If you’re a healthcare provider, dealing with medical billing is probably one of your least favorite parts of the job. It’s a total pain – keeping track of patient information, filing claims, following up on denials, and ensuring you actually get paid for your services. And let’s be honest, the medical billing process is incredibly convoluted and outdated.
Upgrading your medical billing tech could be a game-changer. The right technologies can streamline the whole revenue cycle process, reduce your admin workload, minimize errors, and get you paid faster. So what kind of billing solutions should you be looking at? Let’s dig in.
Electronic Health Records (EHR)
If you haven’t implemented an EHR system yet, that should be priority number one. Ditch those chunky paper files and move to a digital record-keeping system. A solid EHR will store all your patient data – medical history, test results, prescriptions, you name it – in one centralized, secure, and HIPAA-compliant location.
Having this info at your fingertips makes the billing process SO much easier. Your EHR can automatically generate billing claims with all the required diagnosis codes, CPT codes, and patient details pre-populated from their digital chart. No more hunting through file cabinets or risking data entry errors that could delay claims processing.
Certain EHRs even have medical billing capabilities baked right into the software. This lets you skip a separate billing system altogether and manage the whole revenue cycle within one streamlined platform. Convenient, right?
But be warned, EHRs come with a steep learning curve and major upfront costs for implementation and training. It’s a big investment, but switching to digital records will pay dividends in the long run through increased efficiency and better billing performance.
Medical Billing Software
For practices who want to stick with a best-of-breed approach, a dedicated medical billing system is essential. This specialized software is built from the ground up to help you get claims out the door faster and reduce denials.
Here are some must-have features to look for:
- Integrated clearinghouse for seamless claims submission to all major payers
- Coding tools with built-in coding rules and libraries to ensure clean claims
- Robotic Process Automation (RPA) to streamline various tasks such as claims submission, payment posting, and denial management
- Denial management to identify and rework failed claims
- Patient billing and payment processing
- Analytics and reporting dashboards to monitor KPIs like days in A/R, denial rates, etc.
- Scheduler for painless patient appointment booking
- Patient portal for self-service access
- The top billing solutions also integrate with your EHR and practice management systems via HL7 or HL7 FHIR technologies.
This seamless data sharing is key – it creates a frictionless billing workflow by automatically transferring patient information across your tech stack. No more manual data re-entry across multiple systems. The above information should assist you in how to choose the right medical billing software.
Cloud-Based or Server-Based?
One big decision when shopping for billing software is cloud vs server-based deployment. Server-based solutions are the traditional model – you purchase the software upfront and install it on your own local IT infrastructure.
Cloud-based solutions are the more modern approach. The vendor hosts the billing application over the internet, so there’s no need to deal with physical hardware, software installations, or updates. You just access the tools through a web browser anytime, anywhere.
For most practices, cloud solutions make the most sense. They have lower upfront costs since you’re paying a monthly subscription fee instead of purchasing licenses and equipment. Maintenance and updates are the vendor’s problem, not yours. And you get enterprise-grade security and data backups built right in.
Plenty of top medical billing vendors like PUREDI, DrChrono, Kareo, and Waystar offer robust cloud platforms that can cover all your billing needs with affordable monthly pricing.
Rules-Based Claim Scrubbing
Claims with missing info or coding errors are a surefire way to get denials from payers and delay your payments. Preventing these denial-causing errors in the first place is crucial.
Enter: rules-based claim scrubbing. This automated process uses built-in rules to scan claims for any potential errors before they’re submitted. Things like invalid codes, missing patient details, unbundled procedures, and many other common pitfalls are automatically flagged so you can fix the claim.
With guided claim repair workflows, rules-based scrubbing acts as a safeguard to drive up your clean claims rate and minimize denials. Pretty much every major medical billing solution includes some form of claim scrubbing these days. It’s a must-have.
Patient Billing and Payment Tools
Collecting patient payments can be another big admin headache. Dealing with paper statements, calling patients for balances, and manually posting payments eats up tons of time and hurts your cash flow. Not to mention always chasing down those pesky outstanding balances from deadbeat payers who “forgot” to pay.
That’s why investing in modern patient payment solutions is a no-brainer.
Look for integrated billing and payment processing tools that let you:
- Automatically generate digital statements and payment reminders
- Allow patients to view balances and make payments via self-service portals
- Accept all major payment methods – cards, bank transfers, mobile wallets, etc.
