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Medical Billing Software

Medical Billing software manages patient billing and collections for the medical industry.

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Medical Billing Software Buyers Guide

Medical billing software assists healthcare facilities with patient billing and invoicing tasks. It helps users simplify billing-related workflows, manage accounts, bill patients for medical services, code claims, verify insurance coverage and process insurance claims, accept payments, generate financial reports, and track patient demographics such as contact and insurance information.

The benefits of medical billing software

  • Reduce billing errors: Medical billing involves a lot of treatment codes and medical terminologies that must be used correctly by medical staff, general staff, and accountants. A single mistake or incorrect information in a bill can lead to a denied claim for a patient and a legal issue for a practice. Medical billing software provides complete details for each code entered along with the costs associated with the treatment, so practices can ensure that billing and coding are accurate.
  • Cut down on administrative tasks: With the right medical billing software, doctors and their staff can cut down on time spent on administrative paperwork through streamlined workflows, giving them more time to spend with patients. This is especially relevant for smaller practices that do not have enough staff to handle both administrative workloads as well as patient care.
  • Stay compliant: Healthcare is an ever-changing industry, and so are regulations and compliance requirements. With medical billing software, practices can stay up-to-date on the latest regulations and comply with insurance company protocols when submitting claims for approvals.

Typical features of medical billing software

  • Payment processing: Collect and record payments received from patients or their insurance providers for medical treatment and services provided.
  • Invoice history: Create and maintain an organised record of all invoices and view detailed payment history by patient.
  • Patient eligibility checks: Verify insurance claims and cross-check patients' eligibility with their insurance provider.
  • Claims management: Organise claims and submit them to insurance companies for approval.
  • Code and charge entry: Assign billing codes and cost to all treatments and services.
  • Practice management: Manage key business aspects of a medical practice such as capturing patient demographics and scheduling appointments.
  • Remittance advice: Document details provided by insurance payers regarding payments, adjustments, denials, and/or any uncovered charges in a medical claim.

Considerations when purchasing medical billing software

  • Integration with EHR and practice management software: Practices cannot solely rely on billing software to operate efficiently. They also need an electronic health record (EHR) system and/or a fully-fledged practice management software to build a complete modern healthcare facility. If you're looking at independent medical billing software, it's important that your software integrates with other solutions in the medical software family. This will save you from re-entering clinical and patient data.
  • Software deployment method: Medical billing software comes in various deployment options: cloud-based, self-hosted, and hybrid. Each deployment model has its own benefits, drawbacks, and pricing model. Cloud-based medical billing software typically has a monthly subscription fee, while an on-premise deployment option has a larger upfront cost but can prove economical in the long run for larger businesses such as hospitals and multi-chain medical facilities.
  • Patient data security: Patients' medical records hold sensitive personal information. If you choose a cloud-hosted option, it is important to ensure your software will keep your data secure. Ask vendors how and where your clinical data will be stored, who will have access to clinical records, what security standards are used, what the backup policies are, and how long data is retained.
  • Computer-assisted coding (CAC): CAC is a refinement process that uses natural language processing to read medical prescriptions and charts and decode them into digital text formats. It has built-in ICD-10-PCS, ICD-10-CM and CPT codes databases that convert prescriptions into universally accepted codes that can be added to bills and sent to insurance providers for approval. This will bring medical practices onto uniform ground and eliminate billing errors due to incorrect coding. Considering the need for uniformity of codes across practices, most medical billing software will start offering built-in CAC functionality in their solution. Gartner predicts hospitals leveraging CAC in their medical billing process will realise an ROI of at least 20% higher than the others (full research available to Gartner clients).
  • Artificial intelligence and blockchain will revolutionise the billing process: Blockchain adoption is rising in many markets, and is expected to reach up to 5.5. billion by 2026 in the healthcare market. It can be a key technology behind securing medical records as well as improving the efficiency of data exchange between patients, practices, and insurance companies. Blockchain will make it easy to securely record patients' medical history and share it with other facilities. Insurance companies will leverage artificial intelligence (AI) to analyse large datasets of patients' medical records, their previous claims, codes used for billing, and other data points. This can help them generate business-relevant insights and establish a pattern between patients' medical condition, type of treatment provided, and the cost of treatment. Such insights can help insurance companies to highlight errors in claims or even detect fraudulent activities.