge and the allowed amount.
Why are the charges billed to the insurance company so high?
Insurance company reimbursements vary to a great degree from policy to policy. In many cases reimbursements are unreasonably low. The reimbursement usually does not cover even prorated basic costs such as: malpractice, supplies, equipment and modest basic overhead, much less the massive financial and time investment that most physicians have put into their education and training. For this reason billed charges are high for the potential of an occasional reimbursement in full which would go some way to offsetting the low fee paid out by other policies. This does not seem fair but is the reality in most practices.
Why does the insurance company send a check to the patient?
Insurance companies are not particularly keen on encouraging their customers to utilize their out of network benefits. In efforts to make the out of network experience cumbersome, they will sometimes process the claim payments directly to the patient and not the Physician.
How can I tell if a patient has a good health insurance policy?
There are many health insurance carriers. Each carrier has a variety of plans available in the healthcare market. An overall indicator of a good policy is comprehensive coverage with low out of pocket costs. Many plans are inclusive of wellness and preventive services. The highest ranking plans reimburse Physicians adequately, without exclusions, when using in and out of network coverage.
Why is the Surgeon I work for not in-network with any insurance carriers?
Highly specialized and notable physicians can choose to not participate in health insurance networks. Premier physicians render healthcare services that often exceed conventional practices. These physicians often do not receive adequate recognition or compensation for their services. For this reason, many choose to not participate in health insurance networks.
My patient is concerned that their insurance premium will go up if they use their health insurance.
This is a common belief, but not true. Many complex factors contribute to the ever-increasing insurance coverage premiums. Premiums will increase whether or not you use your coverage.
Does the patient have to pay the deductible in full before the insurance company contributes?
All patients are contractually obligated to pay their deductible in full. Deductibles need to be exhausted before the carrier starts to make payments toward eligible services.
How can my patient tell if there is a daily cap for their insurance reimbursement?
Most carriers provide online access to plan benefits and coverage limitations. They can find information on Daily Cap Limits here. They can also call the number on the back of their card, and speak with a representative in the benefits department, and tell them the type of procedure and place of service they wish to learn about.
My patient is frustrated that so many Physicians are not in-network, how should I explain this?
Many doctors believe in providing great care to their patients which involves spending the appropriate amount of time per case. That can limit the number of patients or cases they can accept. In order to be able do that, and cover their overhead, they have to generate enough income per case. That is not possible given the extremely low reimbursement of many insurance carriers. For this reason, many Physicians cannot afford to become in-network and choose to accept payment directly from the patient or on an out of network basis. For this reason patients have a much better choice of care when selecting out-of-network providers.
Will my patient’s insurance cover the cost of the surgical procedure?
If you are not already using PreferredMD’s Insurance Benefits Verification services, now might be the time to try us out! But, if you are not ready, you can instruct your patient to check their plan benefits documents, check for any exclusions, call the number on the back of their card and tell the representative what procedure they are considering. Some surgeries require prior authorization; in that case, the surgeon must obtain the authorization to ensure coverage. Always have them check with their carrier to be absolutely sure.
My patient is upset that they were reimbursed a very small amount for our Out of Network surgeon’s fee.
When a Physician submits an OON claim, the allowed amount is not easily determined at the time of claim processing. The insurance company may underpay the claim. It is the patient and the provider’s responsibility to speak to a claims specialist to review and reprocess the claim. This often results in an additional payment.
How long will it take for my patient to be reimbursed?
Claims processing timeframes vary from carrier to carrier. On average, an insurance company will complete processing a claim within 30-45 business days.
What does it mean to our patient that our Surgeon is Out of Network?
When an OON surgeon provides services, they will be utilizing your patient’s OON benefits. This means the claim will be subject to the OON deductible and coinsurances.
Our patient thinks we just sent them a very large bill?
Many patients mistake an EOB or explanation of benefits for a statement. An EOB is the carrier’s communication to the patient. Instruct your patient to call your office, or facility, and ask you what their responsibility is. Many Physicians may choose not to balance-bill their patients. It’s best for your patient to confirm their balance before making any payments.