Medical Billing Software: The Complete Guide to Streamlining Your Practice
The healthcare industry is continually expanding. And as it evolves, there is a greater need for better technology and more resources to manage patient care and healthcare processes. One of the most productive technologies today is medical billing software.
The process of billing patients, insurers, and healthcare providers is quite complex and time-consuming. Fortunately, medical billing software can streamline all the steps and make it easier for healthcare facilities and professionals to manage patient care and payment administration.
How does medical billing software help with this? Let’s explore what it is and how it works, the benefits of using it, and what healthcare facilities and other stakeholders can do with this robust technology:
What is Medical Billing Software?
Medical billing software is a system that streamlines the healthcare billing and payment process. It is a program that automates repetitive tasks and functions related to healthcare billing and payments.
Medical billing computer software includes medical coding software to make the process as efficient and accurate as needed. Medical coding converts all administrative and medical processes into standardized healthcare codes that all stakeholders can understand. Once the patient’s treatment and procedure codes are outlined, accurate billing can begin.
Robust medical billing and coding software revolutionizes the revenue cycle management of all healthcare facilities, so consistent cash will flow for their benefit. This process includes all clinical and administrative operational functions in managing finances.
This is how medical billing typically works:
- The patient’s account is created once they come in for a consultation.
- The patient’s diagnosis, history, and medical appointments are recorded in their file.
- All medical services, claims, and bills are recorded and submitted.
- Claims are submitted to insurance providers or patients.
- Healthcare providers receive payments from patients, insurance companies, or both.
Part of this cycle is insurance validation, where administrators verify the patient’s information before an appointment. The hospital will also collect the patient’s previous medical history and medical payment records.
Charge capture records what healthcare facilities charge to patients and insurance companies. All diagnoses, appointments, and treatments are translated into code.
Next comes billing. Billable fees are audited and submitted; then, providers have to perform a follow-up to check and review payments. With this accounts receivable follow-up, all payments and claims are reviewed thoroughly.
Denied claims are reviewed and checked for coding errors and other mistakes. These are resolved to speed up future claims processing. The remittance is then processed.
Next, another follow-up is completed, which is especially important for patients under Medicaid or Medicare programs. The bill then goes through patient collections in case there are charges that insurance does not cover.
At the end of the payment cycle, the healthcare facility completes data analytics and reporting to improve its billing management and processes.
All of these steps in the medical billing process are essential in the revenue cycle management of any healthcare organization. Revenue cycle management is how cash flow and finances are maintained in any business. If a healthcare provider can properly manage payment collections, then it guarantees the inflow of revenue.
Healthy cash flow is crucial to the long-term operations of any organization; thus, the importance of accurate and timely medical coding and billing cannot be overstated. Highly trained and experienced professionals that handle every step of the payment process are crucial in maintaining the integrity of the overall medical system.
If there are any issues or unresolved claims in the payment and billing process, the revenue cycle is disturbed, affecting how facilities operate and perform. Patients in need will be affected if facilities lack the resources to provide certain services or treatments.
Steps in Medical Billing
It is critical for all healthcare organizations to follow strict protocols when it comes to billing. These individual steps ensure that proper payments are made and claims are processed as quickly as possible, with no effect on the facility’s operations.
The medical billing process and medical billing technology involve a series of specific steps that ensure proper payment and reimbursement are distributed. Billing for a simple case can be completed within several days, but for some patients, it can take several weeks or even months, depending on the claims.
Here is the outline for the process:
- Determine finances
- Bill creation
- Generate claims
- Submit claims
- Claims monitoring
- Statement preparation
Below we are providing more details about each of them.
The first step is registration. This involves collecting patient information, their diagnosis, and the reason for the visit.
The medical billing company also collects and verifies details of their insurance policy and provider. This critical step registers the patient into the system and creates a file that will serve as a reference for all stakeholders.
Next, the procedures and treatments the patient needs will be compared to their insurance policy to determine their coverage. The patient is informed if they have to pay for certain treatments.
When the patient checks in or comes for a return visit to the hospital, their file is updated. Identification, insurance information, and payments are collected.
Once the procedure is completed, the medical records are translated into code.
The billing company then submits a claim to the insurance company. Every code, standard, and compliance is reviewed to confirm the accuracy of the bill and for the process to move forward.
Once the claim is checked for accuracy, it is submitted to a third-party company that serves as the liaison between the healthcare facility and the insurance company. Medicaid and Medicare claims are exempt from this step.
Insurance companies will then determine if the claim is valid and whether it will be accepted or denied.
The statement is prepared and billed for the charges. This details the treatments, diagnoses, and costs that are paid by insurance and which fall to the patient.
Billers follow up on delinquent payments and report them to collection agencies.
For decades, all of these complex steps were done manually. But now, with technological advancements, robust systems are in place to ensure efficiency and accuracy throughout the process.
