1. Claim Generation
While nearly all software options will offer some form of claim generation—after all, that’s central to medical billing!—research how claims are generated. Why? Well, claims are generated based upon rules and algorithms that assess the claim for insurance eligibility. Great medical billing services will have a knowledge base that updates with each and every claim they process, resulting in a software solution that automatically checks the claim against millions of insurance and regulatory rules.
2. Electronic Transmission
Again, this one is a no brainer in terms of inclusion, since practices are required to transmit the vast majority of claims electronically, under current HIPAA regulations. There are rare occasions, however, that require a manual claim. Research whether or not both options are available as software features, and how streamlined the process is.
Clearinghouses collect insurance claims prior to their being sent to the insurance company or other responsible agency, and double check the claims for accuracy. Any changes or corrections are made, and the claim is then forwarded. While some billing services do not use clearinghouses and advertise a shorter turn around period, the risk of claims being rejected en masse and repeatedly is very real. Whether you opt for a service that uses a clearinghouse or not, research and read reviews to find out if their system is accurate and efficient.
4. Following Up
Claim follow-ups, in the event of a denied or delayed claim, can be initiated by the software user, or may be automated. Any service you use should have a number of simple, automated follow-up processes that allow identifiable errors to be corrected and claims to be submitted without human intervention. Another nice feature is for software to automatically generate a query if the claim has gone unanswered for a significant period of time.
Don’t underestimate the importance of being able to access and manually follow up on claims as well, however. Is the interface intuitive? Can you reach the information you need quickly and efficiently, without undue confusion?
5. Reporting Features
A diverse set of features, options, and presentations fall under this category—which makes it all the more important for you to carefully examine the reporting features of any medical billing software solution in which you’re interested. There are several important considerations. The first is whether or not the software can generate the types of reports that you find necessary, or helpful, for your practice. Accounts receivable reports are necessary for nearly all offices. Statistics like the number of patients during a specific time period may be less important, depending upon your particular priorities.
In addition to making sure the software offers the type of reports you want, and generates them with ease, check on how these reports can be shared and exported. What formats are available? How easy or difficult is it to email or otherwise share these reports with the necessary parties?
One of the best ways to check out the availability of these and other key medical billing software features is to visit TopAdvisor.com’s Medical Billing Software Guide. It’ll give you an overview of important considerations when choosing software, while providing you with profiles of the top solutions in the industry so that you can easily compare them side by side.