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Medical Billing Software: How to Build a Modern Custom Solution?

  • 15-16 min read
  • September 20, 2021
  • 👍 Rating — 5 (3 votes)

With the widening of the services of your medical organization grows the number of daily finance operations. Hence, most medical entities felt an urgent need for accurate management and control of all payments provided within their clinic so that medical workers do not spend much time checking each bill and a medical facility could avoid confusion and money losses. 

In this article, we will talk about the universal software solution that is able to structure and track all financial operations and is called medical billing software. Keep reading to find out why this type of medical software is a must for clinics and how to implement it easily into one of them.

What is medical billing software?

To begin with, let’s figure out what medical billing software is and how this type of healthcare software system is allocated. Basically, medical billing software is an additional app to other already integrated software solutions, this add-on is responsible for automating and managing all billing processes within the medical organization. Commonly, the process of tracking the payments is called a revenue cycle that applies to an entire financial system of a particular healthcare establishment that should be well-managed in order to optimize the process and ultimately better financial performance. 

The revenue cycle actually begins with registering a patient in an internal medical system. This cycle collects all data about a patient’s health, medical services, and tracks all payments that were approved and paid to clinical workers, meaning medical service providers. Medical billing solution aims to make all medical systems interoperable, particularly health insurance billing software, patient systems, hospital billing system, and physician systems. 

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Medical billing
Commonly medical bills contain a large number of errors that lead to huge monetary losses for medical entities. Due to Healthline, the probability of mistakes in medical payments can reach 80%.

The must-have features of a medical billing solution

Appointment Scheduling

The main function of medical software is the ability to schedule an appointment online that would be connected to billing. There is no need to go to the medical building to schedule a visit with your doctor, so the medical software platforms make this process convenient, smooth, and easy for every patient. This option also lets hospitals record all visit information and alert patients about cancellations in advance. 

Patient Pre-Registration

As the revenue cycle starts from the registration of a patient account, the medical billing app incorporates the option of pre-registration. It means that a future patient of a particular medical entity should fill the form to provide the clinic with the insurance information before an in-person visit is scheduled. Thus, all patient health information will be linked to the insurance plans and billing for further payments of medical services. 

Medical Claim Management

Billing software for doctors is tasked with managing all medical claims and payments for medical services to avoid confusion and mistakes that can cause payment delays. Healthcare billing software helps to automate this process and reduces potential risks and problems. Among the features that the billing system provides for medical claim management are:

  • digital claims; 
  • monitoring of all claims;
  • availability of claim history;
  • contact information of insurance workers as a part of health insurance billing software.

Hence, you can easily track and approve all claims and track their processing in order to control all payment operations. 

Automated Coding and Claim Resubmission

Commonly, the number of treatment courses and their details is huge and really complex to remember and handle manually. Medical billing software automates the coding of treatment details for each patient so that the claims would be accurate and appropriate. That usually helps to save time and avoid resubmission of different claims that can lead to even more confusion. However, in case a claim needs to be rebilled it can be easily performed by your medical billing system.

Encryption and Security

A high level of security is a must-have feature for all digital medical systems, and medical billing software development provides just that – security. All medical software solutions should consider governmental privacy laws, particularly HIPAA regulations. This law protects patient health information by requiring software security options from all medical systems. 

Reporting

Custom medical billing platform provides data analytics and eventually generates reports based on this analysis. It usually analyzes all previous/historical as well as current claims monitors the general revenue, and provides an eagle view financial report on the state of the healthcare facility as a whole. 

User-Friendly Interface

Along with the necessary functions of your medical billing system, it is also vital to make sure that your software solution is convenient and easy to use for your staff. It will reduce the time spent for training your medical workers and administrative staff on how to use the system and your healthcare entity can get to work as soon as possible after the integration stage. 

Credit Card Payments

The ability to accept credit card payments is one more vital function for medical billing software as this method is widely used by patients. 

Support of the development team

Shortly after the implementation of medical billing applications into your organization`s workflows, your software solution may need some improvements or tech upgrades due to the constantly evolving nature of the tech world in general and the software market in particular. Thus, before choosing a software development company for your project, make sure that they offer continued maintenance services for your software solution and are nimble in being able to act and also react quickly in fixing any errors to avoid any serious consequences. 

We also encourage you to watch the video below where a medical biller describes the operations and tasks that should be executed by her as the person responsible for medical billing within a medical organization every day. The clinic this medical biller is talking about has an internal software solution but doesn’t have medical billing software development so all financial processes are handled manually. 

