Selecting a Software Vendor by an Outsourced Medical Billing Service Company

Healthcare Billing & Revenue Cycle Management plays a crucial, role in Healthcare Industry and is a most fundamental requirement for healthcare providers. If billing fails, everything else fails. Many Billing Services companies are failing to provide the expected result by healthcare providers due to not having a right Software, and impact of such disappointing result can cause a severe loss to the company. However, finding a perfect off-the-shelf software for a billing services company is almost impossible.

A comprehensive Practice Management Software may be the solution for the moment but may not be for tomorrow. It is the combination of people and technologies make a perfect solution for billing companies. Keeping this in mind, a billing company should consider several factors when you are selecting a Practice Management Software for RCM services, and a few of such factors are as follows.

  • Know People & Your Business Goal: People means, people in the software company that shall be working with you closely. Like other Business Organizations, outsource billing companies want to grow, more clients, and no loss of any opportunities as much as possible. As you grow you face several technical & operational challenges. When you’re supporting new specialties, or entering a new market or wanting to work with large healthcare organizations your current process & features in the software will not be sufficient. For example, to handle the billing for EMS/Ambulance you need additional data fields, for Ambulatory Surgery Centers you need to submit state specific claim data report, to handle Public Health Clinic billing & Practice you will need extra features, unlike other specialties. So, you need to find a company which is flexible and the people involved are ready to help you on such business scenarios so that you can grow. Make sure you get feedback from their existing clients & partners in such scenarios.
  • Should have a great Practice Management Software: “Technology solves complex problems”, it is true, otherwise there is no point of using a software & you’re in trouble if the software doesn’t solve your complex RCM problem. In addition to supporting HIPAA transactions code sets, a right Practice Management Software should be easy to use, easy to navigate the whole billing process, easy to manage & navigate the accounts, accessible, should have a robust appointment scheduling, should be efficient in managing patients, intelligence to identify potentials errors in advance to eliminate any claims denials & rejections, capable of automating various stages in the claim life cycle, being able to track the claims and more importantly solution should be capable of giving any data that you need to do various analysis without depending on software vendor.
  • Compliance & Regulation: Healthcare is a huge industry and it’s very volatile. It’s regulation and standards are keep changing, many software will be outdated and companies shut down if they do not meet such changes. Billing Software is being driven by HIPAA & ANSI X12N EDI standards & it’s transactions code sets. A few recent big changes were ICD-10 support, v5010 EDI support, HCFA-1500 02/12 paper claims form updates, NEMSIS v3.4.0, and such updates had a huge impact on the industry. Next big changes in this industry shall be ANSI v6010, EDI, National Health Plan Identifier (NHPI) and more. So, you should find the software vendor that understand the industry well & has the consistent track record of successfully implementing such changes to their software & no trouble to their existing clients. Electronic Prior – Authorization feature will be another big thing in coming years.
  • Support: Make sure you find out what is turn-around time of every type of issues such as level1, level2 or level 3 issues. Again, do not fall in such 24/7 customer support which we might never use. How often are you going to call at 12 midnight for a support? Medical Billing is a process, not a moment. Understand what kind of support you will need, also most of the Level 1 kind of support issues a good biller can handle themselves. So, why should pay extra for something which you do not need.
  • Special Pricing & Cost structure for billing companies: Some cost factors in Cloud Based/SaaS models are monthly subscription pricing, small onetime set-up cost & sometimes data migration cost. A few popular monthly subscriptions based pricing model you may find are provider/account based, claim based & collected revenue based. Billing Service companies grow over the years, they spend lots of money on sales & marketing efforts to acquire clients and has the potential to bring 10’s of 100’s clients in the future. So, Billing Companies deserve to have special cost structures and relationship from the software vendor.
  • Contract & Termination Clause: In the cloud model, usually there are no long-term contracts being imposed by the software vendor. Off-course, selecting a software or a partner are a long-term process and you may want to work with the company for a longer period. Additionally, you need to find ownership of data after you stop using the software. Clients must own the data, not the vendor. Find out what kind of exit policy software vendor has in place. There are any features that you can use to export data you need and it’s self-sufficient etc.