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Medical billing software has entirely transformed the billing processes we have come to know before. It is a contemporary way of managing the interaction between patients, medical centers, and insurance companies to pay for medical services and control all these processes. In-house billing tool aims to replace paper-based storage by the digitalization of patient information and automation of the billing process in general.
Medical billing applications can be easily integrated into the existing internal software systems that are commonly known as hospital management software. They can be also separate solutions connected with the healthcare entities and insurance companies.
In this article, we covered the main types of invoice creation software and official laws and requirements for the development of a custom billing management system.
Types of medical billing software
Basically, medical billing is part of a multi-aspect medical system that is responsible for managing all payment operations. There can be three different types of medical billing tools, depending on the way health data is used within a certain clinical entity.
An open type of medical billing system provides the ability to exchange patient health records and billing information between different sources like doctors, medical centers, etc., within the EHR system. However, this type of medical solution is a bit risky because it casts some doubts about the security of patient health information during the data exchange. Due to the HIPAA regulation, open medical billing software is not considered to be reliable and worth implementing.
The closed type of medical billing speaks for itself. It does not allow health data exchange with other medical facilities or doctors as its main aim is to keep the health information private within one medical organization. This type is commonly used for EMR internal systems as they are reminiscent of the old paper-based health records, which usually are kept in one place (healthcare facility).
Isolated type is a great fit for those medical tools where patients manage their medical information on their own. A whole medical history is kept in the patient’s hands and is not shared with healthcare organizations without personal permission. However, patients still can use the medical billing platform to handle payments for medical services while not being able to participate in any internal medical solution like EHR or EMR. Of course, it is not related to official medical records that should be accessible by particular parties despite the desire of patients.
There is one more thing to consider in choosing the types of medical billing and its provider for your medical entity. Each medical billing solution must follow legal requirements for keeping PHI secure in any case. Among these standards, we would like to note CMS 1500, 837-I, HIPAA, HL7, etc.
Challenges of medical billing software
The billing process is quite a tough job to do. It counts many details that should be considered to provide smooth and accurate payment processes. Of course, online billing software leads to particular challenges, but all of them are solvable. Some factors can be predicted and some can appear unexpectedly. Hence, we would like to highlight the most common challenges related to medical billing services:
- No access to payments and related information
- Poor customer support and consequently, customer experience;
- Numerous claims to fill before the actual transaction;
- Complex to use solution that can lead to losses and confusion of money and claims as well;
- Payments delay because of system barriers and errors.
We also encourage you to find out more about challenges medical billers struggle with during daily financial operations from the video below.
Ready-made medical billing solutions
It shouldn’t surprise that the range of ready-made medical billing tools is enormous today. They can be both web-based and cloud-based platforms. Commonly, the functionality of available medical billing apps is similar and is not customizable for a particular medical organization. They are considered to be temporary as the range of options can be quite limited and unscalable. Hence, we would like to discuss the negative sides of ready-made medical billing systems below:
High-priced
There is no free ready-made medical billing tool. Some of them offer a 30-day trial period, but then you will have to pay at least USD 40 per one option, not for the whole system. And the more your medical entity develops, the more options you will have to pay for, meaning scaling will be expensive for your facility.
Poor customer support
There is a massive probability of occurring bugs and errors in the work of a medical billing platform. In the case of ready-made solutions, there are no guarantees that you get the response as quickly as possible. You can be forced to wait for hours while the billing operations within your medical facility must not be interrupted ideally.
Irrelevant functionality
Choosing the ready-made medical billing tool, you cannot be sure that its functionality is exactly what your organization requires. As we have already figured out, the price depends on the range of functionality, meaning you have to pay more to get those options that you particularly need. But will these options resolve all issues as you expect? There is a probability of wasting money but not getting the required outcome.
Bad user experience
A convenient interface is important if we talk about billing operations. Can you imagine how many troubles you may get if the users will misunderstand how your medical billing app actually works and what options it performs? Lots and lots of lost money, mixed documents, invoices, and so on. It will be impossible to process all of these issues that lead to poor user experience with your medical billing tool and organization in general.
