Medical Billing and Coding Software: Benefits and Challenges

With the average time between filing a claim and receiving payment approaching 7 weeks or more, the demand for cost-effective and efficient medical billing solutions is unsurprising.

This sector’s employment trends shed information on the future of medical billing and coding (MB&C) software. Hiring medical coders and billers, in particular, is predicted to increase by 8% between 2019 and 2029.

Customers frequently experience payment issues and billing inefficiency as a result of poor medical coding. As a result, one of the most significant advantages of using MB&C software is the capacity to reduce the amount of errors and claim denials.

Whether you are a physician managing your practice, a hospital executive, or a representative of a medical billing company, this evaluation will assist you in investigating the capabilities of various medical billing software and selecting the best solution to increase the pace of your cash flow.

What is Medical Coding?

The process of medical coding begins with a patient visit in a doctor’s office, hospital, or other healthcare facility. When a patient encounter happens, clinicians document the visit or treatment in the patient’s medical record and explain why specific services, materials, or procedures were provided. Medical billing and coding rely on accurate and full clinical documentation during the patient interaction.

What Is Medical Billing?

Medical billing refers to the procedure through which healthcare providers submit claims to payers and bill patients for their financial obligations. While coders are translating medical records, the billing process for the front end has already begun.

Front-End Medical Billing

When a patient registers at the office or hospital and makes an appointment, medical billing begins. Administrative staff members verify that patients complete essential papers and confirm patient information, such as home address and insurance coverage, during pre-registration. Staff should confirm patient financial responsibility after confirming that the patient’s health plan will cover the requested services and filing any prior authorizations.

Staff advises patients of any expenditures they are accountable for during the front-end medical billing process. Ideally, the clinic should be able to collect any copayments from the patient during the session.

When a patient checks out, medical coders get the patient’s medical records and begin the process of converting the information into billable codes.

Back-End Medical Billing

Medical coders and back-end medical billers collaborate to create a “superbill” by combining codes and patient information.

The superbill is an itemized document used by providers to generate claims. Typically, the form comprises:

Challenges in Medical Billing

1. Incorrect Patient Identifier Information

Even slight distractions might cause problems when inputting patient information into your billing system. However, every physician is aware that insurance companies deny claims on a daily basis for simple errors such as incorrectly spelling a patient’s name or reversing numbers on their date of birth.

There are two approaches to dealing with this issue and preventing it from occurring. The first step is to double-check each input you make to guarantee its accuracy. The second option is to use practice management software that automatically populates the patient bill based on their validated information. If you have patients enter their own information and confirm it with you prior to their first first evaluation visit, there is almost no danger of this type of error delaying payment.

2. Missing Information

Another typical error is failing to include important information on a claim, such as the patient’s date of birth or the date of an injury. Even if there is no erroneous information and the patient has coverage, a blank field can result in a rejection from the insurance company.

3. Improper Coding

According to research, one of the most prevalent and time-consuming errors made by physical therapy practices is incorrect coding of medical claims. There are various reasons why claims are incorrectly coded:

While underbilling and upbilling might be intentional, they can also be unintentional. The solution is to use a medical practice management system that includes coding automation that is kept up to date with the latest coding rules. Using software that can only list codes particular to each medical insurance company will drastically cut billing time and eliminate the possibility of errors. When your personnel can simply check up diagnosis and procedure codes, the likelihood of them making a mistake is considerably reduced.

4. Duplicate Billing

Sometimes one of your employees will prepare a bill for a patient, and another will do the same thing, not realizing that the bill has already been prepared. In that instance, there would be a double bill, perhaps resulting in multiple payments for the treatment and an irritated client.

The solution is automation, which can automatically generate a bill and detect duplication if someone attempts to generate another charge for the identical services and treatments.

5. Missing Documentation

To settle claims, every insurance company demands documentation. Without it, they may simply refuse a claim and return it to you, in which case you must produce the required evidence and resubmit the claim. Ideally, your billing software should make it simple for you to attach paperwork when submitting a claim.