With the use of high-end medical billing software, each step can easily be automated. Encoders and other medical and insurance professionals are the only experts needed for human reviews and checks, while tedious manual data entry and record keeping are done by computers.
To be useful and truly contribute to productivity, billing software requires various modules within its programs to make its automation work for patients and healthcare facilities.
Modules of Medical Billing Software Programs
Software programs can automate all of the steps in the billing process. However, they need certain modules to improve the automation of any billing software. These modules are vital in streamlining the overall medical billing process.
Here are the modules that are key to medical billing software:
Appointment scheduling and management
This module simplifies scheduling and appointments and makes it easier for healthcare facilities to update patient visits and treatments.
This allows patients to check their insurance status and validate their eligibility before their appointment. This module reduces claim denials and rejections.
Medical coding support
This provides support for coders and checks for mistakes. It raises flags for accounts and claims that need to be reviewed.
Electronic claim management
Software can be used to implement electronic claim processing, track medical claims, and check schedules and medical history.
Billing software must have automated remittance for billers to import and track all payments.
Reminders and payment notifications
Patients can receive notifications of upcoming payments through the billing software.
Business intelligence analytics and reporting
Business intelligence and analytics tools and reporting features can give healthcare facilities insights into finances and medical reports.
Two highly recommended medical billing programs are NYBillPro and ClaimGenix. Both are used in the medical industry to simplify and streamline billing.
Both systems include several of these modules in their programs. This makes automated billing easier for their clients, and they both help their partner healthcare facilities provide essential services to their patients.
But what modules does each program use? Let’s take a look at each software:
NYBillPro is a Medicaid billing software that helps healthcare facilities manage their billing and revenue cycle management. Its features allow stakeholders to create and submit claims and record patient information. It can also generate reports for analysis.
This program has several features that make it unique among other billing software, including the following:
No app downloads are needed, so stakeholders can easily use it through the web.
The software makes claim reviews and corrections easy.
This feature raises flags for possible claim issues for quick resolutions.
Auto data imports
All data is downloaded automatically.
Provider ID correction
This feature automates provider ID corrections.
Auto remittance resolution
This Automates tracking and managing payments for ease of use.
Using NYBillPro has many advantages for healthcare organizations and insurance companies:
- Combines medical billing with NEMT software to target patients under Medicaid programs.
- Uses electronic data information (EDI) for paster billing and claims processing.
- The system has an intuitive and user-friendly interface that is very easy to navigate and use.
- The software follows all HIPAA compliance regulations.
This is a cloud-based claims management program that simplifies the claims submission and tracks progress. It uses real-time analytics to streamline the reimbursement process for healthcare providers.
ClaimGenix also uses several modules in its system to make the billing process more efficient. These include the following:
Daily automated updates
Patient and payment information are automatically updated for all stakeholders with access to this data.
All claims and patient data are automatically imported into the system.
Business intelligence reporting is distributed for review and analysis.
All claims are automatically reviewed and corrected before submission.
ClaimGenix also offers several advantages to its users:
- Patient and hospital data remains secure with high-level online security features.
- The software follows all HIPAA regulations.
- The ClaimGenix team provides 24/7 premium support for users.
- ClaimGenix can be integrated with any software for easy data transfer. Implementation is easy and flexible and can be done even by beginners.
NYBillPro and ClaimGenix are two different software tools, each designed to help medical facilities manage their billing more accurately and efficiently. They can be used separately, but you can integrate ClaimGenix with other software programs if you so choose.
NYBillPro provides special Medicaid transportation software to target certain patients.
Your choice of software depends on which tools suit your budget and internal billing processes. Both have similar modules in their programs that make the billing process much more manageable.
Benefits of Billing Software
Billing software of all kinds provides certain benefits and advantages. And their specific features should be in line with the healthcare industry’s evolution, including billing and coding.
Accurate and efficient medical billing is critical to the financial success of healthcare practices and the quality of care that patients receive.
So what are the benefits of using the right billing software for healthcare organizations and other stakeholders? Here are the six most important benefits that the best medical billing software should have in your financial system:
Pre-registration benefits healthcare organizations and patients alike. The software collects vital information about the patient, including insurance details, which are then reviewed and checked.
Using billing software that integrates all data from the beginning of the billing process makes updates easy for all future transactions.
Claim management capabilities allow organizations to track and manage all claims. It automates the process and makes it easier for facilities to receive payments when they are due. It also reviews every claim before submission, so organizations can check for possible errors and correct them as quickly as possible.
Thousands of codes are used in medical coding, and encoders can sometimes make mistakes. But if the medical billing software automates the coding process, it ensures accuracy and efficiency.
When using software, it’s also far less likely that healthcare facilities will be rejected or denied claims due to coding errors. This will make it easier to review claims that are up for resubmission.
