Medical Billing - Software Manuals

Medical billing is complicated enough without having to know every inch of your billing software by heart. Because of all the complexities involved, medical billing software manuals are not only critical but they're also enormous. As a matter of fact, most medical billing software manuals are shipped in parts. So you have a decent chance of finding what it is you're looking for, we're going to give you a general breakdown of how a DME software manual is put together.

The first section of the manual is usually where you will find your installation instructions. These will contain step-by-step procedures for installing the software on each type of network, with subheadings for each network. Usually, the table of contents will include the networks covered so you don't have to go hunting for yours.

In this section, you will also find installation instructions for any add ons such as retail sales and barcoding. This is in case your company purchased these extra utilities. If they didn't, then this section won't apply. It's more cost efficient to include the add ons installation instruction in the standard manual than to send out a separate one only for customers who have add ons.

In your next manual, you'll find your instructions for setting up your databases. This is where you will find out how to enter data for doctor files, inventory files, patient files and so on. This section of the manual will usually have diagrams of each data entry screen so the user will know where each field is. Also, a complete description of each field will be included as well. For fields that tie in to medical forms, the manual will also tell the user which forms the field goes to as well as where on the form, such as line number.

The next set of manuals will usually focus on how to do billing, whether it be through printing out HFCA forms or sending claims electronically. Some software manuals have these sections separated. In addition to that, most software companies provide a separate manual plus record specifications for each carrier that is being billed, such as Medicare and Medicaid. In many cases, where a company has a large customer base and bills many different carriers, they may have as many as five or six different medical billing manuals or more.

And if all that isn't enough, there is usually a whole manual dedicated to troubleshooting the system in case there are problems. The reason a software company will go through all that trouble is to cut down on the number of support calls that they get, as each call takes up man hours, which is a lot more expensive than printing out a manual.

When all is said and done, a medical billing company can literally have a bookcase filled for just one piece of software. If a company does DME billing and then has another software for dental billing, that could mean another whole bookcase full of manuals. Because there are so many, usually there is a small manual that has the master table of contents so a person knows what manual to look in for what piece of information. Yes, medical billing software companies sure do kill a lot of trees.

And to top all this off, most companies have online versions of these manuals in case the hard copies get damaged or stolen. They've got all the bases covered so that the medical billing company can spend more time concentrating on actually billing and less time looking for things.

Michael Russell Your Independent guide to Medical Billing

Medical Billing - DME Software Security

In this installment of medical billing and DME software, we're going to cover the topic of security, which can actually apply to any type of medical billing software since security is such a big issue these days.

The whole topic of security pretty much stems from the HIPAA privacy rules. These rules cover just about everything, including health plans, health care providers, health care clearinghouses and billing agencies. If you're associated with the medical profession in any manner shape or form, you are probably under the HIPAA privacy rule umbrella.

The main information that is protected by the HIPAA privacy rule is the patient's past, present, or future medical condition, the provision of health care to the patient, the past, present or future health care to the patient and all the patient's private information including social security number, EIN, or any other private information of the patient, including payments made by the patient or to the patient.

The above is extremely simplified, as the law is pages long. There are also some limited disclosures that are allowed. Some covered agencies are allowed access to this information but they have to show just cause why they need it, such as police, prosecutors, etc. Where this complicates things is with billers. While the billing agency itself needs to know this information in order to properly bill the patient and insurance company, there has been a lot of heated argument about who in the billing agency should have access to this information. Because of this, only people directly involved with the actual billing are granted access to this information. Therefor, non billers, of which there are plenty in a billing house, are not allowed access to this information. This is where the problem comes in.

The solution is DME software security. By restricting workers to certain parts of the system, such as inventory personnel, the administrator of the software can make it so that these people are only given access to their area and therefor gain no access to patient records. This is done in the security options section of the software under each users name.

Most software will have basic access categories so that the administrator doesn't have to go into each individual section and give and deny access one section at a time. By having categories, such as biller, inventory, supervisor, etc., the administrator can just assign a category to the worker and the programs associated with that category are then given to the worker. All other programs are blocked. If individual program access is needed under special circumstances, this is also provided by the software as well.

The job of the software administrator is not an easy one. For one thing, most administrators themselves are not billers and therefor are only allowed certain access. So while they are allowed to give access to patient records to various people, they themselves are not allowed this access. It's a tricky situation to have to deal with but not impossible if the security is set up just so. This makes medical billing just a little easier.

