Medical Billing Software

Overview 

The primary benefit of a modern billing system is optimal revenue cycle management - faster collections, fewer denials and less administrative work. Medical billing software is the core application in most practice management systems, and is often integrated with patient scheduling software and electronic medical records to offer a comprehensive medical office software system.

The billing system enables the office manager and billing staff to check in patients, verify eligibility, code diagnoses (i.e. ICD9 codes) and procedures (i.e. CPT codes), submit claims, track denials and respond to electronic remittance advice (ERA). To support this workflow, the system will maintain a comprehensive set of payor rules and policies. Prior to submitting a claim, billing systems can perform “claim scrubbing” to minimize the likelihood of denials. The system will also calculate the patient portion by tracking deductibles and co-pays by patient and by insurance company. 

Current Trends

The following trends are prominent within the medical billing system market:

• Online medical billing software has gained tremendous popularity due to its ease-of-use and limited IT requirements. In this model, the software is hosted by the vendor. Users access the system through a web browser. Currently, most practices are using on-premise, Windows-based systems such as Medical Manager, Medisoft or Lytec, but web-based systems such as AdvancedMD and HealthFusion are certainly gaining in popularity.
• Electronic medical records (EMRs) are driving much of the replacement activity in the billing market. The HITECH Act stimulus program is motivating many physicians to adopt an EMR; in many cases these providers will opt to implement an integrated EMR and practice management system to achieve a completely paperless office workflow.
• Medical billing service offerings are increasingly bundled together with practice management systems. In this case, practices still use the system to manage scheduling, check-in, superbills and check-out; however, the human capital-intensive activities of defending denials, responding to ERAs / EOBs, and tracking down outstanding receivables are outsourced to the vendor’s service organization. 
• Patient portals are increasingly being deployed by practices that want to improve communication with patients and cut down on administrative tasks. A portal - often included with a web-based practice management system - allows the patient to complete forms before a visit, check on lab results, view their patient statement and settle outstanding balances.
• Multi-site connectivity offered by web-based or networked practice management systems allow larger practices - or networks of practices - to establish a central billing office (CBO). This central location can support the revenue cycle functions of multiple providers and facilities while leveraging economies of scale. Many practices are taking advantage of this model to reduce overhead.

Important Considerations

Practices evaluating new billing systems should consider the following:

• Which claims forms does the system support (e.g. CMS 1500, UB04)?
• Can the system support durable medical equipment (DME) billing?
• What clearinghouse is used for electronic claims submission and what are the fees?
• Does the system maintain payor rules for the practice’s accepted insurance?
• Is the system fully HIPAA compliant, including new standards like ASC X12 version 5010?
• Does the practice prefer an on-premise or web-based system?
• Is the system easy-to-use and easy-to-learn?
• Does the system have an integrated EMR or integrate to third-party EMRs?
• Does the system advere to integration standards like HLC-7?
• Will the practice want billing services too or handle that in-house?
• Does the system offer a patient portal?
• What is the total cost of ownership over the system’s life?