Medical Billing Software

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Behavioral health specific EHR which has been built from the ground up over the last 4.5 years with a software team of approximately 60. Inpatient, outpatient, substance abuse, mental health, psychiatry, Autism, IDD, case management, eRx including controlled substances, labs, portal, secure messaging, credit card integration, reminders, Dragon, key performance indicators and much more.

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DrChrono EHR

DrChrono brings the medical practice of the future to reality by enabling medical providers to be the best they can be. The company built the first iPad and iPhone EHR, and its EHR and medical billing platform is the most flexible and intuitive on the market. With it, you can manage all aspects of patient intake, clinical charting, billing, and revenue cycle management. The platform is cloud-based, mobile-driven, standards-supported, fully compliant, and highly awarded. DrChrono EHR includes customizable medical forms, e-prescribing, access to over 40,000 labs, robust scheduling tools, real-time patient eligibility checks, patient portal and more. The DrChrono App Directory also offers a multitude of apps that a practice can select from to bundle in and a medical API for healthcare app developers. With a 94% clean claim rate, DrChrono RCM services work to improve your practice profitability. We offer you consistent workflows, continuous monitoring of claims and a decrease to your administrative task, so you focus on patient care.Our team of dedicated billing experts, in-house coding compliance officers, and certified medical coders handle the complete lifecycle of your medical claims. The DrChrono EHR can be accessed from web, mobile, or iPad. Have all your information within arms reach at any time. Our fully customizable forms or prebuilt forms created for your specialty will increase your practice’s efficiency or use our pre-built forms that best fit your specialty. Any prescription including those of Electronic Prescribing Controlled Substances can be sent electronically on iPhone, iPad, or the web. Easily submit lab orders from your iPad or web to over 40k local labs around the United States and have the results uploaded directly into your patient’s chart. With our custom vitals, you can create baseline health data and monitor each patient’s health measurements over time.The patient personal health record app (PHR) and patient check-in apps guide patients through registration; at their next visit, they simply confirm their information with a tap.Use Free Draw function to easily annotate on diagrams, x-rays or other files. They can also use the iPad's built-in cameras to take pictures and embed them in the patient's record.Utilize our pre-populated billing codes to bill accurately and get paid much faster.We are integrated with Box, a HIPAA-compliant cloud storage system to allow you to sync and backup files easily between your EHR and the Cloud.

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PracticeSuite Medical Billing

Practice Managers and Medical Billing Company owners are consistently surprised by their PracticeSuite experience - great software at a great price! Tackle all aspects of revenue management from flexible appointment scheduling, to patient self-pay, to complicated insurance billing and denial management. Leverage advanced reporting and dashboards to monitor and improve financial performance.

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Centricity Practice Solutions

Centricity™ Practice Solution is a fully integrated Electronic Medical Record (EMR) and Practice Management solution designed to help you enhance the clinical and financial productivity of your ambulatory practice. Though designed to work as a single fully integrated unit, if desired, the modules may be used independently.

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Valant EHR Platform

Valant is a completely new platform built on modern technologies including an elastic and infinitely scalable data model, mobile app-inspired experience, and an on-demand ability to respond to change without additional investment in time, money, or training. Our platform isn’t an EHR, it’s the technology partner community mental health deserves.

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NueMD EHR

Decrease overhead and ensure profitability with our practice management and billing solutions. We are a partner for doctors and patients alike, so rely upon our dependable software and corporate commitment to customer service.

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Kareo Medical Billing Services

Kareo is a leading medical billing and technology program for an independent practice. With a variety of medical billing and practice marketing tools, this cloud-based software documents and assists clinical processes - from consultation to treatment and follow-up care.

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CareCloud Central

Modern, user-friendly practice management system, providing a complete solution for your practice’s administrative and financial needs – from scheduling and managing patient data through billing and reporting.

