Improve Practice Efficiency With Medical Billing System

Medical professional going over client information

As your practice has grown, your administrative staff may have started to struggle to keep up with billing procedures. They must complete all the necessary forms and provide the most accurate codes, but they also have to manage scheduling, ringing phones, and patients in the waiting room. A medical billing system can remove some of the stress in your office.

Revenue cycle management software has other benefits as well, such as improving the overall efficiency of your practice and increasing your revenue flow. There is an appropriate system for every type of medical practice.

Functions of a Medical Billing System

Medical billing software tracks patient care from the initial appointment through the collection of the final payment. These systems tie in with your electronic health record software and utilize patient data to ensure the integrity of payment information for each record.

The Cycle of Patient Care and Revenue

Your patients make an appointment and complete pre-registration and registration before seeing you. Scheduling and recording insurance information and other necessary data to create or update the patient record are done through your EHR system before the visit.

During the visit, care is provided to the patient. Afterward, the health care provider assigns billable charges to each service and diagnosis, completing the record with patient information and reasons for the procedures or medications.

Medical billing codes are then determined for every procedure, and claims are completed and submitted for payment.

Insurance companies decide what portion of the treatment is covered by the patient's insurance and pay that amount. Patients are billed for the portion of the services not covered by insurance. Once the patient portion is collected, the revenue cycle is complete.

Benefits of a Medical Billing System

Medical billing software supports an efficient, accurate, and timely revenue cycle.

Administrative Functions

In coordination with your EHR system, medical billing software enhances efficiency in your office by streamlining routine administrative tasks such as scheduling and transcription, lightening the workload for your staff, and reducing errors simultaneously.

Keeping centralized patient records allows access to needed data by all medical providers serving the patient. When multiple practitioners can access records, treatment is better coordinated, and patient outcomes improve.

When your staff handles coding, your medical billing system can suggest ICD-10 codes based on the information in the digital record. If you outsource your medical coding, professionals processing your data can directly access lab results and other diagnostic information, preventing unnecessary queries and accelerating the coding process.

Communication and Notification Benefits

Your medical billing system is part of an EHR that supports open communication among providers, staff, and patients. Your RCM software tracks insurance information, appointment times and notes, and messaging between the patient and your practice.

Patient and insurance data are used to prevent errors in billing by ensuring that procedures are not performed too frequently to be covered by insurance and by notifying the provider when Advanced Beneficiary Notice must be obtained before providing treatment.

Enhanced Claim Process

Preparing your claims properly and efficiently so that they are paid in full and on time is the end goal of any medical billing system. Each process step is a building block for a successful and prompt revenue collection.

Billing system software helps you create accurate and properly coded claims and submit them to the correct insurance company on time. This improves the financial flow of your practice and minimizes late or lost revenue.

Prevention of Denied Claims

When insurance companies deny claims, your practice loses money. In case of a claim denial, you should determine why the charges were rejected and attempt to correct the error and resolve the issue. The data in your system can be a big help in reconstructing how the problem occurred.

Even if you are unable to recover the lost revenue, you should be able to avoid repeating the mistake on another claim. A medical billing system can prevent failed claims.

On average, roughly 20% of claims are denied annually for a variety of reasons:

  • Incorrect information, such as a mistake in coding or a blank field
  • The procedure isn't covered, or authorization was not obtained
  • Duplicate or late filing

All of these common issues are addressed by medical billing software. Your system can screen for coding errors or problems with forms, alert your staff and practitioners to the need for prior authorization, and check the patient's insurance for covered procedures. An RCM system can also catch duplicate submissions and keep you up to speed on filing dates.

Preventing these problems before they occur can drastically improve the efficiency and productivity of your practice.

Process of Medical Coding

Your medical billing system works in tandem with the other features of your EHR, supporting efficient processes and a successful claim right from the first step.

Step 1. Patient Visit and Proper Documentation

The coding portion of the RCM process begins with a patient visit. The medical provider delivers care and makes a careful and complete record of all procedures and services. The report must include details about the patient's health and why they were provided with this specific care.

The information is entered into the digital patient record. Anything that the practice will bill for later must be thoroughly and accurately documented at this stage in case of a disputed or rejected claim.

Step 2. Converting Care to Codes

After the patient goes home, your staff and/or a professional medical coder will read through the data regarding this patient visit and assign ICD-10 codes to each item for which the practice can charge. The insurance companies understand this translation from provider notes to language.

Your medical billing system helps by suggesting codes based on the practitioner's documentation and/or providing coding professionals access to the original notes and any lab results or other relevant clinical information in the patient's record.

