How to Develop Web Based Medical Billing Software for Hospitals?
Health professionals agree on one thing: there must be clear, precise, and accurate information among medical providers, insurance companies, and patients when billing occurs. When this communication breaks down, providers do not receive payments on time, patients are frustrated and angry, and insurance companies are always seen as the “bad guys.”
When the System Does Not Operate Smoothly
When claims are high dollar amounts or involve many codes, a medical director with the insurance company usually steps in. Rejected claims are then sent back to the provider who must re-submit. This process often occurs many times until the issues are resolved.
Issues and lengthy “backs and forths” between providers and insurance companies are usually the result of the complexity of the standard medical billing and coding system, as well as errors in the ANSI and CMS files. It is estimated that up to 50% of claims are returned for revision and resubmission. This is inefficient and takes medical providers away from their focuses – patient care.
Finding the Answers in the Right Medical Billing Software Development
For the entire claim and billing process to operate smoothly, there must be exceptional software, based not only on ANSI and CMS standards but, as well, on the specific needs of the health care provider for its internal communication.
Providers (hospitals, small practices, and clinics) need the following:
- Custom electronic medical billing system development that is designed for the unique needs of the institution and still meets the demands of insurance companies and national standards.
- Web based medical billing software development – a product that can be accessed remotely and on multiple devices. For small practices, clinics, and smaller hospitals, there may not be the budgets to employ the full-time employees to conduct the billing activities. They find that outsourcing those activities is a more budget-friendly solution. This solution, however, requires that the internal accounting staff is able to communicate with the outsourced staff in the cloud.
- Medical billing systems must incorporate strong security measures. Hackers are targeting medical billing systems because they have access to such huge amounts of personal information of patients – names, addresses, birthdates, social security numbers – and that information all in one place makes medical billing software an attractive target. Any healthcare billing software developer must build in security that leaves no “bread crumbs” for cyber criminals to find.
“Canned” healthcare billing system solutions which are on the market right now are just that – canned solutions. They do not provide all of what have come to be known as the best practices in healthcare billing services.
How to Create Medical Billing Software – Best Practices
Healthcare professionals are in the business of providing exceptional patient care. And when not treating patients, they are studying – new technologies and procedures, etc. so that they can provide increasingly better patient care. When they are bogged down by an inefficient billing system, patient care can suffer. Best practices in medical billing, then, require that the software is efficient, easily navigated, and incurs the least amount of time possible.
Large hospitals have IT departments, of course, but the demands on those departments are significant. And unless they have specific software engineers to develop billing software, healthcare billing services will suffer. Uniquely trained software developers are needed for this task and that will certainly bring the cost to develop billing systems for hospitals, clinics, and practices to almost prohibitive levels.
- The first is to outsource medical billing to a company that does only that. Their engineers have developed the software, and it is then applied to all of that company’s clients. The problem is this: not all of these companies are “created equal,” and expensive mistakes can be made if a medical facility enters into a long-term contract with a company that simply “goes through the paces” with little flexibility for unique needs of its clients.
- The second is to contract with a company that looks at each client as an individual and that engages in web-based billing software development based on that client’s needs. They employ teams of software engineers who are exceptional coders and developers, who meet with each client to determine individual needs and then develop the billing software accordingly. This is a large part of what is known as “best practices.” When a medical provider can find such an agency, that medical provider is indeed lucky.
Ongoing Review and Revision
This is the other component of best practices in software development. When a hospital or clinic has used the right software development company, it will have the continual long-term service to provide regular review and revision. This is what that looks like:
- When a new process can save money and increase productivity and efficiency, then it should be incorporated into the existing software. A software developer or development company that values its clients will keep abreast of these improvements and make recommendations.
- Best practices involve a plan to provide a regular review of current software – a plan that is developed between the agency and the client. Such reviews can ultimately reduce billing time, increase insurance company acceptance, and keep patients more satisfied. And more important, it can provide critical security upgrades that health providers must have.