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AdvancedBilling™

Drive revenue with ease. AdvancedBilling features all the tools you need to manage your A/R and claims processes in one convenient database. The robust clearinghouse automates manual processes, auto-generated worklists improve productivity expedite reimbursements automatic claims scrubbing gets you an almost-100% first-pass claim acceptance rate. This software is just as powerful as what our 500+ billing service partners use.

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Modernizing Medicine's Healthcare IT Suite

Modernizing Medicine offers a specialty-specific EHR system and healthcare IT suite that includes practice management, analytics, revenue cycle management, patient kiosk and patient portal, plus telehealth and pathology (for dermatology practices). The suite of solutions is available for dermatology, ophthalmology, orthopedics, otolaryngology, urology, plastic surgery and pain medicine practices. A native iPad application includes built-in specialty-specific knowledge, an ICD-10 solution and a MIPS intelligence platform. Built by practicing physicians, Modernizing Medicine collects structured data and is prepared for value-based care under MACRA. The system’s adaptive learning engine can remember a provider’s specific preferences and physicians can actively select commonly used diagnoses, prescriptions and consent forms. Utilizing the Interactive Anatomical Atlas™ and Virtual Exam Room, physicians can tap and touch their way through an exam while facing their patients.EMA™ modmed® Dermatology modmed® Ophthalmology modmed® Orthopedics modmed® Otolaryngology modmed® Pain Management modmed® Plastic Surgery modmed® Urology Practice Management Revenue Cycle Management Analytics Pathology (dermatology only) modmed® Telehealth (dermatology only) modmed® Kiosk Patient Portal*Information relating to our EHR certification, including certain costs and limitations, can be found at www.modmed.com/costs-and-limitations.

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Interactant Revenue Cycle Management

Interactant Revenue Cycle Management (RCM) is a complete, end-to-end solution that simplifies the complex and time-consuming process of billing and tracking reimbursement for services provided. The Interactant RCM features a built-in “rules engine” that calculates net revenue and maintains payor-specific rules that will increase the accuracy and produce clean claims more timely. Interactant RCM helps providers eliminate errors and increase cash flow by identifying underpayments, decreasing denials, and generating clean claims. Bill with Greater Accuracy and Collect Payments Faster Interactant RCM is powerful enough to handle the most challenging and complex billing requirements and contracts. From Medicare to Medicaid, to the most complex payors, Interactant RCM’s contract management and rules engine allows you to define payor-specific variables and rates, regulations, edits, codes, form types, billing specifications, and reimbursement terms. Your staff enters contract variables once, submits claims, and works only on the exceptions. Payor rates are maintained at the charge level, which allows for real-time visibility into net revenue value. Overall, you’ll reduce your operational costs, avoid missing charges, reduce billing errors, decrease A/R days, and increase total revenue with Interactant RCM.

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HCS Interactant EMR

Interactant EMR is a robust, web-based electronic medical records solution that’s easy-to-use, offers unparalleled value in delivering improved quality and safety of care, and provides more accurate and comprehensive healthcare information electronically. It eases the burden of documentation, reduces medical errors, and promotes quality outcomes of care. Interactant EMR extends functionality and value beyond basic EMR including computerized physician order entry (CPOE), online medication administration records, and pharmacy integration. These capabilities lead to better coordinated care across disciplines. It helps verify medications and dosages for accurate dispensing, provides automatic alerts for drug interactions, and gives real-time mobile access to clinical information. Benefits Include: • Better coordinated care across disciplines • Integrated with other Interactant modules • Verification of medications and dosages for accurate dispensing • Automatic alerts for potentially dangerous drug interactions • Real-time web and mobile access to medical information for authorized staff

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Sevocity EHR

Whether you’re a solo family practice provider or a large specialty group, if you’re looking for a long-term, stable EHR company that gets to know and serve you and your practice, you’ve come to the right place. Sevocity and you will make a great fit.

