Medisoft Billing and RCM Support for Small Practices

What is CGM MEDISOFT, and who runs it?

CGM MEDISOFT is a practice management system from CompuGroup Medical (CGM) that handles scheduling, charge entry, claims, remittances and patient statements. CGM's page titles it "Practice Management and EHR". CGM's wider portfolio is on our CompuGroup Medical page.

CGM releases a new version every year, and v31 is the latest on its page. CGM's upgrade matrix says versions before v30 are no longer supported by the developer, so we ask your version first.

The v31 brochure says the Basic edition is being phased out. Advanced has full patient accounting and revenue cycle tools, MultiLink codes and an AR Tracker with AR status codes and tasks. Basic offered only limited versions of the first two.

CGM says MEDISOFT can interface with an EHR such as CGM APRIMA. See every EHR system we work in.

How do claims move from MEDISOFT to the clearinghouse and payer?

A procedure or MultiLink code on an appointment becomes a ready-to-post charge after check-out, and the claim then goes to a clearinghouse before the payer. CGM's brochure names eMEDIX as the only approved and fully supported clearinghouse for CGM MEDISOFT.

If your claims go out another way, we ask how it was approved and who supports it. CGM's matrix marks several features as available only with eMEDIX.

CGM's MEDISOFT page also opens with a banner asking if MEDISOFT PM users are impacted by Optum's EDI changes. If that applies to you, we ask which connection is live and whether files were held.

A professional claim is the electronic 837P, and the paper form behind it is the CMS-1500.

Which CMS-1500 items matter most when MEDISOFT builds a claim?

These are the items we check on a small-practice claim. The rules come from the CMS Claims Processing Manual, chapter 26, which gives Medicare's instructions. Commercial payers publish their own.

CGM's matrix lists an option to limit diagnosis pointers in Transaction Entry, which fits the 24E rule, and Transaction Entry Alerts that warn of date-sensitive entries such as outdated codes.

Definitions: place of service, modifier, NDC, NPI.

How does MEDISOFT catch charges that never became claims?

CGM's v31 adds Create Unprocessed Charges. It adds charges for every checked-out appointment at once, using each visit's Procedure and MultiLink codes, and flags anything it cannot process cleanly.

A visit with no charge never reaches a payer, so we run the same test as a routine check: compare checked-out appointments with charges entered, work the flagged items and watch charge lag. The brochure says MultiLink codes, which the function uses, are not in Basic.

CGM also lists a visual flag for patients with multiple open cases, which it says helps avoid mis-posted transactions. We confirm the case on a charge before posting.

How does MEDISOFT post ERA and 835 remittances?

Posting happens in Revenue Management, where CGM says v31 lets staff assign AR status codes and AR notes directly within an ERA. The brochure says updates save to the AR Tracker and the claim, and ERA codes can be mapped once to AR status codes.

A new preference checks patient responsibility lines when you post a secondary remit. The ERA carries the payer's adjustments as CARC and RARC codes, and we read every one rather than rely on the automatic check.

Unpaid and short-paid lines move to accounts receivable follow-up.

How do patient statements and payments work in MEDISOFT?

CGM's matrix lists statements through eMEDIX, including a QR code for online patient payment and improved delivery preferences. It marks fully integrated eMEDIX statements and CGM PAY, CGM's payment product, as priced separately.

The matrix also lists a write-off tool that sorts balances by responsible party. We separate insurance from patient balances before statements go out. See our patient billing page.

What access does a billing partner need in MEDISOFT?

We need a named user for each team member, created by you and limited to billing roles, after a BAA is signed.

Data protection is on our security page: HIPAA training and NDAs for all staff, encrypted automatic backups and a dedicated compliance officer.

What do we do inside MEDISOFT?

• Charge review against the visit, catching a missing diagnosis or modifier.
• Claim edits and submission through your clearinghouse, with claims sent within 24 hours of charge entry.
• ERA posting in Revenue Management, with each CARC read against the contract.
• Denial work queues, with denials worked within 48 hours.
• AR follow-up using the AR Tracker, by payer and age.
• Patient statements on balances left after insurance.

See professional medical billing.

Which MEDISOFT reports matter for denial and A/R tracking?

CGM's matrix lists an AR tracker for working AR balances, a financial KPI dashboard of charges, adjustments and payments year over year, and a patient encounters dashboard. We agree report names with you at setup.

What billing mistakes are common in MEDISOFT?

We attribute no defects to the vendor. These checks come from what CGM documents, plus general checks.

Which practices and specialties use MEDISOFT?

CGM's product page lists no specialties. See family medicine billing, internal medicine billing and pain management billing.

Similar systems: Crystal PM, Office Ally, CollaborateMD.

How we handle billing in MEDISOFT

We confirm your version, edition and clearinghouse connection, then take the queues you give us from named accounts under a signed BAA. Claims run through your clearinghouse. Scope and reporting are agreed with you at setup.

To talk through your setup, book a call. For the wider service, see revenue cycle management.