Medical Providers Must Ask the Right Questions
Any medical provider – hospital, clinic, private practice – must know what questions to ask when it is considering employing a custom medical billing software provider and justifying the cost to develop the billing system for hospitals. Here are the most important of these:
- What languages are best for custom medical billing software? Which do you use? Why? There is great potential in Java for medical billing software development, and developers who use it are generally able to code more efficiently, costing a client less.
- How often will you meet with me for a review and for recommendations for improvement that will impact both our bottom line and the level of patient care we can provide?
- How often will you review our security systems and make recommendations based on the latest research and practices? How often will you test our security systems?
- How much initial and ongoing training will you provide our staff?
- Will you routinely resolve coding issues and update coding based upon standards and insurance company requirements?
- Will you upgrade based upon our changing specialized needs and provide carefully planned and developed solutions?
Understanding The Activity And Communication During The Billing Process
- The patient visits a provider.
- Patient’s medical record is then updated and electronically recorded – diagnosis, treatment, and other information.
- From the medical record, a five-digit code is assigned to the procedure and entered into the database; another code identifies the diagnosis. These two codes are the critical pieces that are used in processing medical billing – either to an insurance company or to the patient.
- Codes are transmitted to the insurance carrier and/or translated to verbiage for a patient bill. In most instances, both types of communicators are developed, so that the patient has an understanding of the costs of each item – office visit, tests, details of hospital care, dispensed medications, etc. Patients with insurance will receive these statements from the insurance carrier, along with an explanation of the paid benefits.
- When codes are sent to insurance companies, they are usually transmitted using an ANSI 837 file, and the claim is then processed for payment. Likewise, Medicare and Medicaid claims are transmitted via the CMS 1500 file.
- When claims are coded correctly, the pre-negotiated payment amount is then paid to the provider, and the patient is billed for that which is his/her responsibility.
Medical Billing Software Development: Key Product Features
While each product offers in scope and functionality, our medical billing software developers suggest implementing the next key features to optimize your business processes:
- Smart Claim Processing: To streamline all the communication and activity during the billing process mentioned above, our developers can create an automatic claim validation mechanism and code checking to verify the data before any claim is sent. This will help you reduce the risks of unpaid claims and save your staff time on dealing with rejected/incomplete ones.
- Eligibility Verifications: Certain customers may come unaware of their lost insurance status. This product feature will allow you to obtain the current patient’s insurance information and make respective inquiries with the patient before the appointment. In this case, both your facility and the patient will avoid frustrating confrontation.
- Auto-backups: To avoid any data loss your solution should be enabled with scheduled data backups, which would either download the critical data on hard drivers or send it to the cloud.
- Custom electronic bills which would include comprehensive information on the scope of services provided to the patient, can be personalized/modified in a few clicks. Different doctors can choose to create custom forms for charge slips that a processed online. Again, this will save you hours of sorting out all the bills.
- Payment reminders: you may want to incorporate a set of soft reminders on overdue payments, which could be automatically sent to the patients in the set amount of days after the payment was due. Again, that would save a lot of time on making personal calls or sending letters manually.
- Customizable report functionality: your web app will organize all the billing data in the format you specify and could be sorted by different values for simpler monitoring. Additionally, you could have a smart analytics tool, which will compare billings for different periods, make financial forecasts and provide other types of insight at hotkey access.
Additionally, you should consider a solution with an easy and streamlined UX and UI, so that current and new employees can learn to operate it quickly and navigate efficiently.
One of the definitive advantages of the medical billing software we create is 100% HIPAA compliance and all the data will be encrypted up to the latest security standards.
Romexsoft Can Be Your Solution
We are a development company specializing in healthcare, fintech, and media/entertainment. For over 12 years we have provided software solutions involving over 100 projects for new and returning clients
It matters not whether you need cloud based online billing for startup requirements or a major hospital in need of a complex billing service, Romexsoft developers have the skills, the experience, and the commitment to give you the best solution on the market.
Written by Romexsoft on November 24, 2016