- Set up recurring payment plans for expensive procedures
- Automate refunds or payment plans for overpaid accounts
- Outsource collections to a third-party agency
This automated billing cuts down on your admin workload while also giving patients modern, convenient payment options. Some solutions can even claim a 60% or higher increase in patient payment collection after implementing these tools!
Online Patient Portals and Apps
Here’s a simple truth – patients HATE dealing with the medical bill side. Complicated bills, confusing codes, endless phone calls, it drives them just as crazy as it does you.
So what’s the solution? Giving patients self-service access through online portals and apps. Healthcare consumerism is on the rise, and patients want that same seamless experience they’ve grown accustomed to with consumer services.
With portals and apps, patients can handle common billing tasks on their own like:
- Viewing current balances and past statement history
- Making secure online payments
- Updating billing and insurance information
- Messaging providers with questions
- Accessing payment plan tools
- Downloading receipts and records
Self-service portals relieve your front-desk staff from a huge volume of patient inquiries and requests over the phone or in-person. It helps increase transparency, improve patient satisfaction, and reduce your staff workload around billing.
Many EHR/PM and medical billing vendors are rolling out white-labeled app versions of their patient portals to meet this demand for consumer convenience.
Data Analytics and Business Intelligence
Simply having medical billing technology isn’t enough – you need tools that give you visibility into how that tech is actually performing. Are you monitoring the right metrics? How can you optimize your billing process for peak efficiency?
This is where data analytics and business intelligence software comes into play.
With built-in reporting dashboards, these tools give you a command center view into all your key billing and revenue cycle KPIs like:
- Clean claim rate, denial rates, denial reasons
- Net collections, days in A/R, write-off amounts
- Amounts pending, payer reimbursement trends
- Productivity metrics like claims processed per staff
Healthcare analytics platforms pull data from your EHR, billing software, clearinghouse, and sometimes even payer remits to generate detailed reports and visualizations on demand. You get clear visibility into your entire revenue cycle performance, plus drill-down capabilities to analyze issues at a granular level.
No more static monthly reporting. Data-driven practices using analytics can continually monitor operations, catch issues earlier, and make fast decisions on how to improve billing performance.
Robotic Process Automation (RPA)
Let’s be real – medical billing is tedious, repetitive work full of manual administrative tasks. Submitting claims, posting payments, following up on denials, data entry across multiple systems – it’s a mind-numbing grind.
What if you could hand off those rote, high-volume billing tasks to digital robots instead of your human staff? That’s exactly what Robotic Process Automation (RPA) enables.
RPA bots are essentially software robots trained to mimic routine, rules-based human tasks and processes across different applications and systems.
For medical billing, you can deploy RPA bots to automatically:
- Extract and input data between your EHR, PM system, and billing software
- Submit claims to clearinghouses
- Post claim statuses, payments, and adjustments in different systems
- Scrub claims and route denials to human staff for rework
- Validate patient demographic changes across systems
- And much more!
By offloading these mundane, repetitive tasks to bots, your human staff is freed to focus on higher-value work that drives better financial performance. RPA isn’t full automation by any means, but it is a powerful enabler for streamlining inefficient manual billing processes.
Top RPA vendors like UiPath have even developed dedicated healthcare-focused RPA solutions for automating revenue cycle and medical billing processes. The possibilities seem endless – and the ROI can be massive when bots take over routine admin work at scale.
At the same time, RPA isn’t a magical solution. Implementing it requires upfront investment in the software licensing, process mapping, and bot training. You’ll need internal change management to get staff on board with this shift towards automation. But for healthcare organizations looking to seriously optimize their billing operations, RPA should absolutely be on the radar.
Clearinghouse and Payer Connectivity
Having the right clearinghouse partner is low-key one of the most important things for efficient medical billing. These intermediary services transmit your claims securely to payers and handle all the complex requirements for submission.
Using a clearinghouse:
- Ensures HIPAA compliance in data transmission
- Gets claims processed faster through direct payer links
- Streamlines payment posting by consolidating remits
- Reduces rejections from incorrect payer formatting
Basically, they act as the crucial “middle layer” to simplify the ridiculously convoluted claims process with each payer.
