Key Findings:

1. Almost 40 percent of buyers were looking to replace their existing medical billing software.
 
2. Regulatory compliance was a top concern for most buyers replacing existing software (19 percent).
 
3. Mobile billing was the most-requested functionality, mentioned 21 percent of the time.

Few Buyers Using Manual Methods

The greatest percentage of prospective buyers we spoke with were replacing existing medical billing software: 38 percent cited this as the primary reason for evaluating new solutions. Another 20 percent were starting a new practice, while just 13 percent were using paper records or other manual methods for billing purposes—a number we continue to see fall year over year.

Prospective Buyers’ Current Methods

Another 13 percent of buyers were using a billing services provider. Many of these buyers noted that they were interested in bringing their billing back in-house in order to save money and have more control over the process. (Since medical billing services take a percentage of the overall billed amount, practices are required to plan ahead to account for this varying expense.)

Insurance company Web portals, which provide a platform for providers to submit claims directly to a patient’s insurance, accounted for 3 percent of prospective buyers’ current methods. Finally, 13 percent did not specify how they were currently handling billing.

Many Buyers Seeking Software to Comply With Regulations

In a previous report, Software Advice addressed the multitude of reasons why buyers replace their practice management software, which included regulatory compliance, having outdated systems and the desire to integrate with electronic health records (EHR) software. The reasons for medical billing were quite similar, with 19 percent of buyers citing compliance with government regulations as the primary reason for replacing current billing methods.

Top Reasons for Replacing Existing Software

Integrating a medical billing application with an EHR can also be highly beneficial for medical practices—especially as a time-saving measure, since billing codes can be automatically transcribed from patient records to claim submissions or patient bills. Eighteen percent said their current system’s inability to integrate smoothly with other applications, such as EHR and practice management (PM) solutions, was a motivating factor.

Another 17 percent were seeking to eliminate paper from their practice and digitize their billing and claims submission process. Fifteen percent of buyers noted that their current system was outdated, citing problems with crashes and poor or infrequent updates that affected their ability to generate revenue. A smaller number of buyers (6 percent) also mentioned that they wanted to see if new, updated software would improve their practice’s efficiency.

Interestingly, only 5 percent of buyers explicitly stated their need for the new ICD-10 codes, which are scheduled to go into effect on Oct. 1, 2015. It’s possible that the year-long delay from the original 2014 compliance deadline and buzz about the possibility of another delay has led buyers to become less concerned about how their practice will meet the new regulations.

Another possibility is that ICD-10-related stress has been superseded by practices’ focus on the continued struggle to attest for Meaningful Use Stage II. And yet other sources suggest that the delay has already helped practices get up to speed with the new codes: According to an American Health Information Management (AHIMA) survey, 65 percent of practices will be ready by the new 2015 deadline.

Most Buyers Seeking Mobile Access

Mobile billing applications for tablets and smartphones was the top-requested functionality, with 21 percent of our sample saying they would favor software that offered it. EHR mobile applications have increased in popularity as more physicians seek the benefits of increased mobility and the ability to enter and review information on the go, so it’s no surprise that physicians and office staff would like these benefits to extend to billing applications as well.

Top-Requested Medical Billing Software Functionality

Despite the advantages of mobile, not to mention the advances being made in mobile medical apps and apps that transfer money, such as Venmo and Square, mobile medical billing has yet to fully break into the mainstream. Sources suggest this lag is due to a combination of concerns of complying with health care regulations—the top reason buyers from our sample gave for seeking software—and the additional complexity of medical bills. However, as secure and compliant medical applications continue to proliferate, the demand for mobile medical billing options is likely to increase.

Predictably, both claim scrubbing (16 percent) and eligibility inquiries (15 percent) were desired by medical billers. Both tools help reduce the amount of rejected insurance claims that providers receive; claim scrubbers review the claim for errors before sending, and eligibility inquiries are a quick way to find out if a patient is covered for a test or procedure. Since over 200 million insurance claims are rejected each year, these features can serve as a valuable part of any medical billing application.

Nearly 90 Percent of Buyers Want Integrated Suites

Since many buyers desired EHR integration, it follows that 87 percent of buyers preferred an integrated suite. Integrated suites are systems where multiple applications are bundled into one software package. For example, an integrated suite of medical software might include an EHR, a practice management and a medical billing application. Just 11 percent of buyers preferred a best-of-breed system, meaning a stand-alone application just for medical billing; 1 percent were interested in using multiple products.

Integration Preferences

Medical billing buyers discussed many ways in which an integrated suite could benefit their practice, specifically in terms of information exchange between applications, increased billing accuracy and fewer rejected claims. Indeed, this preference for integrated suites is a trend that we’ve noticed across our other 2014 medical software BuyerViews.

Most Buyers Come From Small Practices

Altogether, more than half of the buyers we spoke to were either office staff (34 percent) or physicians (27 percent). Another 23 percent were executives at larger health networks, or described themselves as the owner of a practice. What’s more, the sample was almost evenly split between solo practices (53 percent) and practices with at least two physicians on staff (46 percent).

Conclusion

Our data suggests that medical billing buyers, especially those from smaller practices, are looking for the best software tools to effectively comply with health care regulations, increase their billing effectiveness and keep more revenue within the practice. Buyers we sampled were seeking mobile medical billing options, functionality to address rejected insurance claims and the ability to integrate the system with their existing EHR software. And most buyers were looking to replace the medical billing software they already had in place: evidence that medical billing professionals are increasingly considering how software can be used to address their practice’s needs.

Methodology

Software Advice regularly speaks with buyers who contact us seeking new medical billing software. To create this report, we randomly selected 385 of these phone interactions from 2014 to analyze. These findings exclusively represent those buyers who contacted Software Advice for guidance on software selection, and may not be indicative of the market as a whole.

Expert commentary solely represents the views of the individual. Chart values are rounded to the nearest whole number.

If you have comments or would like to obtain access to any of the charts above, please contact kathleenirwin@softwareadvice.com.