Medical billing is a critical function in any practice. Prompt and accurate billing procedures ensure timely reimbursement and predictable cash flow. Unlike other industries, the billing process for medical practices is anything but straightforward. Practices need to submit claims to multiple payers using specialized coding, and they may require follow-up action if the initial claim is delayed or denied. All of this takes time, skill, and knowledge.
Medical billing software eases the burden of the billing process. Dynamic billing platforms can interface with electronic health records and insurance payment systems to streamline claims submission. Dynamic updates can ensure that software remains current with coding norms, HIPAA regulations, Medicare guidelines, and insurance industry changes.
Small practices can benefit from using billing software to manage claims and billing. Before investing in software or outside billing support, it’s important to consider the needs of your practice. Look for key features that will ensure efficient, accurate, and timely billing and payments.
Technical Functions
When choosing medical billing software for small practices, look for features that automate the core functions needed for efficient billing and accounts receivable management.
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Claims Management: Claims management is the core function of any billing software. This function includes submitting payment claims to insurers and following up with them to ensure payment. When looking at software, ask about follow-up on unpaid claims. Most denied claims can be edited and resubmitted. Not all medical billing solutions include follow-up functionality, which can result in lost revenue.
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Claims Scrubbing: One way to avoid claims denial is to submit claims that have all the necessary information and relevant coding. Look for a billing solution that provides claims scrubbing. The scrubbing process is a review of all claims to check for documentation, coding, insurance eligibility, and other potential errors that can delay payment. Claims scrubbing improves the rate of clean claims that are approved and paid on the first submission. Not every software package includes claims scrubbing as an option.
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Insurance Eligibility Verification: Some billing solutions offer automated verification of patient insurance coverage for certain procedures. This process allows patients and providers to know in advance what the out-of-pocket costs will be. Patients can make informed choices about procedures. This also reduces the number of claims denied due to ineligibility. Not every billing package can check insurance eligibility; some may only be compatible with certain insurance plans.
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Compliance Tracking: The field of medicine is subject to broad regulatory oversight. Changes in regulations can affect both clinical practice and practice administration. Ideally, billing solutions are updated to reflect changes in regulations related to patient privacy, reimbursement rules, and record keeping. In addition, revenue management solutions can assist with keeping practice certifications with Medicare and Medicaid current so there are no lapses in eligibility. Systems that don't offer compliance updates leave practices at risk of inadvertently violating regulations.
Other Functions
Aside from all the tasks required for billing, your practice should consider other factors when choosing billing software.
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Medical Specialty: It’s important to choose billing software that can be customized for your medical specialty. If you are planning to add related specialists to your practice, discuss whether those specialties are supported before committing to a software solution.
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Compatibility: Not all billing solutions are compatible with all electronic health record platforms. Make sure your billing software can synchronize with your existing software to ensure ease of use.
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Reporting: Detailed reporting and analytics can be invaluable tools for assessing the health of your practice. Look for billing software that can compile periodic reports that show how many claims you’re submitting, claims denial rates, payment turnaround times, and other administrative data.
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Customer Support: Technical difficulties are a fact of life. Some problems are minor, and using a chatbot or emailing a support request is a fine solution. Other problems require immediate help from a live person. Check to see if your billing software plan includes live support options.
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Scalability: If you have plans to grow your practice, your billing software will need to grow with you. Ask about the process for adding more clinicians to your practice, joining additional insurance networks, and increasing your menu of services.
Comprehensive Solutions
PUREDI is a 100% cloud-based intelligent billing software solution that can be customized for the needs of small practices. We have over two decades of experience in medical billing and administration, and we work with a range of specialists, including surgeons, internists, hospitalists, dermatologists, and behavioral health clinicians.
Our core services include claims management, claims scrubbing, insurance eligibility verification, and compliance tracking. We also offer comprehensive reporting and analytics, compatibility with a variety of electronic health record (EHR) systems, and live customer support. We can also provide complete practice management services and offer strategic consulting on growing your practice.
Contact us today to learn how our customized suite of services can simplify your billing process and improve your practice’s financial health.