Michael Russell Your Independent guide to Medical Billing

Centralized Workflow Management for Outsourced Electronic Medical Billing Service and Software

The reduction of accounts receivable is key responsibility of billing function in a medical practice. This article compares traditional (distributed) billing function with centralized workflow management. It shows that centralized workflow management yields significant advantages over the distributed approach in terms of the ability to manage accounts receivable. However, it also requires significant investment in process, technology, and personnel training.

Benefits of Centralized Workflow Management for Medical Billing

Centralized workflow management is superior to traditional billing operations management because it enables continuous billing process improvement and avoidance repetition of errors, while reducing dependency on specific individual billing knowledge. The billing process improves systematically along the key performance dimensions, including payment amount and its timeliness.

Centralized workflow management accomplishes such important benefits using a two-pronged approach based on formal encoding of billing and compliance knowledge and a computer program to apply the knowledge and manage claim followup lists.

As encoded billing knowledge base grows, the accuracy of the claims and the speed of the process increases. Additionally, the staff can spend more time focusing on exceptions, while an increasing majority of claims is processed automatically.

Moreover, centralized workflow shares its billing rules across all providers and billers. Therefore, errors discovered and corrected for one provider will be avoided in the future for all of the providers using the system.

What is Workflow?

Workflow is defined as a sequence of actions performed on a claim until it is paid. Centralized workflow management must quickly separate “clean” claims from potential failures, submit clean claims to payers, and flag potential failures for correction. Workflow must also track the correction process, ensuring its integration with other sources of failures and successful completion. Finally, workflow must facilitate meticulous documentation of every step to enable continuous improvement and learning from experience.

Failed Claim

A failed claim is a claim that is flagged by the workflow system upfront as an invalid claim, is rejected by the payer after submission, or is not properly adjudicated within 30 days -- in other words, a claim that requires followup.

Workbench

Centralized workflow manages such followup lists of failed claims using workbenches. A workbench is a list of failed claims assigned to individual biller or operator. Such individual assignment of work enables continuous and individual performance tracking and improvement.

Activity Triggers

In medical billing operation, the followup lists and “to-do” lists of individual actions for each failed claim constantly change. To manage multiple to-do lists, the centralized workflow system has activity triggers. Activity triggers are the heart of task automation; they help determine what's important. Activity triggers match up promises with events and manage individual work queues in the process.

Remembering to call a payer or a provider weeks after a phone conversation when payment or claim clarification was promised requires a billing clerk to sort through their call-on-receipt folder several times a day. Activity triggers eliminate the reliance on personal memory and enable communication between individual workbenches. They are the strings that tie billing activities together. When Mary from the provider’s office updates the claim with correct ICD-9, the system needs to be aware that the claim is ready for validation, and John in billing office needs to know so he can review it again, if the validation failed or schedule its transmission to the payer.

Task Automation

Centralized workflow eliminates paper-based steps. Like a relay team passing the baton, the billing staff members electronically pass along their work without delays. Instead of printing, faxing, and following up with an e-mail or a phone call, all tasks arrive complete with supporting documentation. Rather than thumbing through reams of paper reading scribbled notes, billers receive onscreen reminders when tasks are due.

Process Monitoring

Centralized workflow also simplifies process monitoring. Providers and managers use dashboards to review key indicators. Like activity triggers, dashboards help focus personnel on what is important from high-level perspective. They show key business information that tells us if we are paid more or less over time, if our charges are going up or down, and if our followup policies are too lenient. They tell us whether we are heading in the right direction and act like lighthouses to keep us off the shoals. When we see that warning light, we can drill into the details and take corrective action.

Summary

The key difference between vericle-like centralized workflow management and traditional approaches is that a centralized workflow guides the operator in terms of claims that need followup. There is no need to manually look up reports to analyze data and select claims for followup. Vericle-like approach ensures followup consistency and timeliness.
 

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

Medical Billing Software - How to Choose the Right One for Your Needs

When it comes to Medical Office Billing Software, you will find there is no shortage! There are hundreds to choose from and they vary in price from $99 to several thousand dollars. It is important to pick a billing software that is right for your needs. Ask yourself the following questions before purchasing a medical office billing software:

• Are you a medical office or billing service? This makes a difference in the capabilities you will need in a software.

• Are you a specialty practice? Some softwares are for a specific specialty. For example, Lytec has a chiropractic version. RLI is a software specifically for optometry offices.