Finally, suppose a coder is still unclear on how to code a particular item. In that case, they can query the health care provider through the EHR or CRM software communication portal for needed details.

Step 3. Preparing the Claim

Once the codes have been assigned, the proper claim forms must be completed. These vary depending on the type of insurance the patient carries and the practice that provided the care.

These forms allow you to present the information the insurance company needs in the format they require for processing your claim. Your billing system helps by ensuring that you don't leave necessary fields blank or put the wrong data type into a particular field.

Step 4. Review and Submit the Claim

Codes are done, and the claim form is complete. If you outsource your billing, a professional will thoroughly review the claim form before submission. If not, this part of the process is done by you or a member of your administrative staff.

You've followed the procedures, and your medical billing system should have prevented common errors, but it's still important to look everything over before submitting a claim. If there is a mistake in the paperwork, you lose precious time to submit a correct claim in the allowable window during which the insurance company will pay. It is far more efficient to take a moment now than to rush ahead with a claim that will be rejected.

Step 5. Revenue Collection or Claim Rejection

After your claim is coded, reviewed, and submitted, you should be paid.

If the insurance company pays for covered expenses, but there is a patient responsibility for an unpaid balance, you'll need to bill the patient directly for the difference. In this case, you have all the necessary information in your medical billing system to create and send an accurate and detailed bill easily.

In the case of claim denial, you should be able to examine the patient history in your EHR and RCM system and pinpoint the cause of the problem with relative ease. If you have to make a correction and resubmit the claim, the system can help you do it quickly.

Ways That Medical Billing Systems Improve Your Practice

You can see how RCM and EHR systems increase the efficiency of routine administrative tasks, from data entry to scheduling and billing. The right software lowers costs, prevents common errors, and improves patient care by better managing information and patient records.

Centralized Patient Data

Another benefit of a good medical billing system is keeping all the data secure in a central location where everyone who needs access can find it.

For example, if a patient has multiple health care providers, the patient's records are available to all of the people involved in the patient's care. This makes collaboration easier, ensures that each practitioner knows all treatment being received, and promotes more accurate diagnoses and better patient outcomes.

Reliable Revenue

Accelerating the claims process and reducing the incidence of claim denials improves your bottom line. Your cash flow is stable and predictable when claims are processed successfully on the first submission and paid in a timely fashion. You're not leaving money on the table due to errors or running over submission deadlines.

Data Analytics

Data analytics is simply the process of reading and interpreting data to recognize trends. All industries use analytics, and it's no mystery why: Understanding emerging trends can make the difference between a successful business and one that limps along or simply fails.

If you miss the trends, you will miss opportunities.

In health care, you have business data just as with any other enterprise, but you also have patient data. By applying the art and science of analytics to this human data, you may quite literally save lives. Your database holds immeasurable amounts of data that can reveal unexpected trends in your patient population or the spread of an illness.

Without an accurate, well-documented, and searchable data system such as an EHR or CRM medical billing system, you can't take advantage of the ever-expanding field of analytics. Many systems and services include integrated analytics.

E-Prescribe and Telemedicine

You can access your patient records from any secure connection as a practitioner. If you need to prescribe in an emergency, you can do so from your home or wherever you happen to be. Some systems include or integrate telemedicine features, allowing you to "see" patients from remote locations.

Unsurprisingly, these features have grown exponentially in popularity in the past couple of years, and they are not expected to go away anytime soon. Remote visits can be convenient and cost-saving for the health care provider and the patient.

Electronic Referrals & Patient Reminders

Practitioners can save time and paper with e-referrals as well. Like prescriptions, referrals can be initiated through the system from anywhere with an internet connection.

Reminder notices can be automatically sent to patients to encourage them to schedule follow-up visits or to remember an upcoming appointment. Using the EHR system for reminders is far more efficient than requiring your administrators to call patients individually.

Effectiveness of a Medical Billing System

There are countless ways in which a good EHR and medical billing system improves the productivity and organization of your practice. From the moment a new patient requests an appointment to the collection of the final balance due, your billing software supports your patients, practitioners, and administrators.

When selecting a system for your office, choose software that suits your specific needs, ensuring that you will have the capacity to handle records, communications, and billing for the size and type of your practice. Consider future growth and compare features, services, compatibility, and price.

Search our database at Medical Billing Hub to find excellent medical billing system solutions for your unique needs. We can help you find appropriate software for a specialist office such as oncology or ophthalmology, a large urban hospital, a small family practice, or anything in between.


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