Custom solutions over ready-made
As we have already figured out, invoice software can be integrated into the existing EHR or EMR internal systems and can be a separate system as well. In case you have previously adopted EHR from a particular provider, it is advisable to integrate medical billing apps from the same provider or with the same technology stack to get them to work together correctly.
Custom medical billing platform is quite another matter as it can be designed individually to match your existing internal tools – developed by third-party vendors as well as custom. Often the ready-made solutions cannot cover the amounts of work within a certain medical entity that makes them irrelevant and partially harmful. However, you won’t be able to add any amendments to such systems as it’s up to the providers.
Hence, we would like to note what more value you can get by developing and using custom medical billing systems for your services and organization in general.
Improved security
As a medical billing tool is tasked to automate the claims filing, processing, and accepting, a custom system should provide high-level user authorization via an app, website, or whatever it is. It is the most urgent for cloud-based invoicing software as it is vital to allow access only to one or two superior admins. Among the safest types of authentication, we would mark email, phone, or caller validation.
The demand for cloud-based billing software continues to grow and is expected to be integrated into most hospitals by 2027.
Lower cost of medical bills
Invoice creation software reduces the number of paper-based documents required to give patient bills for medical services. Administrative costs take a larger part of the organization`s expenses as the billing information should be sent to insurance companies, hospitals, medical centers, patients, etc. The medical billing tool digitizes this process, and all needed patient information is accessible in one electronic system.
Lower risk of human error
Talking about medical services, there is no chance even for a tiny mistake made by staff as it can have severe implications for the medical center as well as for its patients. One wrong number can lead to huge monetary losses for the medical organization. Custom medical billing system software replaces the need for human resources and automates operations, related to payments and management of medical expenses.
Constant support
You may think that support is not really important but do not forget that any software system constantly needs monitoring and updates. Ready-made solutions mostly provide a very poor level of support from the development team as the number of medical entities that implement this solution can be really huge. In the case of custom medical billing, you will have your own personal maintenance team that will be ready to fix any errors as soon as possible to make the work of your medical billing app smooth and proper.
What to consider when developing billing software?
The most responsible task in integrating your medical facility with medical billing tools is choosing the right development team. The Healthcare industry demands meeting a range of official rules and standards that should be considered in any type of medical software, including medical billing as well. Therefore, we have decided to gather these standards in one place and describe their necessity for your medical billing system:
- HIPAA – federal regulation, created by national standards, that is tasked to protect PHI or Patient Health Information from transmissions and disclosures without consent of a particular patient;
- HIPAA 5010 – this is an addition to HIPAA law that was extended due to the digitalization of medical billing and includes regulation of claims, referrals, and money transfers between patients and hospitals, pharmacies, physicians, and others. This regulation is a must to consider as it also covers the medical billing software providers.
- IEC 62304 – this standard defines the requirements to the medical software development life cycle, it gives a range of demands that show if the medical tool or device is acceptable to be used in medical centers.
You can also learn more regulations related to medical software and medical devices from the official CMS website by the following link.
The knowledge of official medical software laws is extremely important when you start looking for a technical partner and are willing to choose a development team to build a custom medical billing app for your organization. You must be sure to choose a technology partner that is fully aware of all medical software regulations and development and integration standards, including the latest changes in these standards.
At Altamira, we focus on the digitalization of healthcare processes with the help of diverse software systems, considering all compliances like HIPAA, HL7, CMS, and ONS regulations, and so on. We know that medical software is impossible to integrate without strictly following the official international and local laws.
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Final thoughts
The advantages of custom medical billing software are evident, compared to the ready-made ones. It is designed and developed considering the individual preferences and requirements of your medical entity and staff. Custom software development doesn’t offer low prices but it guarantees successful and smooth integration of medical billing apps into your healthcare organization. Custom software is supposed to be an excellent investment in the growth and development of your medical facility, considering the latest technologies and their beneficial use in everyday processes.