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Azalea EHR/RCM

Azalea EHR is 2015 ONC certified and supports Promoting Interoperability (PI). Users can document SOAP notes, send orders and capture billing from a single screen. The HIPAA-compliant telehealth platform is fully integrated and enables real-time charting. Patient records can be accessed at home, in the practice or in the hospital. Azalea also offers a fully-integrated mobile application, appointment reminders and patient portal. A data integrity validation feature will check various field entries (such as date of birth, insurance, and address) and then notify users of inaccuracies. Designed for efficiency, the cloud-based infrastructure drives cost savings in hardware, speeds deployment and training time, and increases application availability. Azalea is suitable for community and rural health care settings, including multiple speciality practices.

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Praxis EMR

The philosophy behind the Praxis EMR electronic medical records platform is that no two doctor’s offices are alike, and EMR software needs to be customizable and versatile in order to support today's healthcare industry. By bringing this innovative approach to health record management, this EMR system is supporting healthcare providers in key ways. One way to describe the utility of Praxis EMR as a cloud-based EHR and EMR system is as a self-learning resource. By accumulating and presenting data, Praxis EMR can help doctors to look at real trends and establish the commonality of various kinds of presentations. By using this intuitive software, doctors can figure out how to most efficiently document common cases, and how to tackle the more rare cases that emerge in their offices.

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Call SelectHub for a free 15-minute selection analysis: 1-855-850-3850

athenaCollector

Conventional medical billing systems give you just software. athenaCollector delivers more, combining our network of over 75,000 providers, our continuously updated rules engine, and our back-office teams working on your behalf. Our experts take on your most time-consuming tasks, like claim submission and follow-up, denial management, payment posting and more, getting practices paid 6% more, and 32% faster.1 By working at massive scale for our 72,000+ clients, athenahealth drives results with unparalleled accuracy and efficiency. It’s part of our proven approach.

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Intergy EHR

Intergy EHR, a product created in conjunction with Greenway Health, is an EHR system designed to be assistive to medical practices – it’s engineered to help clinical processes along, not hinder the work of clinicians or documenting staff. In multiple areas of practice administration, offices can utilize aspects of this cloud-based EHR platform to make workflows flow more smoothly and to free up time for doctors to focus on quality patient care.

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eClinicalWorks EHR/PM

A versatile electronic medical record software tool helps medical provider offices to streamline clinical workflows and work efficiently in a high-stakes, high-pressure field. eClinicalWorks EHR/PM is made to accomplish key objectives in healthcare: its cloud-based EHR design assures doctors and others of competent medical billing procedures, a good interconnected EHR system, and great communications and interoperability for architectures.

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EpicCare EMR

The award-winning EpicCare EMR is known for being fast and physician-friendly. Integrated access and revenue systems simplify administration. The "one patient, one record" approach improves care in both Physician Group and Hospital.

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CureMD EMR

CureMD EMR supports each clinical consultation, and much more. This electronic medical record system helped with medical billing, charting, and other aspects of both clinical care and practice administration.

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MedicsPremier

Getting paid may not be everything, but it’s close. MedicsPremier enables that with a remarkable 99% success rate on first-attempt clearinghouse claims as reported by Emdeon. Add to that its CPT / DG linking, Auto-Eligibility Checking and Auto-Modifiers, patient / provider credentialing, copayment displays, and more, MedicsPremier really is the system that gets you paid!

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Cerner Practice Management

Cerner Ambulatory Practice Management solutions simplify and streamline your front-and back-office tasks that lead to faster reimbursement.

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NextGen Practice Management

NextGen Healthcare provides practice management solutions that support a patient-centric revenue cycle, enabling practices of all sizes to succeed in today's complex healthcare climate. Our real-time clinical and administrative workflows help reduce physician burnout and achieve value-based reimbursement goals. Available on any device or platform, our powerful functionality helps automate patient registration, appointment scheduling, medical billing, claims processing, and reporting.