Benefits of using a medical billing software

Medical billing app needs to be implemented in healthcare entities for the purpose of optimizing financial operations and making them better managed. There is no need to build out a separate application as medical billing software can be integrated into existing health software systems like EHR or EMR. You may ask why your internal system requires the implementation of this type of software. So we would like to provide you with the key benefits of using a medical billing software solution. 

Cloud services

Basically, there are two types of medical billing systems – web-based and cloud-based. The fact is, most organizations of different industries migrate to cloud-based software as it is much more efficient for the workflows, and we would like to explain why. A cloud-based medical billing solution implies gathering any amounts of data without allowing it to get mixed up.
or lost. Moreover, all your data will be encrypted and securely stored. It can also be accessed from any location, even offline, and can be exchanged with other medical systems that consider interoperability. 

Automation of the operations

The primary goal of the medical billing app is to reduce paperwork and engagement of human resources by automating particular financial operations so that medical workers could have more time for other, no less important tasks. So what operations can be automated with this type of healthcare software? These are:

  • notifications about upcoming and executing payments;
  • verification of insurance before the patient arrives ( pre-registration function);
  • digital claim submissions;
  • available patient billing records; 
  • individual validation of claims by patients.

Payment Options

Medical billing systems provide the option of payment processing and payment plans for all patients who have their online accounts/portal logins set up with the medical institutions. Patients can wire payments for medical services from the comfort of their homes in advance for upcoming or past treatments. Patients can also set their individual payment plans to automatic payments for the procedures they are going to receive by linking their card to their electronic medical account. Thus, the likelihood of lost, misplaced, or missing payments will be decreased or eliminated. 

Best medical billing software


NextGen
NextGen is a web-based healthcare software solution that is tasked with structuring the medical services, including the billing process. It is an entire medical internal system that includes Electronic Health Records, interoperability with other medical systems, data analysis, and financial management. Among the common functions, we would like to note are:

  • patient data exchange;
  • claim management;
  • billing management;
  • appointment management.

NextGen can provide a medical entity with a free trial period, though, in case the entity wants to continue using the software services, they will have to go ahead and start paying the monthly fee according to the chosen pricing plan. 

SimplePractice
SimplePractice is a cloud-based software solution that aims to automate daily operations within one healthcare organization in order to provide better interaction with patients\customers. It is suitable for small and medium-sized organizations and can help them with the following functions: Appointment scheduling and reminders;

  • claims management;
  • portal for patients\customers;
  • compliance tracking;
  • payments tracking.

SimplePractice offers two pricing plans that provide different options for healthcare facilities and pricing ranges from $39 to $59 every month. 

TheraNest
TheraNest is a web-based medical solution that is tasked to reach mental health treatment. This software is a great tool for providing telemedicine. Along with the EHR option, it also offers management of all financial operations conducted within the organization. Talking about pricing plans, TheraNest offers a free trial month but then you should pay at least $39 for each feature you would like to add and use in your medical entity. 

What is the difference between on-site and cloud-based medical billing software?

As you might have noticed, medical billing platforms can be divided into web-based and cloud-based systems. So here comes a question if there is a real difference between these two types of software and which one is supposed to be better in most cases. These days most business software solutions are cloud-based systems as it is much more beneficial compared to web-based solutions. In addition, we would like to highlight what these benefits actually are:

  • Collaboration – a cloud-based system is accessible from anyplace, anytime; there is no need to wait for a response from other branches of a particular organization as each medical worker can have access to a single database where all of the entity`s documents, records, and information is stored;
  • Data security – the healthcare industry differs from others namely by its high demand for data security and privacy, medical workers should care about the privacy of all electronic health records and the cloud is a good solution for those demands, the deal is that the cloud can be accessed with the use of special passwords and other authenticators like fingerprints and face IDs, etc;
  • Regular system updates – as the medical facility cannot own cloud as it is a service and managed by the service provider, this service provider is also responsible for regular system updates in order to fix system errors, bugs as well as improve the overall level of services;
  • Flexibility and scalability – cloud-based software is surely flexible as its functionality can be widened up to your needs because of a growing number of daily operations, information, and workers, you also don’t have to think of these changes and their execution as it is the responsibility of your service provider.
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Cloud-based software
Apporximately 90% of healthcare providers use cloud-based software solutions.

Ways to integrate medical billing software into existing EHR

If your medical organization has already employed one of the EHR or EMR systems, billing software can become an addiction to this solution and can be integrated into your common workflows. This billing software can be provided by the same vendor or you can choose any other medical billing application to be implemented into your entity. However, as both solutions are not individual-based and are used by many healthcare organizations at a time, you can face some challenges with the adoption of new billing services. 

First of all, there is no guarantee that the medical billing system you choose will suit your organization 100%. As this is a ready-made solution it cannot be customized up to your demands so cannot provide your organization with the highest possible boost to productivity levels. 

