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Medical Billing Software

Steve Verno, a seasoned medical billing professional shares the following with us about medical billing software:

Medical Billing requires billing software so we can:

(1) Send claims
(2) Send Statements
(3) Electronically document the visit with icd-9 and CPT codes
(4) Document incidents that occur with the account
(a) Patient calls
(b) Non-patient calls
(c) Correspondence received such as subpoenas, medical record requests, denials, attorney requests for statements/records
and how we responded to these incidents.
(4) Scan charts, EOBs and other correspondence.
(5) Perform claims followup and to complete the claims adjudication process.

Physicians Offices use practice management software to manage patient appointments and electronic medical records and if using their own in-house billing staff, submit claims and to do their own inhouse billing.

The big question new billers who want to work out of their homes or offices, want to make sure that the money they invest is done wisely.

Software can be very expensive. Some billing software programs can go as high as $200,000 or more. Some can go as cheaply as $600. There is the thought that the more expensive the software, the better it is. But, this is not necessarily so. You can buy a $500 car and it gets you from point a to point b. You can buy a $1,000,000 car but if it doesnt get you from point a to point b, what good is it to you?

There are so many software choices out there. You have Lytec, Medisoft, Versyss, Unisys, Medical Manager, Centricity, Collaborate MD, Zirmed, EBC, and many more. I cant name them all, there are so many. If you google medical Billing software, you get more than 5,000,000 hits.

I used to use Lytec since 1994 but I havent used it for several years and they made many great changes to it. I liked it because it was vey easy to use. I was also the systems manager for Medical Manager, but its been 5 years since I used it. A couple of minutes behind the keys will get me back to normal again. Ive also used Centricity and a billing company that worked for my provider used EBC.  The last I used was Zirmed. Very simple to use with almost no training. I have seen Collaborate MD at a seminar and I liked what I saw. I wont mention the ones I didnt like because I dont want to be sued by those companies. You see, if you provide an opinion, and it is not favorable, the software owner, distributor, or creator considers it as slander. So, to play it safe, it is best to not make a comment about the software.

Buying software can be a gamble. There is no 100% guarantee. Its like buying a used car as is. Once you drive it off the lot, the problems are now yours. Some software companies provide free demos you can download and play with. Most demos allow you to play with up to 3-4 accounts. The demo does everything that the real program does. You can buy an activation key which makes the demo a live program. if you wish to send claims electronically, you need to hire a clearinghouse. The software may be able to be used with different clearinghouses or it may be restricted to one clearinghouse. Like software, there are many clearinghouses. With a clearinghouse, there will be startup costs, monthly costs, and a per claim cost.

When I checked out a billing software, I would call their customer service line at different times per day. It would see how long it would take to get through to customer service. Customer Service is an additional cost you will face. Ive seen it as low as $600 per year. It can go higher. We once paid the $600 fee and after doing so, the customer service department said they couldnt answer our question. It took letters to the software CEO, the BBB and FTC to get our money back. After all, why pay for customer service if they cant answer our question. If I couldnt get through to customer service, then there was no need to obtain the software. This is because if we had a problem and we ouldnt get through to anyone, we were stuck and that costs money.

Do you and the doctor need the same software? It helps. But, if not, you need to enter data you get from the doctor, manually, unless the doctor has the ability to export the informaion and your software allows you to import the data. You may have to tweek the data so that the fields exported are the same as your import fields. For example, in the doctors software, field 1 is the last name of the patient and in your software, field 1 is the account number. To make the appopriate changes, I would use Excel and move the fields around. Then I would save my work as an ASCII file. I would find the field files so that if mistakes are made, i can delete the bad one. You dont want garbage into your software because if you input garbage it outputs garbage. The term GIGO means garbage in, garbage out. Garbage out is money loss.

Now, speaking of clearinghouses, as I stated, your software may allow you to send your claims file to random clearinghouses, and it may restrict you to one clearinghouse of the software company's choice. There are also many clearinghouses out there. Some examples Ive seen are ANS, Availity, Emdeon, Ingenix,Proxymed, and Zirmed. I do not endorse any of these companies. I have worked with Availity and Zirmed and liked both. When using a clearinghouse, your billing software creates an electronic file of claims you send to an insurance company. The file is sent to the clearinghouse. The clearinghouse scrubs the file for errors and distributes your claims to the insurance company that the clearinghouse contracts with to send claims to. Each clearinghouse has a list of insurance companies, also called a payor list, they send claims directly to, electronically. For example. ABC Clearinghouse lists Aetna, Blue Cross, Cigna, Humana,Medicare and Medicaid. If you need a claim to go to Aetna, you will set up your billing software to show Aetna as an electronic claim using an electronic number for aetna supplied by the clearinghouse. For example Aetna may have number N3562 (Made Up NUmber). This number is called an NEIC payer number. The clearinghouse should be able to provide you with a payer list before you sign a contract with them. Your software may process electronic claims first and paper claims second. Lets say you need a claim to go to Sunrise insurance. ABC Clearinghouse does not send claims to Sunrise. You do not set up Sunrise as an electronic insurance. You can print the claims yourself or you can contract with the clearinghouse to print and send them for you, naturally at a cost to you. Some insurance companies may allow you to send claims directly to them via their website, but this may be reserved for doctors that are contracted with the insurance company.  When doing this you need to find out how you will know whether the claims were received because some do not provide anything.  You later find out the claims were not on file.  Its always important that you verify, verify, verify everything. 

When using a clearinghouse, there will be a contract for your to review and sign. Some clearinghouses want a set up fee. Lets say ABC Clearinghouse charges a $500 set up fee per provider. YOu have 3 providers, your set up fee is going to be $1,500. This is before you send any claim. Some clearinghouses also charge you on a per claim basis. This can be anywhere from $2.00 to $10 pe claim. It varies, so ask for all expenses ahead of time. When you contract with a clearinghouse, make sure you get a report showing the claims were received by the clearinghouse. Also ask for a report showing that the insurance company received the claim. There is nothing worse than checking the status of your claim and finding out the insurance company says it is not on file. You also want to have your contract specify what happens when the insurance company denies receipt of the claim. I made the clearinghouse contact the insurance company or resend the claim for free. But, I wanted them to work with the insurance company. The receipt reports were helpful when I contacted the CEO of the insurance company and the regulatory authorities for a possible violation of State insurance laws.

As we always recommend, do your homework, but you can only go so far. Again, there are no guarantees for 100% satisfaction. Make sure your medical billing service agreements and contracts are specific, that they address your needs, that they address resolution issues and they work for you. As always, have contracts reviewed by an attorney for your protection.

(Reprinted with permission from the author, Steve Verno, Medical Biller)

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