Medical billing software was once considered the preserve of established healthcare facilities. But that was long before medical practitioners truly appreciated the significance of these cutting-edge technological solutions. Today, many hospitals rely on medical billing tools to improve their revenue cycle performance for optimized performance and efficiency.
The surging demand for medical billing systems is evidenced in a recent market survey by Grand View Research, which estimated the global medical billing software market size at USD 16.34 billion in 2023. Findings from the same survey indicate that the industry may record a compound annual growth rate (CAGR) of 10.2% from 2023 to 2030.
However, picking the right software may be challenging for newbies with dozens of medical billing systems.
Fortunately, we’ve outlined the critical factors to consider when selecting a medical billing provider for your practice.
1. Analyze the Scale of Your Practice’s Needs
Medical billing systems vary depending on the scale of work they’re designed to handle.
While some billing software can effectively manage larger medical practices that cater to hundreds of patients daily, others specialize in smaller facilities.
However, since “size” is relative, the thumb rule is essential when picking a medical billing company based on its ability to handle your practice’s number of physicians and daily patient volume.
2. Consider The Provider’s Technical Expertise
Coding errors account for a significant percentage of billing denials. Therefore, choosing a medical billing company with demonstrated coding experience makes sense.
Look out for providers that work with professional coders accredited by the American Academy of Professional Coders (AAPC). The coders should preferably demonstrate proficiency in the International Classification of Diseases (ICD)-10 and the Current Procedural Terminology (CPT).
Besides coding skills, look for evidence of other technical competencies, such as medical insurance knowledge and experience dealing with varied patient billing scenarios.
3. Insist On Specialized Providers
When it comes to medical billing systems, jacks of all trades simply don’t cut it.
Shun companies that purportedly “cater to all medical practices.” Instead, insist on those with evidence of specialty in your field.
If you run a dental practice, you’ll be better off with a medical billing system that caters primarily to dentists.
4. Assess the Range Of Services Offered
While selecting a medical billing system specializing in your field is prudent, ensure the company provides a suite of end-to-end revenue cycle management (RCM) solutions.
Choose a billing system that handles everything, from patient registration to claims processing.
By automating the entire medical billing process, you can free your staff from repetitive tasks and redeploy them to other critical departments.
5. Sample Reviews and Testimonials
Many medical billing companies describe themselves with fancy adjectives like “reputable” and “credible.”
However, these could be nothing but overly hyped marketing clichés.
To prove that a medical billing provider is truly reputed, sample testimonials from their previous clients. Pay attention to reviews posted by individuals in your area of specialty.
6. Check for Regulatory Compliance
The right medical billing company should comply with regulatory protocols and best practices.
Working with such providers offers the peace of mind that your practice’s protected health information (PHI) will be handled professionally and strictly conform to the industry’s standards.
A good starting point is to check for adherence to the Health Insurance Portability and Accountability Act (HIPAA) specifications. Compliance with other relevant protocols, such as the Anti-Kickback Laws, is an added advantage.
7. Prioritize Scalable Solutions
Despite your practice’s current size, the facility might grow and require more robust medical billing solutions. Switching between billing providers can cause severe operational downtimes and software incompatibility issues, both of which can hurt your bottom line.
Therefore, picking a medical billing system that can grow with you is essential.
Look out for companies that offer different packages that you can customize to meet your practice’s changing needs.
8. Examine Software Compatibility
If your medical practice already uses internal patient management software, you’ll want to pick a billing system compatible with your existing apps.
Otherwise, you may incur extra costs transitioning to new software. Not to mention the time required to train your staff on the latest tools.
Experts recommend consulting your employees before integrating a new medical billing system into your practice. To optimize your workflows, the intended users of the software must find the tool considerably user-friendly.
9. Inquire About Handling Rejected Claims
Medical claims can be declined for various reasons, from filling out incorrect information to missing the claims deadlines. Statistics indicate that up to 65% of medical billers do not resubmit rejected claims.
If not followed up, declined claims can cause your practice untold revenue losses and reputational damage. Therefore, you deserve a medical billing system with elaborate systems for resubmitting rejected claims.
It’s also prudent to assess a medical billing system’s prevalence of declined claims. More rejections indicate serious billing and coding problems, which is a sufficient justification to switch to a new provider.
Final Thoughts
Medical billing is inherently complicated and resource-intensive. However, with proper software, you can automate the process and focus on improving other operations in your practice.
Remember that each healthcare facility is unique. Understanding your needs is the most critical step in determining the suitability of a medical billing system.
Prioritize billing providers that align with your practice’s current needs and operational budget while providing the flexibility to scale as required.