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WRS EMR and Practice Management

WRS EMR practice management software can be a major asset for physician offices. Practices can get comprehensive security from an electronic medical record system that incorporates Internet service models, and demonstrates best practices for life cycle management in a doctor's office. WRS medical record EMR software solutions offer complete connectivity with patient care models, and the ability to scrutinize business intelligence for trends.With WRS, doctors and practice administrators get real-time information about what's happening inside the digital side of the office. Look at how patients access their own health information through patient portals. Evaluate how employees use in-house revenue cycle software or medical billing software in their pursuit of routine tasks. Take a look at the full suite of functionality offered with this and other EMR software tools for effective medical record handling and practice management in any clinical environment.With a combination of patient-facing features and others that support a busy office, WRS medical practice management software offers the chance to build an IT architecture that gives clinicians peace of mind without disrupting day-to-day operations. Support the people who make the office work by giving them the practice management and medical billing tools to succeed, and to compete in a fast-paced digital healthcare environment.

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Navicure Total RCM

Solving reimbursement bottlenecks is not a one-time activity. Changes in payer policies, annual coding changes, staff turnover, and other volatile factors mean that there are always challenges to overcome when maintaining a consistent and predictable cash flow. Navicure® Perform™ lets you stay on top of the ever-changing landscape of your revenue cycle by providing ongoing actionable data that is updated nightly (rather than monthly as with many other solutions) and points your staff to the specific issues impeding reimbursement. This lets you focus on which claims and payers need attention to make immediate improvements and to prevent the same problems from resurfacing in the future.

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CollaborateMD Medical Billing Services

For billing services of all sizes, CollaborateMD truly makes the billing process easier and more profitable by helping optimize the revenue lifecycle. With the ability to file both professional and institutional claims, and with access to a wide variety of time-saving features, we offer the fastest and most affordable medical billing software. Get ready to increase customer satisfaction and at the same time save money when you choose CollaborateMD.

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Compulink RCM

Compulink’s all-in-one solution combines our expert billing services with the industry’s leading EHR and Practice Management solution to increase your income and take the pain out of getting paid. Learn More Request Pricing

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Healthpac Medical Billing Software

Our customizable medical billing software options provide customers with the efficiency needed to run their practice smoothly. The medical billing software we have created was made in an effort to speed up the billing process for many different medical offices and hospital departments and improve entry accuracy in every step. Please click on the links above for detailed features of each area of medical billing software we provide and contact us with any questions you or your office may have.

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RxNT

RxNT’s cloud-based Practice Management solution complete with full medical billing platform and office scheduler, allows you to run your front and back office from one simple solution. Go back to what you love and leave the rest to us.

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DocuTAP

The EMR, also referred to as an EHR (Electronic Health Record), was originally designed with the patient and provider in mind. It goes beyond charting on paper by having patient medical history in one easy-to-use digital software. From treatment to diagnoses, an EMR ensures patient information is both secure and accessible. DocuTAP’s EMR has been refined to chart cases in record time, generate more revenue per visit than the industry average—thanks to our auto-coding and documentation support—and streamline patient check-in for shorter wait times.

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expEDIum

The expEDIum Medical Billing (eMB) comprehensive, secure Web-based Medical Billing Software and Practice Management Solution that allows medical billing companies and healthcare providers to effectively manage the practice, automate complete Medical Billing and Claims Processing workflow. This Medical Billing Software is HIPAA Compliant and supports both CMS-1500 and UB-04 claims in electronic paper. This solution is ICD-10 codes ready and meets every standard based changes in the industry without any additional cost to clients.

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PracticeAdmin Practice Management & Medical Billing Software

PracticeAdmin provides healthcare providers and medical billers with a full range of cloud-based practice management and medical billing software solutions which help you manage and file medical claims as efficiently as possible. We serve large, established practices, as well as small practices, and third-party billing and coding services. PracticeAdmin’s Practice Management Software as a Service (SaaS) integrates with leading EHR systems providing you with a powerful platform that coordinates patient data and claims between the PM and EMR systems, and helps keep your profits in your pocket.

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Last updated on October 16th, 2018

Medical Billing Software Buyer’s Guide

Medical billing software streamlines financial activities for your practice

As a medical practice, your chief focus is your patients’ health. But when it comes to running your day-to-day operations, medical billing software can significantly impact the financial health of your practice. As part of a medical practice management system (MPM) or an integrated EHR solution, it must perform multiple tasks to ensure payment for your services is done accurately, cost-effectively and in a timely manner.

