How to Select the Right Software Vendor for Your Medical Billing Services?

How to Select the Right Software Vendor for Your Medical Billing Services?

Medical Billing and Revenue Cycle Management are integral parts of the healthcare industry and are one of the professional technological solutions that healthcare workers rely on frequently. If, for instance, the billing fails in a reputed clinic, then every operation that happens on a day-to-day basis fails. Often, many billing services companies fail to provide or delay the expected outcomes owing to not having a proper software. The impact of such a disappointing result can indeed cause a severe loss to the company. However, finding perfect off-the-shelf software for a billing services company is almost uncertain but never impossible.

A comprehensive Practice Management Software (PMS) or Revenue Cycle Management (RCM) could be the ideal solution for the moment, but maybe not for tomorrow. The combination of people and technological advancements makes a perfect solution for billing companies. Keeping this in mind, a billing company must consider several factors when selecting Practice Management Software for RCM services, and a few such factors are as follows.

Know the Audience & Your Business Goals: 

Like any other business organization, outsourced billing companies want to grow, attract more clients, and have as many growth opportunities as possible. Therefore, when you’re supporting new specialties, entering a new market, or wanting to work with large healthcare organizations, your current process & features in the software will not be sufficient. If you take the example of Ambulatory Surgery Centers (ASCs), you need to submit state-specific claim data reports, which perhaps your firm might not be equipped entirely with. Thus, you need to find a flexible company that can assist you no matter the situation. You may also want to ensure that you get feedback from their existing clients & partners in such scenarios.

Select the Right PCM or RCM Software: 

If the RCM software you have chosen fails to solve your complex RCM problem, there is no point in relying on it. In other words, it is clearly a waste of money and time. The notable features that you need to keep an eye out for in Practice Management Software include:

  • Should have a robust patient appointment scheduling
  • Should be efficient in managing patient accounts
  • Easy to use and navigate the billing process
  • Intelligence to identify potential errors in advance to eliminate any claim denials & rejections
  • Capable of automating various stages in the claim life cycle and tracking them and
  • Supports the HIPAA transactions code sets and standards

The software should be able to address most issues on its own rather than the concerned individual always relying on the vendor.

Compliance & Regulation: 

The healthcare sector has its own challenges and shortcomings due to its developing nature. For instance, periodically, many software solutions are becoming outdated, and companies are shutting down as they cannot meet such changes. When it comes to billing software, it is driven by HIPAA & ANSI X12N EDI standards & their own transaction code sets. Recent significant changes include ICD-10 support, X12N v5010 EDI support, HCFA-1500 02/12 & UB-04 paper claim form updates, Medicare Beneficiary Identifier (MBI), and NEMSIS v3.4.0. The future successive changes in this industry shall be X12N v6020 EDI, National Health Plan Identifier (NHPI), Electronic Prior Authorizations, and Electronic Claim Attachments. Therefore, you should find a software vendor that understands the industry well & has a consistent track record of successfully implementing such changes to their software.


How often are you going to call at midnight for support? Medical Billing is a process, not a moment. It is imperative to understand what kind of support you will need. Also, if you notice, most of the Level 1 kind of support issues, good billers can handle themselves. So, why should you pay extra for something you do not need? Hence, ensure you find the turn-around time for every issue, such as level1, level2, or level 3.

Special Pricing & Cost structure for billing companies:

Some cost factors are associated with Cloud Based/SaaS models, including monthly subscriptions, small one-time setup fees, and data migration fees. A few popular monthly subscription-based pricing models are provider/account based, claim based & collected on a revenue basis. Billing Service companies have grown over the years. They spend lots of money on sales & marketing efforts to acquire clients and have the potential to bring hundreds of clients in the future. So, Billing Companies deserve to have unique cost structures and relationships with the software vendor.

Contract & Termination Clause: 

It is common for software vendors not to impose long-term contracts in a cloud-based model. However, it is natural to want to work with a software provider or a partner for a long time. In addition to that, after you stop using the software, you need to also find out who owns the data. It is the clients that must own the data, not the vendor. While signing the contract, find out what kind of exit policy the software vendor has. Sometimes, certain policies might not allow you to get out if you are dissatisfied midway through, or to redeem your money if you find out you are locked in for a year. In this regard, it is prudent to choose vendors who have quarterly or half-yearly exit policies. 

In your quest to find a medical billing company that can fulfill most of the points listed above, you will discover that most companies fall short in some way. With our customized tool expEDIum, iTech Workshop not only fulfills the pointers but goes beyond them. As we strive for goodwill and favorable customer feedback, we ensure high quality and operations standards. With this approach, we have established long-term partnerships, and we’d love a chance to run a pilot project for you so that you can know the benefits for yourself.