Reputable billing software follows all HIPAA regulations and guidelines at every step of the process. The software should also have encryption and password security features to protect patient information from cybersecurity threats and other vulnerabilities.
Here’s how medical billing software solutions can help healthcare practices improve the security of their billing processes:
Protecting patient information
Medical billing solution encrypts and protects all data in the system, which reduces the risk of data breaches and protects patient privacy.
Medical billing software provides secure access to patient data and billing information, which minimizes the risk of unauthorized access.
Billing software must have a reporting tool where organizations can regularly review their data. These tools will make it easy to track trends and gather insights so businesses can make intelligent decisions based on data.
Good reporting tools also provide healthcare practices with valuable data that can be used for reporting and analysis. These can affect the following:
This can be used to identify long-term and short-term trends and patterns in billing, which can further improve operational efficiency.
Financial data, such as revenue and expenses, can be used to analyze the practice’s economic performance. This data can be used to develop strategies to boost the business’s bottom line.
Top medical billing software providers should ensure 24/7 support is readily available for all stakeholders. Encoders can ask for coding support, while healthcare administrative personnel can call for troubleshooting help if they experience issues throughout the day. Good support should definitely make it to the list of medical billing software requirements.
The provider should offer multiple avenues of communication if their clients need assistance. Live chats and phone calls are practical options that will provide much-needed service and support.
Additional Benefits of Billing Software
There are many other benefits that medical billing software can give insurance companies and healthcare facilities. Consider the following:
Medical billing software can help healthcare practices improve the accuracy of their billing processes. Here are several instances where it can help:
Automatic coding and billing
The software automatically generates codes and bills based on patient information, which reduces the risk of errors.
Error detection and correction
Medical billing software can detect and automatically correct errors in billing, such as duplicate charges or incorrect codes, before bills are sent out.
Compliance with regulations
Software can help ensure billing practices comply with all regulations, such as HIPAA, which reduces the risk of legal and financial penalties.
Medical billing software can also help healthcare practices improve their overall efficiency.
Streamline the billing process
Software automates many of the manual processes involved in billing, such as data entry and record-keeping, which saves time and resources. It also minimizes the risk of human error.
Faster claims processing
Software processes claims much faster than traditional manual methods, which means quicker bill distribution. This also means healthcare practices can get paid more quickly.
Improved patient satisfaction
Faster and more accurate billing does wonders to improve patient satisfaction. This is critical to the long-term success and growth of healthcare practices.
Medical billing software can also help healthcare practices reduce costs and save money. Using software allows them to achieve the following:
Reduced administrative costs
Because many of the tasks involved in billing are automated, minimal resources are needed for administrative staff and equipment.
Improved revenue cycle management
Software can help healthcare practices identify and address issues in their revenue cycle. This includes denied and rejected claims, which can boost revenue and reduce expenses.
The Future of Medical Billing Lies in Technology
Technology has improved the billing process and made it much less time-consuming. It has also significantly reduced the manual effort needed to submit claims and collect payments. It has made any healthcare provider’s revenue cycle more efficient and productive.
However, new technologies such as artificial intelligence (AI) and blockchain technology are making inroads in the healthcare industry to further improve efficiency, accuracy, and security.
What does this say for the future of medical billing?
Artificial intelligence (AI) and machine learning are transforming medical billing through automation. Some healthcare organizations are exploring how AI can analyze medical codes and identify potential errors. Human coders then serve as quality controllers, ensuring that there is no missing information in each bill.
Machine learning algorithms can also predict which claims are likely to be denied and suggest ways to improve the chances of approval. This can save healthcare providers a significant amount of time and money.
Blockchain is a distributed ledger technology that ensures secure, transparent, and tamper-proof electronic health record-keeping. This can be applied to medical billing data, reducing the risk of errors and fraud. It can also provide real-time access to medical records, improving patient care.
These three emerging technologies will affect how healthcare billing software will evolve. Healthcare providers must choose software systems that continue to update and upgrade to integrate these advancements and make the billing process more efficient.
The future of medical billing seems to be a continuation of progress and increasing automation. Electronic claims submissions and automated coding can significantly improve the process. It also promises better accuracy and fewer errors.
Many variations of billing software are now available, and they offer many advantages to healthcare stakeholders. Programs like NYBillPro and ClaimGenix are cloud-based systems that would not have been possible a few years ago.
Now, these systems combine AI, data collection, and reporting tools that help the healthcare industry improve its services and help patients. It is more important than ever for healthcare providers to stay up-to-date on the latest technologies and trends in medical billing.
Using the right technology improves revenue cycle management and provides patients with the best service possible when it comes to billing and payments. It also eases concerns about insurance claim rejections or denials. This means a lot for healthcare providers, as they can focus on specialized patient care and treatment.