Is Medical Billing And Coding Easy – Timely payments from customers are the fuel that keeps any business running. Healthcare providers are an exception, but in their case getting paid is a long multi-step journey involving multiple rules and players. While hospitals can’t shorten this process, they can speed it up by automating the billing process.
In our article about EHR systems, we described several options with integrated billing models. This time we will review personal solutions focusing on medical bills.
Is Medical Billing And Coding Easy
Whether you’re a physician running your own practice, a hospital operator, or a representative of a medical billing company, this review will help you explore the capabilities of available medical billing software and choose the best option to speed up your cash flow.
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Providing good patient care is only one piece of the healthcare puzzle. To run a successful medical practice, providers must tame the financial beast known as RCM or Revenue Cycle Management.
The revenue cycle can be described as the financial distribution system of a health care organization. It includes both clinical and administrative functions aimed at capturing, managing and collecting patient service revenue.
The cycle begins with creating a patient account, then providing medical services and submitting claims to the final point where care providers receive payment from the patient or insurance carrier. Managing this complex system is known as Healthcare Revenue Cycle Management.
Medical billing is an integral part of the healthcare revenue cycle that involves paying healthcare providers for their services. This process begins before services are provided, and includes several important steps.
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Verification of patient insurance determines whether the patient’s insurance coverage is valid. This process is usually done by front desk administrators before scheduling an appointment with a doctor. The health care facility also collects demographic information about the patient including their medical history with diagnoses, frequency of visits with physicians, previous charges, charge sheets, etc.
Expense capture records medical services and expenses provided. It is usually performed by doctors or other health care providers.
Medical coding converts medical services, treatment procedures, diagnoses and prescriptions into standard healthcare codes. Codes must be correctly assigned according to Common Procedural Terminology (CPT), International Classification of Diseases (ICD-10), and Healthcare Common Procedural Coding System (HCPCS) standards.
Accounts receivable or A/R follow-up ensures that healthcare providers are able to recover late payments. Simply put, accounts receivable represent money that is owed to a hospital for services rendered to patients. A/R follow-up includes tracking denied claims, checking partial payments, rescheduling claims, and other important tasks.
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Rejection management is all about tracking common rejection reason codes. It exposes weaknesses in medical billing, recording and coding processes. Problems are then addressed to minimize future rejections and ensure that applications are accepted the first time.
Referral processing means the review of payments resulting from bills for medical services rendered to determine whether payment should be accepted or denied.
Third-party review involves the collection of payments from third-party payers. The measure is important because agencies may bill Medicaid or Medicare only after trying other options.
Patient collections collect all co-pays and uncovered costs from patients if the bill for health care services is covered only by insurance.
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The purpose of data reporting and analysis is to improve the financial performance of a healthcare facility by drawing insights from the data.
If done manually, these steps require a lot of time, paper and human resources increasing operational costs. Additionally, the high probability of errors in coding and applications leads to more payment rejections and affects the organization’s cash flow.
Medical billing software automates nearly every part of the healthcare billing workflow, from scheduling doctor appointments to processing electronic payments. We have identified the key components and capabilities that a medical billing application needs to function effectively.
Registration and management of posts. Convenient patient registration linked to your account makes managing each appointment easy as it only takes a few clicks to view previous appointments, no-shows, cancellations and planned events.
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Advance patient registration. Some patients may not be aware of their current insurance status, so it’s always a good idea to take the appropriate steps to conduct a pre-enrollment check. Checking insurance eligibility before scheduling an appointment saves time and reduces claim denials.
Medical coding support. No matter how good your staff is at medical coding, there is a good chance of error when entering data manually. Algorithms can scan some medical coding billing programs for errors and identify anything that needs to be corrected. This way, coders make fewer mistakes, increasing the ratio of applications accepted on their first application.
Electronic medical application guide. Smart claims management is half of your medical center’s success. With advanced software, you’ll be able to implement an electronic claims process, including submitting and tracking your medical claims, checking their status and history, and much more.
Transmission Management. Medical billing software is worth your attention if it offers electronic payment capabilities. This way, you will be able to get information about all the payments entered.
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Payment reminders. Electronically notifying your patients of delayed or upcoming payments is an essential feature of medical billing software.
BE and report. By choosing advanced and easy-to-use billing software with BI or business intelligence tools and reporting features, you can access a wide range of useful views such as financial reports, patient history, utilization reports, etc.
You need to make sure that the solution you are considering is suitable for your use. We recommend that you find answers to the following questions before deciding to go with a dealer or other vendor.
Since all medical facilities are subject to the Health Care Insurance Portability and Accountability Act (HIPAA), attention to data security compliance should be a top priority. Under US law, medical software must be HIPAA compliant, but it’s always a good idea to double-check the provider you choose.
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Buying a medical billing software program is only half of the deal. Its effectiveness largely depends on the ability of your employees to maximize their efficiency. This, in turn, depends on the learning curve. While some apps have very simple and intuitive interfaces, others need to be thoroughly explored to explore their full potential. Before choosing a solution, determine whether the learning curve is steep or gentle. Some vendors offer helpful guides and video tutorials that explain how to work with their automated billing services.
If you already have an EMR or EHR (and/or other practice management software), check first to find out if your EHR vendor offers medical billing services as this is the best way to achieve smooth integration. Otherwise, make sure the chosen application is compatible with your existing IT infrastructure and what it takes to connect your new application with other software to achieve interoperability. You may need to find a third-party tech provider to resolve integration issues.
It makes sense that a practice with a large volume of patients might need a different medical billing software program than one with only a few daily appointments. It’s worth asking your software provider if there is a product designed for uses similar to yours. Also, decide what type of application you need: software to be hosted on your local network, a cloud-based application, or a SaaS (software-as-a-service) product.
As we have already mentioned, healthcare needs and regulations are constantly changing. That means you need to make sure that the app you want to choose is updated regularly. Additionally, know whether or not updates are offered throughout the time you use the app. Some software providers do not include upgrades in certain price plans.
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While medical billing software doesn’t include such a thing as support, it shouldn’t be underestimated. Some vendors provide a direct phone number for 24/7 contact for immediate problem resolution but others are only available via email during certain working hours. It is recommended that you look for a provider that offers all types of support, including email, phone and online chat.
Medical billing software pricing plans vary widely. There are two influencing factors involved. Vendors typically offer cheaper solutions and per-appointment plans for solo practices with low volumes of patients and more expensive packages for mid- and large-sized practices. Meanwhile, medical billing software costs also depend on the features included. If, say, you’re looking for advanced reporting and filing capabilities or credit card processing, you may have to pay extra.
Finding the most suitable software product can be a daunting task. Platforms like SoftwareAdvice offer an impressive catalog of over 300 products. By using filters, you can narrow down the options, but there’s still a lot of research to be done. To help you out, we have selected the top 5 medical billing apps that deserve your attention.
One of the best medical billing technologies, Kareo is a web-based, all-in-one platform used by medical doctors and billing companies to streamline their workflow.
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Kareo’s billing software solution allows for patient appointment scheduling, payment management, claims processing, document storage, custom report generation and more.
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