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Marc Klar

By: Marc Klar on October 20th, 2017

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Top Questions to Ask When Looking for Medical Billing Software

Medical Billing / RCM

You may not have gone into medicine primarily for the money, but that doesn’t mean that you have to ignore economic realities, especially when it comes to getting paid in a more timely manner.

Once your team has provided medical services to a patient, it’s time to make arrangements for payment. Actually, with the correct software, making payment arrangements, ensuring the provider is recognized by the payer, and verifying coverage is in effect can all happen before services are provided. At the very least, practices and groups should be able to rely on automation to ensure optimized income flow and for getting paid for services rendered.

Chief benefits of medical billing software include real-time claim tracking and a feature that allows your staff to manage any denials, right on the spot. If it includes an ability to handle multiple Tax IDs, has master patient index (MPI) architecture, and solid tools to enable you to generate customized reports and work with analytics to discern patterns in your financial and operations, so much the better. Getting the correct medical billing software for your group or practice can be tricky. The five questions presented should help make for a successful billing software search.


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Question 1: How Are Updates Handled?

Good medical billing software cannot remain static and unchanging. For that reason, you'll want to ensure that the vendor has demonstrated a commitment to keeping the application updated on a regular basis. The longer the vendor has been in operation, and the more years their software has been in the field, the better the chances are that keeping it updated isn't a problem for that vendor.

Chances are also good for well-established vendors that updates -- which also includes those that are governmentally mandated -- will be provided for the entire software lifecycle.

Make sure updates and version enhancements won't cost extra, but instead, are covered as part of (1) having a current support agreement for customer-hosted systems, or (2) are provided by way of having a current cloud subscription.

Question 2: What Do You Have in the Way of Training for Our Staff?

Your new medical billing software is only as good as the end users who have been trained in working with it. Make sure to ask the vendor about what type of training they offer. You'll want your staff to use the software as fully and comprehensively as possible in order to take advantage of all of its timesaving features.

See if training can be role-based or if the vendor only offers set, rigid training that may work best for the vendor but not you.

Question 3: Does it Have any Reporting Capabilities, and if so, What Kind?

You’ll want a system that generates both cursory and detailed management and financial key performance indicator (KPI) reports, statistics, and analytics in any number of user-defined formats, displays, and dashboards. An ability to drill into specific “pieces” of reports for details is critical, as is empowering users to compile and save personalized report parameters, and then have reports be automatically compiled on specific days / times, etc. without having to “reinvent the wheel” every time.

Compiling reports should be able to be limited to specific staff members / roles by login since not all team members are generally given permission to access any report they’d like. Having a background audit trail “watching” and keeping tabs on system use is of the utmost importance, especially when it can also track which users are generating what reports, and when. It’s equally as important that users themselves know that compiling reports is something the audit trail is monitoring.

The last point on reports is this: are reports easily generated or do users need doctorates in computer programming? Obviously you want the former, not the latter. You also don’t want the system to require expensive, add-on report writing utilities for which an on-staff PhD programmer might also be needed. You want a system that can compile comprehensive reports easily as part of the program, and that are exportable to Excel™.

Reports and data are the backbone to any medical practice or group, as they are to virtually any other business. You’ll want to know the good news and where things are going well, and also areas that could use improvement. A solid reporting capability should open eyes when needed.

Question 4: Does it Integrate With my EHR System?

If you like the electronic health record or EHR system that you already have in place and only need a more comprehensive billing / practice management system, you’ll need to see if the PM system will integrate with the EHR. Ideally, it would be a bi-directional integration. The idea is you shouldn’t be forced to drop your EHR in order to implement a better billing system than the one you have now.

So, make it a priority to ask the billing / PM system vendor about that, if that’s a concern for you. You certainly don’t want to end up with two disparate systems that aren’t “talking” to each other. The other option is to explore the billing vendor’s EHR solution if they have one, if only for comparison’s sake.

If you work with two separate systems, you’ll want to be assured that the interface with the EHR will enable a clean transmission of encounter data from it to the billing / PM system so that claims can be quickly submitted. Of course, both systems from one vendor would assure that.

Question 5: Can the Billing / Practice Management System Accommodate Your Unique Requirements?

Some things are needed no matter what the scenario. For example, any practice that accepts insurance (most practices) should want an ability to obtain alerts when scheduling appointments if the selected provider isn’t recognized by the patient’s payer heads off a very bad problem from ever happening. A scheduler that supports pre-appointment batch eligibility verification is another for ensuring everyone arriving for their appointment is covered. So is having a denial manager and real time / any time access to claim tracking.

Besides these commonly-needed capabilities, there are so many variables in what any practice or group needs, either by specialty or multiple specialties and the numbers of providers / system operators / locations involved. What if any of these need to be increased? Can the system accommodate growth when needed?

Do you need multiple tax IDs or a single tax ID? Do you prefer a cloud or a customer hosted implementation? As mentioned previously, can you get the billing system without having to also get the EHR that goes with it if you don’t want another EHR?

Are UB, workers comp, and / or no-fault claims needed? What about a capability for managing patients’ attorneys and multiple cases per patient? Does your practice sell products and / or provide non-medical services for which sales tax needs to be calculated with inventory management? Is yours a specialty where payments by gift cards or coupons is needed? Do you do marketing and need a CRM to help manage and report on those efforts?

Do you need texting of appointment reminders, or a credit card authorization utility, or an ability to scan patients’ insurance / drivers’ licenses for effortlessly capturing their data? Or are those not needed / wanted?

There are so many different ways to go. The billing / PM system should be flexible, versatile, and all-encompassing enough to handle exactly what works for your practice or group…not what works for the vendor.

Key Takeaways:

  • The software is only as good as the vendor behind it, and then only if it's updated and kept relevant.
  • The best software in the world is useless if the people operating it aren't trained properly, and aren't using it to its fullest capacity.
  • Your group or practice is a business, and like all businesses, you can't operate in the dark. You need solid financial and operational data to thrive and be successful.
  • The system must be non-proprietary and able to integrate with any number of systems, including EHRs.
  • Your practice or group had its own unique needs; without question, the billing system must satisfy those needs, not the vendor's needs.

These top five questions are intended to help you start the conversation among your stakeholders and the medical billing software vendors you're considering.

It’s inevitable that more questions will arise as you consider your options for medical billing software. You can remain current and gain more insight into medical billing software and technology issues by clicking here to subscribe to the blog.

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About Marc Klar

Marc was introduced to medical software sales after several years working in operations, management, and sales in the NYC hotel industry. He quickly learned the medical industry/software and more than held his own in sales. He got into assisting with marketing, created new business development teams and marketing programs with two different vendors, one of which became the largest vendor of that system in the country for three consecutive years. He then moved to Advanced Data Systems; as VP of Marketing, Marc oversees the company’s entire marketing effort. Among other things, Marc enjoys reading, cooking, and performing comedy which sometimes isn’t funny for him or his audience. He has an appreciation and respect for good music and art (where an apple is an apple…not someone’s head). Marc became an accomplished drummer and teacher after studying with some of the top jazz drummers in NYC, all as a result of being told since early in life to “beat it.”