Executive Summary

  • Medical billing software streamlines financial activities for your medical practice.
  • The main benefits and goals of medical billing software are revenue cycle management, error reduction, maximizing reimbursement and improving efficiency throughout the practice.
  • Many medical billing systems offer advanced features like scheduling and reporting that can benefit your practice in ways outside of its cash flow.
  • Before selecting a medical billing program, users should ask a range of questions both of themselves and of their vendor shortlist to ensure they are targeting the right features for their practice.

Quick Navigation to this Guide

Benefits of Medical Billing Software

Growing data demands, technological innovation and changing regulatory and reimbursement requirements can make the evaluation and selection of medical billing software seem overwhelming and confusing for physician practices

.If your practice wants to focus solely on the delivery of care, you may prefer to outsource your billing and financial processes to a third-party medical billing service provider.

This medical billing software buyer’s guide is for those who want to keep medical billing in-house and retain more control of your practice’s operations. It gives you a comprehensive overview of features and functions, primary and secondary considerations, as well as guidance in the evaluation and selection process of medical billing software.

For a deeper dive into medical billing services vs medical billing software, check out Why You Should (or Shouldn’t) Use Medical Billing Software.

Why is the Right Medical Billing Software so Important?

Medical billing software is a chief component of your revenue cycle management (RCM) process. According to the Healthcare Financial Management Association (HFMA), the revenue cycle includes all the administrative and clinical functions that contribute to the capture, management and collection of patient service revenue.

The key is selecting a medical billing solution best suited for the unique needs of your practice both at present and as it evolves. It would be a lot easier if there were a one-size-fits-all solution, but unfortunately one probably doesn’t exist. We will address features and considerations in further detail, but it’s important to understand how your selection enhances workflow. Performance and morale will suffer if your staff finds it disruptive.

In addition, the right software can automate services, accommodate different needs and reduce billing errors that will positively impact the patient experience and boost satisfaction.

Implementation Goals

Selecting the right medical billing software can help your practice:

Goal 1

Improve Accuracy and Decrease Duplication

Most medical billing software programs offer clearinghouse solutions that de-duplicate data and help users catch potential errors. This prevents costly mistakes and takes human error out of the equation.

Goal 2

Increase Productivity

Instead of filling out time-consuming forms and chasing down patients to obtain payments, staff can spend time delivering patient care.

Goal 3

Reduce Staffing Needs

A medical billing solution can replace employees who previously would have performed claims management, billing and collection actions.

Goal 4

Track and Measure Practice Performance

With reporting and business intelligence capabilities, medical billing systems offer insights into practice performance.

Goal 5

Manage Cash Flow

Medical billing solutions offer claims management, collection and billing capabilities that track revenue.

Goal 6

Accelerate Payments

The claims management module processes and executes insurance claims to facilitate interactions with both patients and insurance companies.

Goal 7

Maximize Reimbursements

With denial management, payment reminders, claim reconciliation, remittance alerts and other advanced billing capabilities, medical billing systems ensure your practice is paid what it is due in a timely manner.

Goal 8

Automate Processes

Billing software for physician practices automate processes such as sending claims, collection letters, de-duplication and accounting.

Goal 9

Assist with Compliance

Medical billing programs offer a range of security features and reminders to ensure HIPAA, ANSI 5010 and ICD code compliance.

Changing Regulatory Environment and Reimbursement

Given the importance of reimbursement and compliance, it’s important to review how a medical billing solution will keep pace with the changing regulatory environment. The practice of medicine is witnessing a shift away from a volume-based, fee-for-service payment model and toward data-driven, value-based care which will place additional demands on your billing team.