6. Service Not Covered

Patient insurance coverage may vary due to a variety of factors, including a change in work. There may also be restrictions on how many physical therapy visits or treatments are reimbursed, and when a patient’s coverage is exhausted, they must pay out of pocket. Improperly charging an insurance company can cause costly delays and make collecting from the patient or their new carrier more challenging.

Key Benefits of Using Medical Billing Software for Your Medical Practice

1. Minimize Paperwork, Manual Work, and Errors

Paperwork in the medical sector is becoming increasingly obsolete, and even small clinics are choosing for a better, more effective means of handling invoicing and claims while minimizing the number of paper and physical forms required in a modern office. Medical billing software helps to significantly decrease paperwork and errors associated with manually filling out forms and securely keeping those data. You may almost eliminate paperwork in your practice if you have a medical billing solution in place.

2. Make Patient Information More Accessible

Paperwork in the medical sector is becoming increasingly obsolete, and even small clinics are choosing for a better, more effective means of handling invoicing and claims while minimizing the number of paper and physical forms required in a modern office. Medical billing software helps to significantly decrease paperwork and errors associated with manually filling out forms and securely keeping those data. You may almost eliminate paperwork in your practice if you have a medical billing solution in place.

3. Improve Claim Tracking

Medical billing software greatly aids in the tracking and processing of claims. The program can assist you in determining patient coverage, notifying you of denied claims, and guiding you through the procedure and timelines required for resubmissions.

Medical billing software will also alert you to coding problems or discrepancies in a patient’s file, which could result in an insurance company rejecting the claim. Overall, medical billing systems help to improve data quality and speed up the claims process, allowing you to get paid faster and send accurate bills to your patients.

4. Enhance Financial Reporting

Real-time reporting is an essential component of a strong medical billing system or a comprehensive suite of practice management tools, and it can assist you in measuring and demonstrating meaningful usage of patient health records. Reports can also be used to track the performance of your practice or clinic in order to improve the patient experience and increase efficiency. You can also view payment reports and do a more in-depth examination of claims and the profitability of your firm (and where your biggest losses are as well).

5. Streamline Coding

ICD (International Classification of Diseases) coding is in its tenth iteration (ICD-10) and is slowly becoming the standard, common coding system for physicians and medical professionals. A standardized set of medical codes assists in streamlining the coding process and ensuring efficiencies in individual practices. On a bigger scale, this classification system enables the development of a comprehensive database of codes that represent specific diseases or courses of therapy.

While it is still in its early stages, artificial intelligence (AI) technology is being utilized to streamline and automate coding and charting. AI can scan medical documents and extract key information for coding and billing. Automating the coding process saves time and reduces data entry errors, allowing records to be updated precisely.

6. Improve Patient Care with Payment Ease

The patient experience is quickly rising to the top of the list of medical practice priorities. As in retail or other businesses that serve customers, modern medical practice is focusing on patient care and long-term retention in a competitive field by delivering outstanding service and a smooth experience.

Payment convenience is a critical component of offering a seamless experience for patients. Patients demand more online and electronic payment choices, as well as patient portals that assist them in understanding their benefits and the bills they must pay for their care.

The Evolution & Future of Medical Billing

Medical billing procedures used to be done on paper with handwritten records, but with the introduction of new technology in the healthcare industry, the process has been turned into an electronic one. This has resulted in time and money savings, as well as fewer human and administrative errors.

Medical billing software has alleviated the burden of paper-based medical billing, which was labor-intensive, time-consuming, and prone to costly billing errors. Medical billing software has enabled clinics to manage a greater number of claims efficiently than was previously possible by transferring billing to an exclusively electronic format.

Technology will almost probably continue to shape medical billing. Many clients have come to demand quick service and simple access to information, as well as technology that simplify the patient experience and increase patient participation. Computer-Assisted Coding (CAC) and blockchain are two critical technologies that will play an important role in medical billing software.

CAC increases production while decreasing claim backlogs. It can assist clinicians in identifying gaps in clinical documentation and billing patients more swiftly. Implementing blockchain data storage in EHRs, on the other hand, might increase privacy protections, make information exchange quicker and more efficient, and give patients much more control over their personal data that is shared.