The process of billing medical or physical therapy claims is both tedious and complicated. Even for those who have received training for this profession, it can be extremely time consuming.
Medical billing and coding software makes this job substantially easier by automating accounts, appointments, fees, insurance, and billing information. Of course, selecting the best software for your medical billing needs is an arduous process. With limitless options as far as cost and features, identifying the right software takes research. If you’re trying to select medical billing and coding software, be sure to look for these areas and features.
Having key components work together is key. Integration refers to the way that various factors involved in the medical billing process interact. Authorizations, eligibility, payer type, secondary insurance, tertiary insurance, and numerous other factors form part of the process. The software must be able to seamlessly integrate all of these factors, automatically identifying which ones should be assigned to a claim before its submitted to a clearinghouse.
The workflow steps that the software must follow in order for it to operate efficiently and effectively are as follows:
- Check the patient’s eligibility.
- Create the patient’s chart, including insurance data.
- A schedule is made for the patient, assigning them to a healthcare provider and customizing the appointment type.
- ONC-certified medical billing software populates the appointment.
- The provider completes the appointment and any necessary documentation.
- The completed documentation populates as a claim.
- The claim populates the information according to the eligibility check, the documentation, and the built-in fee schedule.
- The biller and coder scrub the claim with the help of integrated scrubbing tools.
- The claim is submitted to the clearinghouse via a built-in feature.
- Follow-up details are tracked in real-time.
- The claim is accepted and returned within the software.
Eligibility Status and Patient Chart Creation
In most healthcare settings, it’s helpful to be able to instantly check a patient’s eligibility for a service. This helps the practice to quickly identify what portion of costs will be covered by the patient’s insurance company, how many visits or hours of service the patient can access, copayment amounts, and other information necessary to both the healthcare professional and the patient. This feature needs to be including in medical coding software.
Features that integrate clearinghouse components must be included in medical billing software. This feature involves syncing that happens in real-time, allowing electronic medical records and billing software data to be automatically sent to clearinghouses so that no time is lost. This allows the billing party to track a claim from the time it’s submitted to the time it is resolved.
When it comes to paying claims and fees on time, software that offers time stamps is critical. Claims can be tracked through utilities within the billing system to ensure that payers do not delay payment. The biller is able to pre-scrub a claim to identify discrepancies, which reduces the likelihood of a delay in the payment process.