In this reimbursement model, the health of your patients matters more than the number of tests and procedures you perform or patients you see.As part of the transition toward value-based reimbursement, Congress passed MACRA, the Medicare Access and CHIP Reauthorization Act of 2015. Among its provisions, MACRA establishes new ways to pay physicians who successfully demonstrate quality and effectiveness over volume in treating Medicare beneficiaries. Under MACRA, eligible clinicians can participate in Merit-based Incentive Payments Systems (MIPS) or Advanced Alternative Payment Models (AAPMs).

Among the challenges of a quality of care reimbursement model will be physicians’ taking into account a full range of patient’s health issues and chronic diseases that are not reflected in their claim. This is vital to avoid being penalized for poor documentation of patients' conditions.

Basic Features and Functionality

Medical billing software should integrate into your overall project management solution and seamlessly link all your stakeholders to improve your practice’s payment cycle and optimize cash flow.The revenue management cycle entails front office and patient visit functions (collection and verification of patient insurance information) and back office functions (diagnosis and procedure coding, charge capture and clinical care documentation, account reconciliation, claim submission, collection, and final payments).

Insurance Validation and Verification
Verifying insurance eligibility to minimize billing delays and denials.
Payment Processing
Processing co-pays, deductibles or coinsurance payments at the time of the office visit via cash and credit card.
Payment
Allowing for both self-pay and insurance, does your practice have a sliding scale for patients who don’t file insurance or opt to pay out of pocket?
Charge Capture/Medical Coding
Rendering medical services into billable charges. Charge capture allows providers to input the correct diagnosis (ICD-10) and procedure (CPT) codes used in a medical claim. Software should minimize the time it takes to identify and insert the right billing code. The billing software should allow for annual medical code updates. A reliable charge capture feature simplifies the process and helps you avoid improper coding or incomplete information that can result in lost revenue.
Claim Submissions
Checking for claim errors (scrubbing) before submission to payers and enabling electronic claims to be submitted to clearinghouses, which in turn “scrub” claims to make sure requirements and stipulations are met.
Reimbursements
Tracking revenue from claims reimbursements as well as the portion of your patient services that comes from patient self-pay, co-pays and deductibles.
Remittance Processing and Electronic Remittance Advice (ERA)
Applying or rejecting payments through remittance processing. Importing ERA documents supplied by the insurance payer that provide notices and explanations of reasons for payment, adjustment, denial and/or uncovered charges of a medical claim.
Collections/Billing
Collecting payments from third-party insurers. Tracking claim status (including rejected claims, claims paid below market rate, resubmissions); Recording, posting and tracking 30/60/90/120 day receivables and following up with patients carrying balances after insurer payments (as well as patient non-payment/bad debt).

Advanced Features

These features may be key to your business, but not all medical billing software systems will offer them all. Identify which advanced features your practice will need in advance to guide your selection.

Insurance Relationships
Tracking different contract rates/discounts of accepted payers.
Reporting/Benchmarking/Forecasting
Providing reports can give important insights into the practice productivity and profitability of your overall practice as well as by individual providers, codes and procedures. This is helpful in setting benchmarks for your practice, measuring against practice norms and identifying key performance indicators.
Scheduling
Including a patient and staff scheduling module within the medical billing software can negate the need for a separate patient scheduling system
Workflow Management
Offering a workflow dashboard, rules management engine, claim code validation and code/charge entry helps streamline staff tasks and promote organized workflows.

Other Key Considerations

In addition to medical billing functionality, here are some other key considerations to factor in:

Workflow and User Interface

One of the key differentiators between software solutions is how well they track payments and help organize and quicken payment schedules. Here are some questions to ask:

  • How automated are the features for insurance verification and claims submission?
  • How easy is it to create and resubmit insurance claims?
  • Does it increase accuracy associated with charge capture to minimize denials and resubmissions (e.g., an error correction feature to flag wrong billing codes or insurance policy information)?
  • Is the navigation process and interface streamlined to reduce the number of clicks and screens and allow keyboard shortcuts?
  • Does the software support the automated creation and assignment of tasks generated from the billing process?
In addition to minimizing the number of steps, how does the solution facilitate collaboration and handoffs between stakeholders?  Can it help reduce the time lag from submission to remittance?

