Factors to Consider when Implementing Medical Billing Software

Factors to Consider when Implementing Medical Billing Software


The Healthcare industry faces numerous challenges amid the Coronavirus, and medical practices are striving to integrate all the modern solutions and systems to improve workflow efficiencies. For most healthcare organizations, revenue cycle management (RCM) is critical to dispense health facilities to the patients and properly reimburse the healthcare practitioners.

One of the most essential aspects of an RCM system is medical billing that starts when a patient books an appointment and ends when all the medical procedures are done and the healthcare providers are reimbursed. Medical billing is defined as a process of submitting, following up, and appealing a medical claim to the insurance company to receive payment on the healthcare service rendered to the patients.

Traditionally, medical bills and claim submission were handled manually, but it was challenging and time-consuming. The hospital staff had first to schedule an appointment and then enter the patient’s details into the system and, more importantly, verify the insurance status and eligibility. The next crucial task is applying certain medical codes according to the diagnosis and treatment of the patient's illness.

Healthcare organizations mostly rely on payments from insurance providers to manage financial stability. On the other hand, insurance companies only pay full if the medical claim is accurate and without any errors. According to research, more than 50% of the medical claims are rejected due to medical coding and billing errors.

The Need for a Robust Medical Billing Software

One of the best solutions to help a medical practice ensure a seamless revenue cycle is to install medical billing software and integrate it with the existing hospital management system. Automation always helps as manual work is always quite laborious and prone to errors, both minor and major. There are hundreds of different codes, and a medical coder can face difficulty knowing and remembering particular code.

Also, the medical codes get revised every year, and due to Covid-19, many new codes are added. A medical practice needs medical billing software where the codes are preloaded and receive the online update that comply with HIPAA (Health Insurance Portability and Accountability Act) code regulations.

A medical practice must partner up with an established third party that is technology savvy when designing and developing custom medical billing software. PETTIGREW is one company that is offering a purposeful and complete suite of billing and coding solutions.

Each medical practice is different with different needs, and no one solution fits all. A custom medical billing software is vital to improve workflows from scheduling appointments to coding to processing payments. In many healthcare organizations, the billing software is integrated with the EMR (Electronic Medical Records) to reduce errors and streamline claim processing and submission.

The Important Factors to Consider for Medical Billing Software

Choosing the best medical billing software can be a daunting task, but key considerations can be taken to avoid mistakes and help with the constant stream of payments in the revenue cycle. The factors for a healthcare organization to consider include

  • Taking advice from the Billing Team
  • Choosing the right billing software for medical practice is crucial as the entire revenue cycle depends on it. The first and foremost task is to involve the billing team as they not only know how the system works but will also be using it. Taking their advice is necessary for selecting the best features and options and keeping in mind the ease of use and functionality. Any issue can be identified and resolved to optimize the claim processing function.

  • Design and Features
  • One of the most common mistakes that hospitals and medical practices make is not selecting the appropriate user interface to effectively integrate with the existing system and align with the financial workflows. Some of the essential value-added features to install include claim scrubbing, scheduling, and reporting and analytics.

  • Integration with EMR software
  • Medical practices big and small are all trying to automate their workflows to achieve efficiency. Medical software that does not properly integrate with the EMR system is no good as the patient records could not be accessed quickly when needed. Medical software must have the functionality that can help to load the patient’s history, diagnosis, and any previous treatment quickly.

  • Compliance with Rules and Regulations
  • The medical billing software must be designed and developed according to the rules given by the regularity authority. The codes must be updated as many times the software may be programmed according to old coding guidelines which can result in incorrect medical and denied claim.

  • Proper training of Staff
  • The use of incorrect codes is the most common factor that causes rejected claims. The staff managing the coding and billing tasks must be familiar and receive proper training on the coding regulations and how to prepare the claim and submit it to the insurance company. The latest medical billing software is quite advanced to spot errors and discrepancies and steps to fix it. The team must also be trained to do follow-ups and respond to denied claims efficiently.

What the Medical Practices must do

The modern medical software is cloud-based, which allows remote work and easy access from smartphones and mobile tablets. Also, maintaining and upgrading the software is the responsibility of the billing software vendor. A cloud-based system also means around the clock security and maintenance.

A medical practice can always ask for a demo software with the features they want and then request required modifications. Patients have coverage plans from different insurance companies, so the medical practice must ensure that all the relevant insurance providers are registered, so there is no trouble collecting the payments. The medical billing software must be designed to follow the requirements of the Centers for Medicare and Medicaid.

The software must also be scalable and allow the practice to cope with growth and expansion. The software must be upgraded on a timely basis to prevent any backlogs and inconvenience. The doctors, physicians, and nurses should be asked for feedback as they will use the software.

According to estimates, almost $125 billion is lost due to billing errors, which can be quite tough, particularly for medium and small-sized medical practices. However, the advancement of technology and automation can help reduce the loss and improve the revenue cycle for the medical practices to sustain.