A Good Medical Billing Software for Billing Service Companies

With an ideal Medical Billing Software, the medical billing companies can accomplish more accurate and profitable results on their billing. The Ideal software for outsourced billing companies should have features that can control the billing workflow, accuracy, security, fewer claims denial and is easy to manage the claim life cycle. The speed and efficiency of billing software should reduce costs and increase cash flow. The solution should have the capability to provide necessary data that show the current billing status to practice/clients at any given point of time.

Most widely used billing software is Web-Based or Cloud-Based, wherein such software and its delivery model have a single pricing for all the features, support, and training. A Software should also have the flexibility and capabilities to connect with other applications (EHR & Clearinghouse) to streamline the billing workflow. The technology should also be beneficial to providers that outsourced their billing.

A Few features to be considered before selecting a Billing Software:

  • An Actionable Dash-Board: A Dashboard should display actionable data sets at a quick glance. This will help the billers to save lots of time and can plan the day ahead. Make sure that the software has various dashboards and it is manually configurable.
  • Track of Patient & Insurance Data: The Software should have a robust patient management module that can give the data that you need. You should be able to filter the data of patients with specific payers, locations, balance, transactions, and other patient date & transactions. A feature which is extensible to manage additional datasets would be an advantage too.
  • Seamless Insurance Eligibility Features: The expEDIum Software showed that over 15% of denials were related to the incorrect patient data and a patient not eligible for a service. So, such denials can be eliminated using eligibility verification feature.
  • Avoid Errors that Leads to Claim Denials & Rejections: A solution that has standard based (X12N EDI, HIPAA rules & regulations, any specialty specific rules, payer specific rules) edits which can identify any potential errors before claims being submitted to Payers, help to reduce the number of claims denial and rejection.
  • Managing Errors should be easy: The system should allow users to find any errors, rejections or denials and the reasons for such errors so that users can decide for the next steps without spending lots of time and calling to the payer to get the reasons.
  • Claims Life Cycle Management: Claim life cycle becomes more predictable with the frequent handling of claims. A good billing software should have a robust claim management module that shows every stage of claim life cycle clearly and can find any claim at any given point of time.
  • Automation is Everything: High volume billing companies need to automate the billing process as much as possible. So, a billing solution that has an open architecture that allows integration with other applications, an optimized UX and which support most of the standard HIPAA transactions electronically will provide an edge.
  • Data of Things (DOT): Data is everything. A good billing system should have the capabilities to extract any data that you need without depending on the software vendor, and you should be owning the data, not the software vendor.
  • Aggregation of Data: Billing Companies manage several practices/accounts. So, having a feature, or a module where the billing manager or CXOs can see the aggregated data of various accounts/clients in the system would be a no brainer.
  • Industry & Business Goals: Healthcare Industry is volatiles with new regulations, mandatory features & updates being imposed in times. Make sure to verify how the vendor handles such changes and any specific requirements of their current clients.
  • A Complete Billing Application: According to CAQH reports in 2016 shown around 94% of claims are processed electronically and remaining are manual (only standards claim forms). However, expEDIum Medical Billing Software (eMB) record shown 70% as electronic (standards 837P/I) and 30% are manual (standards UB-04 & HCFA-1500, non-standards forms, and self-pay billing) after analyzing over 2 million claims. Additionally, expEDIum Solution record shown over 15% claims was processed as secondary, hence, seamless secondary claims processing feature are critical. So, a good billing application should be equally focused on optimally managing both paper/manual and electronic claims. Again, such percentage could be different based on Locations or Specialties.
  • Bigger the Better: Finally, a billing software with more features and supports most of the HIPAA EDI transaction sets are better. Such solution has more shelf-life and you can start providing any additional services for a new revenue stream to your clients. A research report published by CAQH in 2016 shown there are 4.8 billion transactions in 2015. Out of this almost 50% goes as Insurance Eligibility transactions, 30% as claims and the third biggest item was claim status inquiry. Electronic Prior Authorization has increased to 18% (increased by 8% from 2014) and expecting to grow further. Electronic Prior-Authorization will be the next big items in the industry.


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