Customization

How templates and workflow processes can be customized by practice specialty, multi-specialty, subspecialty, size and location(s) and billing user level. Can the system support durable medical equipment billing?

Compliance/Data Governance

How the audit trail performs in tracing the detailed transactions relating to who accessed patients, when they were accessed and what changes were made; What are its capabilities for data retention and automated backups and data management (where the data is stored and secured)?

HIPAA/Security

How the solution encrypts data at rest and in motion and how access controls (authentication and authorization) ensure information is secured and restricted on a need-to-know basis. These issues are particularly important considerations given the rise of data security breaches, ransomware and malware.

Scalability

How the software performs as your practice evolves and grows.

Migration/Integration

How the solution can handle migration of data from your current system. How easily does it integrate with your patient portal?

Technical Support (Installation, Training, Maintenance)

What is the level of support and costs associated with installation, training your staff (including training after upgrades) and system maintenance? Is the system easy to use and easy to learn?

Mobile/Telemedicine

How accessible the solution is by mobile devices or a remote location. How is data secured and is its interface compatible with a mobile device? Does it account for billing and payment for professional services furnished via telehealth?

Pricing/Licensing

What the total cost of ownership is over the system’s life cycle. What are the costs of upgrades and updates for features? What is the pricing and costs associated with the number of users?

The Selection/Evaluation Process

Selecting the right medical billing software system can seem daunting, but with the right tools and support it’s very achievable. Here are some steps to take to prepare for purchasing medical billing software:

Identify Stakeholders and Solicit Input

This involves clinicians, administrators, IT and billing staff who all play a role in moving a patient through the revenue cycle management process. Administrators are concerned with reporting functions and cash flow. Back office staff focus on the navigation process, and clinicians are concerned with accurate charge capture.

Assess Billing Needs

This involves assessing staffing, productivity, current and future patient volume, patient mix and demographics, and the number and types of insurance plans (both private and government payers).

Assess Current Performance

What are the key performance indicators?  What are your estimated processing time and total costs for billing and insurance-related activities?  To what extent does your system streamline and automate processes without compromising accuracy?

Identify and Compare Medical Billing Systems

Once your list of vendors is narrowed down to the top two or three vendors at the most, ask them to demonstrate how their system will work and how it performs when in action. See if they have a trial version, and test the software to make sure it’s easy to use and meets your practice’s needs.Be thorough. Talk to references for each vendor. But don’t only rely on your vendors’ references who will likely offer the most positive reviews. Ideally, you should reach out to additional contacts for more information and opinions to get a complete picture of your candidates.

Questions to Ask Vendors

In discussions with potential vendors, understand their solution’s ability to handle the dual requirements of fee-for-service and value-based reimbursements. Some questions to consider asking yourself prior to purchasing:

  • Is your practice growing? Do you need this solution to be scalable?
  • What types of reports do you need to generate?
  • What is your budget?
  • Do you want on-premise or cloud-based deployment?
  • Do you need a system with extensive customizations?
Some questions to ask when selecting vendors:

  • How long has the vendor been working in this field?
  • How satisfied are customers with their decision to use this vendor?
  • How disruptive was the installation of the new system?
  • How HIPAA compliant is this vendor?
  • What types of reports will this system generate?
  • Will this vendor alert you to contract issues?
  • What kind of customer support does this vendor offer?
  • How customizable is this system? Does customization incur additional charges?

Final Considerations

Remember, a medical billing solution is only as good as the billing team it supports. A well-trained and experienced billing team can help your practice avoid coding errors and incorrect data entry, which impact revenue.

Credentialing: Selecting credentialed billing and coding professionals can ensure best practices are employed to help avoid audits and keep aware of industry changes.

Communication: Given the many functions and stakeholders involved in the revenue cycle management process, coordinated communication is key where individual roles are clearly defined to minimize errors, duplication and missed deadlines.

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