Medical Billing Software: Key Capabilities, Top Vendors, and Selection Tips lyrics



Timely payments from customers are the fuel that keeps any business going. Healthcare providers are no exception, but in their case getting paid is a long multi-step journey with numerous regulations and players involved. While hospitals can't make this way shorter, they may make it faster — by automating billing operations
In our article about EHR systems, we described several options with the integrated billing module. This time we’ll review separate solutions that focus on medical billing
Whether you are a physician running your practice, a hospital executive, or a medical billing company representative, this review will help you investigate the capabilities of available medical billing software and choose the best option to boost the speed of your cash flow
Medical billing and healthcare revenue cycle management
Taking good care of patients is only a part of the healthcare puzzle. To run a successful medical practice, providers need to tame the financial beast called RCM, or revenue cycle management.MedsDental is a renowned Dental Billing Company in the united states, equipped with revenue cycle experts who are highly proficient in delivering fast and error-free billing services to dental practices by using cutting-edge technology

The medical billing system is a vital part of the revenue cycle
The revenue cycle can be described as the financial circulatory system of a healthcare organization. It comprises both clinical and administrative functions that aim at capturing, managing, and collecting patient service revenue

Read More: MedsIT Nexus

The cycle starts from the creation of a patient's account, then goes all way through providing medical services and submitting claims to the endpoint where care providers receive payments either from a patient or through an insurance carrier. The management of this complex system is referred to as healthcare revenue cycle management
Medical billing is an integral part of the healthcare revenue cycle that consists of getting a healthcare provider paid for their services. This process begins before the services are even provided, and encompasses several important steps

Managing the billing process accurately is not easy as providers might face hurdles in revenue cycle management. Moreover, Net Collection Rate below 95% shows that your practice is facing troubles in the billing process. To eliminate all these hurdles and maintain your NCR up to 96%, MedsIT Nexus Medical Coding Services are around the corner for you so that your practice does not have to face a loss

Medical billing workflow
Patient insurance validation verifies whether a patient's insurance coverage is valid. The procedure is usually done by administrators at the front desk before scheduling an appointment with a doctor. A healthcare facility also collects demographic information about a patient including their medical history with diagnoses, frequency of appointments with physicians, previous charges, charge-sheets, etc
Charge capture records rendered medical services and charges. It is usually performed by doctors or other healthcare providers
Medical coding converts medical services, treatment procedures, diagnoses, and prescriptions into standard healthcare codes. The codes must be assigned accurately per Current Procedure Terminology (CPT), International Classification of Diseases (ICD-10), and Healthcare Common Procedure Coding System (HCPCS) standards
Claims submission is the auditing and submitting of billable fees to the insurance companies for reimbursement
Accounts receivable or A/R follow-up ensures that healthcare providers will be able to recover overdue payments. Simply put, accounts receivable represents money patients owe to a hospital for services provided. The A/R follow-up involves keeping track of denied claims, checking partial payments, re-filing claims, and other important operations
Denial management is about tracking common denial reason codes. It reveals billing, registration, and medical coding process weaknesses. The problems are then solved to cut down on future denials and ensure the acceptance of claims the first time
Remittance processing means the inspection of payments resulting from a bill for rendered medical services to regulate whether the payments should be accepted or denied
Third-party follow-up includes collecting payments from third-party payers. The step is crucial as organizations can only bill Medicaid or Medicare after they tried other options
Patient collections gather all the copays and non-covered charges from patients in case a bill for healthcare services is covered only partially by insurance
Reporting and data analysis aims at improving the financial operations of a healthcare facility by extracting insights from data
If done manually, these steps require a lot of time, paperwork, and human resources increasing operational costs. Besides that, the higher probability of errors in coding and claims leads to increased payment denials and affects an organization’s cash flow
To deal with these challenges and streamline the entire process, providers need efficient medical billing software
Key modules of medical billing software programs
Medical billing software automates almost every part of the healthcare billing workflow from scheduling a doctor's appointment to processing electronic payments. We've singled out the core components and capabilities a medical billing app needs for effective work
The checklist of key medical billing app modules
Appointment scheduling and management. Convenient patient scheduling connected to your billing simplifies the management of all appointments as it takes only a few clicks to check previous visits, no-shows, cancellations, and planned encounters

Appointment scheduler dashboard. Source: AdvancedMD
Patient pre-registration. Some patients might be unaware of their current insurance status, so it is always a good idea to have suitable functionality to do the pre-registration check-up. Insurance eligibility validation before scheduling an appointment saves time and reduces claims denials
Medical coding support. No matter how great your employees are at medical coding, there's still a decent chance of making a mistake when data is entered manually. The algorithms of some billing programs can scan medical coding for errors and flag whatever needs to be reviewed. In this way, coders make fewer mistakes, increasing the ratio of claims accepted on their first submission

Claims denial analysis dashboard. Source: DrChrono
Electronic medical claim management. Smart claim management is half the success of your medical center. With advanced software, you will be able to implement electronic claim processing, including submitting and tracking your medical claims, checking their status and history, and much more
Remittance management. Medical billing software is worth your attention only if it provides electronic remittance functionality. In this way, you will have the capacity of importing and tracking information about all the payments rendered
Payment reminders. Notifying your patients about overdue or upcoming payments electronically is a must-have feature of medical billing software
BI and reporting. By opting for advanced and user-friendly billing software with BI or business intelligence tools and reporting features, you will get access to a wide array of useful insights such as financial reports, patient history, practice reports, etc

Medical billing software tab with reports. Source: Kareo
Questions to ask before picking medical billing software
You need to make sure that the solution you consider fits your practice. We suggest that you find answers to the following questions before deciding to go with one or another vendor

Questions to ask at the pre-decision phase
Is it HIPAA-compliant?
As all medical establishments are subject to the Healthcare Insurance Portability and Accountability Act (HIPAA), taking care of data security compliance has to be a top priority. Under US law, medical software must be HIPAA-compliant, but it's always a good idea to double-check a provider you pick
Is the learning curve steep or low?
Purchasing a medical billing software program is only half the deal. Its efficiency largely depends on the ability of your staff to use the functionality to the fullest. This, in turn, relies on the learning curve. Whereas some applications have pretty straightforward and intuitive interfaces, others need to be examined thoroughly to explore their full potential. Before you pick a solution, find out if the learning curve is steep or light. Some vendors offer useful guides and video tutorials that explain how to work with their automated billing services
Is it compatible with your EHR system?
In case you already have an EMR or EHR (and/or other practice management software) in place, reach out to your EHR vendor first to find out if they offer medical billing services as it is the best way to get smooth integration. Otherwise, make sure that the chosen application is compatible with your existing IT infrastructure and what it will take to connect your new app with other pieces of software to achieve interoperability. You may need to find a third-party tech provider to solve integration problems
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