Medical billing is an important part of the healthcare industry. It is a process through which the healthcare provider contacts the insurance company for reimbursements of the bills raised against diagnosis and treatment of the insured. Though it may look easy, it is actually a tedious and cumbersome process. The complete treatment history has to be maintained to get the payment cleared from the insurer. Any lapse in the keeping of records may cost dear to the healthcare provider. This is why the best medical billing software is the need of the hour. Medical billing is the term used in general though its official names include medical practice management software and revenue cycle management software. They all help in better communication between the healthcare provider and the payer (the insurance company).
Many institutions and colleges offer formal education to the aspirants seeking to enter the field. Though the law does not require medical billers to possess a degree or certification, it is advisable to take up a course to better understand the process.
Why use medical billing software?
There was a time when all the things were done manually. We all know that it has several disadvantages. First of all, heaps of documents and bills are generated. It takes a lot of time and effort to refer to older receipts. Misplaced or left out receipts and documents created a problem for the healthcare provider when he presented the claim. The health care providers were on their toes all the time. They had to outsource the process to play it safe. When they began using the medical billing software, they felt better. Small setups freed up their staff to focus more on serving the patient. Large setups speeded up the claims process to save their time and effort.
A little info about the claims and reimbursement process:
After the claims are submitted by the healthcare provider, the insurance company examines them. Once the verification and examination process is completed, the insurance company finalizes an amount. This amount is then released to the provider with details. In the case of higher amount claims, the insurance company may employ better brains to examine and verify the claims. Several things are examined in the process including eligibility of the patient, necessity of the diagnosis and treatment, and credentials of the health care provider. In the case of rejected claims, the health care provider is informed. However, a rejected claim does not mean that it can’t be processed further. In most cases, a claim is submitted back multiple times with corrections before it is finally cleared.
The best medical billing software would have the following qualities:
• They would be up to date with the changing requirements of the insurance companies. Medical companies keep coming up with updates. The software should allow for these updates to be accommodated in it.
• The best software would have a high rate of first-pass. This means that the claims processed by the software are reimbursed without being sent back. This may not happen all the time but the higher the average, the better is the performance of the software. A poor software would leave many loopholes in the claim. Such claims are sent back by the insurer.
• The software should offer flexible tools for submission and management of the claims. This is crucial as there are situations when the claims are sent back by the insurer. The software should allow for making corrections and re-submissions.
• It should be easy to use. It should use the ‘what you see is what you get’ type of interface.
• The software should be secure so that you can keep the information of your patients safe. It should follow the standards set by the authorities of the industry.
• There should be a good help and support staff for solving problems related to the software. They should be accessible all the time through a phone number.
• The software should also allow for managing the complete history of the patient right from the moment he comes to you to the day he leaves your place.
• It should increase your collection rates. The insurance company clears a pre-negotiated amount to the healthcare provider. This amount does not cover the complete cost of the diagnosis and treatment. Thus, to get the most out of the process, you need the best software that can get increase your collection rate.
• The software should make it easy for you to answer patient’s queries. Whenever a patient inquiries about a certain diagnosis and treatment, you should be able to tell him the details right away.
• If your claims are supported by proper details, you can expect them to be cleared in most circumstances. The best medical software can keep things clear and up to date for the payer to verify and examine.
• The software should have options for keeping everybody well informed. Only the needed information should be communicated or shown to the concerning parties. You should be able to filter information that you want to save to the recipients.
• The software should allow for a robust ‘search’ option. You should be able to search by type of treatment, diagnosis, date, name, place, disease, amount, and other things. The search results should be relevant and help the biller prepare proper reports.
In the coming times, you can expect a more active role of the patient in the medical billing process. The best medical billing software would keep them in the loop to maintain transparency and make the process straightforward.