Secondly, nobody promises that a third-party billing solution will work correctly in interaction with the existing EHR even if both are provided by the same vendor. Of course, we are not telling you that errors or inconsistencies are certain to arise, but the guarantee is quite weak. 

And finally, the decision to choose the vendor for a medical billing solution is one to be taken seriously. It should be something that is easy to use by medical workers and works correctly and precisely in accordance with your daily financial operations needs in order to avoid any confusion about money-related matters that could potentially trigger harmful consequences such as financial losses and arguments.

How to build a custom medical billing system?

Before we will talk about the development of medical billing systems as a custom part of the existing EHR solution in your medical organization, let us first describe the flow of a single financial operation within one medical entity so that you can understand how medical billing solution actually improves it and why it is vital to make it customizable. 

Let’s imagine a situation when a patient gets a certain medical service (procedure) under his or her insurance plan. In case a medical billing system is absent, a clinician has to create a needed document within the personal EHR and send it to the clearinghouse so that they could transfer the bill to the insurance company. Sounds a bit long and complex, right?

The medical billing system automates and manages this process. So a clinician just has to create a new recording in a patient’s EHR so that medical billing software could create the bill and send it over to the insurance company. Moreover, the medical billing solution updates the status of the payments, and also sends and saves invoices within a personal EHR. 

To make this process smooth and accurate, the development of a custom medical billing app will be the most appropriate variant for your medical office. As we have mentioned above, there is no guarantee that your vendor`s or other vendor`s medical billing system will suit your organization correctly and we would not recommend you to verify it for sure in order to avoid serious consequences

Custom software development implies building a solution from scratch considering the requirements and peculiarities of your healthcare facility so that no errors and confusion could prop up in this chain between clinic (EHR) and insurance billing software.

How to hire a development team?

All medical software solutions must be compliant with international and local regulations like HL7, HIPAA, etc. Hence, the first thing to consider when looking for the right software development company is to ensure that this software development company is aware of the required rules to be compliant with. Basically, there are some main things that one definitely needs to pay attention to when choosing a reliable software development company, where reliable is a keyword:

  • industry expertise;
  • technical expertise;
  • skills of developers that will be engaged in your project;
  • internal processes and project management tools;
  • feedback from clients;
  • post-implementation maintenance services;
  • MVP development;

To say a few words about the cost of the development of electronic medical billing software, it mostly depends on the range of features that your medical entity requires and the number of developers that will be needed to execute the development process. The average price of MVP would amount to at least $25,000 and the final sum will be announced on the further stage of the development.

GBKSOFT team is constantly abreast and aware of the latest novelties in the healthcare industry in order to make sure to keep up with the latest trends and integrate them into medical solutions we develop for our clients to adapt them to the most modern realities. We know the healthcare software requires thorough attention, particularly it is related to the privacy regulations that should be followed by any type of medical software solution. Feel free to contact our team to discuss the specialties of your medical organization and look for ways of automating the financial operations within your healthcare facility.

The choice of medical billing software program primarily depends on the peculiarities and requirements of a particular medical organization. The range of ready-made solutions is vast however most of them are really expensive and cannot be customizable. Thus, custom development would be a great fit so contact us for discussing your case. 
There are basically three different types of medical billing software – open, closed, and isolated. Open allows transferring the EHR with other healthcare organizations and doctors, close one forbids this data exchange, and isolated implies access to health data for patients only.
Medical billing software simplifies the process of payments for the executed medical services. It connects a clinic with the insurance company so that all payments could be automated and accurate.

To end up

As we have figured out, medical billing software can be easily integrated into the existing internal software systems like EHR or EMR. The decision is up to you if it will be a ready solution or custom development. Based on our experience, we are telling you that custom software is that area that definitely worth investing in once so that you can use it for years with the ability to improve and upgrade in case of need.

We recommend you schedule a discussion with our Business Analyst so that we together could find efficient ways of how to boost your medical organization’s productivity and automate the financial operations.

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Creator

Due to my Master`s Degree in journalism, I focus on the details while doing the research on the topic. My particular curiosity is about the latest mobile app developments that start in 2015 that make life easier and save much time to spend it more productive. I am an expert in reviewing and consulting web projects related to web applications, especially if they are connected with wearables.
Alexandra Rostovtseva

Expert

Being a proficient leader with over 10 years of experience in Project and Product Management, Business Development and Sales, I have strong skills in Negotiations, Crisis, Client and Risk management. Being an outstanding communicator I’m also a good mentor and leader in the tech industry. Experience and expertise are the key foundations in my ability to provide deep insights into the industry and as result I’ve also been published or was a contributor to several tech and business articles.
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