Most major medical billing software platforms come pre-integrated with leading clearinghouses like Change Healthcare, Ability, or Availity. This lets you submit to any payer through one system and gives you visibility into claim statuses across your entire revenue cycle.
Don’t sleep on payer connectivity either.
As high-deductible plans rise, your billing system needs tight payer integration to:
- Verify patient insurance eligibility in real-time
- Estimate accurate out-of-pocket costs for upfront collections
- Pull remaining deductibles and patient payment responsibility
- Identify coding requirements from each payer to minimize denials
This level of payer integration and price transparency is critical for avoiding surprises and combating rising patient financial responsibility. Many modern billing systems also include payment estimation tools that map your services to payer fee schedules and coverage rules.
Training, Outsourcing, and Managed Services
Even with fancy new billing tech, you can’t forget about the human element of medical billing operations. It’s a highly specialized set of skills that demands continuous training.
Adopt new billing solutions? You’ll need to retrain your admins on the new workflows and processes. Updates to coding guidelines or payer rules? More training required. Staff turnover in your billing department? Cue training new hires from scratch.
This why it’s critical to invest in comprehensive medical coding and billing training for your staff. Explore certification and credentialing courses, workshops, webinars, eLearning platforms, and any other resources to build skills.
Another path is to outsource part or all of your medical billing operations to a third-party service. This could be a nationwide revenue cycle management (RCM) firm or a regionally-based medical billing company.
While pricier than in-house billing staff, outsourced RCM services have the specialization and economy of scale to potentially boost your revenue performance and reduce overhead costs. You hand over claims processing, AR management, and other billing functions to an external team dedicated solely to that work.
Most RCM providers offer a menu of “managed services” – maybe you keep medical coding in-house but use their lockbox services for payment posting. Perhaps you want them to just handle denials management through their own team of experts. This a la carte approach allows you to essentially rent the RCM capabilities you need.
Outsourcing adds another vendor relationship to manage, so it requires a leap of faith in relinquishing some control. But for healthcare organizations struggling with billing inefficiencies or lack of resources, RCM services can be the perfect remedy to drive revenue cycle improvements.
Next-Gen Technologies on the Horizon
The future of medical billing tech is starting to take shape, so it’s worth peeking at some emerging innovations:
- Advanced data analytics using machine learning models to find root causes of denials, predict revenue risk, optimize staff productivity
- Voice recognition and conversational AI for hands-free coding, dictating notes, or pulling data
- Blockchain networks to create immutable data sharing between providers, payers, patients
- Comprehensive price transparency tools that reconcile costs across your payer contracts
These kinds of technologies aim to make billing smarter, more collaborative, and patient-centric. RPA was just the first wave of automation – AI, blockchain, ambient data capture, and other next-gen innovations promise to transform billing operations in the years ahead.
The Bottom Line
Healthcare organizations can’t afford to neglect their medical billing tech any longer. The revenue cycle is too crucial to just rely on a hodgepodge of manual processes and legacy systems. That’s an easy way to leave money on the table through lost reimbursements, inefficiencies, and dissatisfied patients.
For most providers, the ideal approach blends proven solutions like EHRs, billing software, and clearinghouse connectivity with cutting-edge tools for automation, analytics, and patient engagement. It’s all about creating a streamlined, tech-driven billing workflow spanning every step of the revenue cycle.
Sure, overhauling your billing tech stack won’t be easy or cheap. You’re looking at steep investments for new software licenses, implementation costs, training overhead, potential outsourcing fees, and more. Not to mention the arduous change management involved in getting your entire staff on board with new processes and systems.
But here’s the reality – every dollar you spend optimizing your medical billing capabilities has the potential to generate multiples in return through:
- Faster reimbursements and fewer denials thanks to cleaner claims
- Lower administrative costs from reducing manual work
- Improved patient satisfaction and loyalty from modern billing experiences
- Better revenue forecasting and financial decision-making using real-time data
With today’s shrinking margins and financial pressures, you can’t afford NOT to modernize your billing operations at some level. So assess your current pain points, map your goals for efficiency and revenue cycle performance, and start strategically investing in billing technologies that move the needle.
Your patients expect customer experiences on par with other service industries. And you can bet your competitors are working to deliver that through innovative billing tech. Don’t get left holding the paper files and playing catch up. Embrace the right mix of billing solutions to simplify your operations and set your practice up for financial success.
