Important Factors to Consider When Selecting Software for Medical Billing Services

The implementation of the Affordable Care Act (ACA) has been a “mixed bag” for medical billing services. It could be argued that the ACA has caused medical practices to partner with billing services to eliminate the need to maintain potentially costly in-house billing staff. However, at the same time, most agree that the ACA has reduced claim reimbursement revenue while also increasing claim denial rates. This combination makes it extremely challenging for billing services to thrive on what were already razor-thin margins.So, now more than ever, it is critical to ask the right questions when selecting software for medical billing services. We would suggest that billing services strongly consider the following factors when evaluating medical billing software.

1. Is the software ICD-10 compliant and does it offer tools to help billing staff convert an ICD-9 code to its respective ICD-10 code? While the implementation of ICD-10 has been pushed back a year, it is still important to ensure that the system that you select is ICD-10 compliant. Systems that do not include the new ICD-10 codes may have an underlying system issue that will make future ICD-10 compliance difficult if not impossible.

2. Is the system cloud-based and flexible enough to work on both PCs and Macs? Most modern systems are cloud-based which reduces the amount of capital spent on equipment since you are not required to purchase servers and dedicated terminals. However, there are very few medical billing systems that function equally well on PCs and Macs. It is important to select a system that is fully functional using both PCs and Macs to offer your business the flexibility to make computer hardware changes in the future.

3. Does the system automate the billing process to the greatest degree possible? For instance, can you inquire on a patient’s insurance policy validity directly from the software or must you interact with the payer by phone or through the payer’s website? Does the billing system automatically scrub service lines for billing errors prior to creating the claim or must you export all service lines to a separate scrubbing system to check for errors?

4. Can the system auto-adjudicate Electronic Remittance Advice payments and automatically create the claim to the next responsible payer? Choosing a system that has a high success rate of auto-adjudication can make a huge impact on the bottom line since fewer personnel are required to post insurance payments.

5. What types of reports can you generate? Are you able to create the reports that your clients want? Can you schedule those reports to run automatically? Can the system then send those scheduled reports to interested parties via email without requiring your intervention?

6. Lastly, and perhaps most important, does the medical billing software provider compete with you for clients? That is, do they also offer billing services and may they someday view your clients as prospective customers? It is best to select a software vendor who does not offer billing services as well.

Of course there are many factors to consider when evaluating billing systems, but hopefully this list of questions provides a good starting point.