If you have an in-house medical billing system and the necessary staff to handle the workflow, using medical billing software can dramatically improve the productivity and revenue cycle of your practice. Software can help automate the labor-intensive parts of the medical billing process and considerably speed up time-consuming (and error-prone) tasks such as patient data entry, claims submission, and payment application.

There are many good software applications that are available on the market and choosing the right one can be a daunting task if you don’t know what to look for.

Below are some features to check for when doing your research:

Medical Codes

One of the biggest advantages of using billing software is that you can eliminate cumbersome paper manuals on coding. Medical billing software gives you and your staff the ability to quickly search and insert billing codes with the simple click of a mouse. This vastly simplifies the process of claims preparation.

It is important however, to ensure that the medical billing software comes with an exhaustive and updated list of CPT, ICD, and HSPCS codes with a reliable system for periodically updating this list. Most software companies provide annual updates that can be bought for a small fee and installed either through a disc or downloaded from an online location.

It is also advisable to test-run the software to check for ease of use. The software should ideally offer a simple graphical interface for creating claims with easy search options and point-and-click functionality for choosing codes from a list.

HIPAA compliance

Apart from improving efficiency and reducing the number of errors, medical billing software can also help your practice meet HIPAA regulations related to individual privacy and security of healthcare information. There are many tools employed by different software development companies to meet these regulations. While these tools may not make your practice 100% HIPAA compliant, they can make a significant contribution. Most good medical billing software applications have several or all of the following tools built in:

Data encryption – This ensures that any information transferred online is intelligible only to the authorized recipients. 128-bit encryption is considered the industry standard.

Multi-level user authentication – This includes measures such as password protection, role-based access to restricted areas of the software/database, and automatic (timed) log off in case a workstation has been idle for some time.

Audit trails – Audit trails are records of all system activities including login information, files accessed, changes made to patient data, etc. These records are crucial for internal security audits.

Scheduled backups – These are necessary to prevent data loss. Most medical billing software comes with scheduled backup systems that allow you to periodically download critical patient data onto your hard drive or other secure location.

Claims Management
Electronic claims transmission not only speeds up the payment cycle but also reduces the number of rejected claims. Medical billing applications come with several time & cost saving features that can help practices improve their claims management system.

Visual Editors
Visual editors allow users to create and edit insurance claims forms through a graphical interface. Users can quickly add notes, make changes and submit claims at the click of a mouse.

Error Correction
This feature helps in minimizing rejected claims by highlighting missing information, mismatched ICD/CPT codes, and invalid insurance policy numbers, etc. before a claim is submitted for processing. This is a big time-saver and naturally reduces the possibility of claims being declined due to incorrect/incomplete forms.

Claims Submission
Submitting claims electronically can save hours of labor, reduce the number of rejected claims, and also speed up claims processing. Some insurance companies delay paper claims to up to 28 days, while electronically submitted claims can take just 24-48 hours.

Depending on the medical billing product you choose, there are several methods available for submitting claims electronically. One option is to send all claims to a clearinghouse. The clearinghouse will then forward the claims to the appropriate insurance carriers. This may, however, turn out to be expensive because of the per claim fee charged by the clearinghouse. Costs can be reduced by submitting claims directly to Medicare and Medicaid and processing the remaining through a clearinghouse.

Another option is direct online billing at the websites of the insurance carriers. Although there are no additional fees involved in this method, you must be an in-network provider with the relevant carrier to be able to submit claims at the carrier’s website.

Revenue Management
Medical billing software can significantly improve the payment cycle of any practice. This is through the account receivable module that comes with most software applications. This module helps practices keep track of payments received and payments outstanding. The software application also helps with faster payment applications to specific claims/charges, tracking how much of a payment remains to be applied, reporting payments receivable, automatic calculation of the write-off amounts, tracking billing, and other activities for improving the A/R cycle.

When choosing medical billing software, it is advisable to look for applications that either have these accounting features built-in or allow for easy integration with external accounting software such as Quicken or Peachtree. It’s also a good idea to thoroughly test the software to see if it has all the features required for your particular practice.

Medical Scheduling
Many software packages come with medical appointment schedulers that allow for easy management of patient appointments. Multiple features such as making or editing appointments, viewing daily, weekly, monthly appointments, viewing relevant patient demographics along with appointment details, scheduling recurring/multiple appointments, etc., can make these schedulers very useful for busy practices.

Trial period and Training
Most medical billing software developers offer trial versions of their software. Some also include on-site training for staff members who handle billing for a practice. These features give you the opportunity to not only check if the software has all the features advertised but also to test the suitability of the application for your particular practice. The usual trial period is of 30 days and provides you ample time to thoroughly test the software.

Technical support
As with all software applications, you and your staff would need ongoing technical assistance for the correct use and maintenance of the medical billing software. It’s therefore important to choose a vendor who can provide the necessary installation, training, and technical support. Most vendors provide an initial period of free support and then monthly or annual paid services.

There are many other features that can be compared and considered when deciding on the perfect medical billing software for your practice – software applications are constantly evolving to include more and better functionalities – but keeping these basic features in mind can help you make a reasonable choice.

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