• Do you need a multi-user software or is a single user ok? Some medical office billing softwares have a limit on the number of users that can be using the software at one time. It is important that you know the limit and that you consider your needs, not only right now, but in the future. If you purchase a software with a limit on the number of users, you may want to find out if you can upgrade to more users down the road.

• What are the aging report capabilities? For billing services this is a HUGE deal. Unfortunately for many medical offices, aging reports are never run, which is an area where they lose a lot of money. Whatever your situation, you will want to know what the aging report capabilities are. (One of the offices we bill for has a very expensive program. However, in the aging reports, it doesn’t show the date of service, it shows the last date the account was adjusted. Also, the report does not separate charges by the number of days old. It only runs a report showing everything that is outstanding. There report makes it almost impossible to follow up on the oldest charges.)

• What is the cost of the software? The old saying ‘you get what you pay for’ is usually true, and applies in the case of billing software. Again, you will need to consider your specific needs when determining how much you should spend on your software. If you are a solo practitioner who sees patients part time out of your house, you will not need a terribly complex program, but if you are a 5 doctor medical office, you will need to look at an appropriate medical office billing software.

• What are the report writing capabilities? Sometimes it is necessary to create your own report. For example, you may have a form that is required but it is not a standard insurance form. If you have to fill out a number of them a month, it may be worth having a report in your billing software that does it for you. (One of our practices had to submit Medicaid claims on their preprinted forms. It was very time consuming, and they did quite a volume of them weekly. We wrote a report in Lytec to fill the forms out, and it was a HUGE time saver!)

• Is the software user friendly? Most softwares today are user friendly, but you should do a demo of the program before buying. You may also want to find out if hands on training is available. It may be beneficial to you to hire someone to train your staff. A lot of times, offices don’t use even a fraction of the billing software’s capabilities, because they were never trained properly.

• Does your software allow for more than one practice? If you are a billing service, you will need to be able to bill for multiple practices from the same software and be able to keep them separate. Or maybe you are a medical office with more than one location, and you want to keep them separate. In any case, make sure the software you are buying has the capability.

• Do you need an appointment scheduler? For billing services this feature is usually not required. Most software comes with it built in, but some are much more elaborate and easy to use. If you have a busy medical office, this feature will be important to look at.

After answering all of the above questions, make yourself a list of the features that you will need in your software. A list will make it easier when you begin your search. Compare your list to the list of features and you will be able to eliminate softwares that will not work for you and narrow your list down to ones that will. Then you can decide based on price, ease of use, and extra features that are not necessities for you.

When we started our billing service, we tested a lot of different demos of medical office billing software. At the time we started there were still programs that ran on DOS? (There’s a term you don’t hear a lot anymore!) We wanted a medical office billing software that definitely ran on windows, and was user friendly. As a billing service, we would need to train people on it as we grew.

Listing the features that were important to us was very helpful in choosing our software. It helps to eliminate options that won’t work.

Michele Redmond is co-owner of Solutions Medical Billing and has been in business since 1994. She has a bachelor’s degree in Computer Information Science and is responsible for the medical billing for over 50 providers. For more information on medical billing software and other topics visit her website at http://www.solutions-medical-billing.com

Billing Medical Software

Billing medical software is used as a medical management system that can automate and track the process of submitting medical claims to insurance companies. It records the process from the first time a patient visits the doctor, through all the visits and diagnosis held from thereafter, till the end of the treatment. Plus it has several automatic processes and reports based on the information entered that can take much of the load experienced to run the medical process in a non-computerized environment.

Some of the features billing medical software has are:
1. appointment scheduling
2. electronic claims
3. flexible reporting
4. claim tracking
5. patient eligibility
6. ability to interact with other 3rd party software

Like other software applications, billing medical software needs to be easy to use and have the possibility to log the events that occur during the treatment. It needs to have a simple approach to the medical billing process as a whole, which normally, when done on paper, is a very time consuming process.

The advantages of billing medical software can be summarized as:
1. automatic billing computations for patients
2. auditable history of a treatment case at a glance
3. updated patient details availability
4. reduced time to process

Clients can benefit immensely from billing medical software. Some obvious benefits are:
1. confidentiality
2. eligibility verification
3. claims submission

Apart from offering the above advantages for both parties, billing medical software can automate the billing and collection process as well as offering simplified procedures for the main tasks needed as part of the medical and treatment process.

But who exactly can take advantage of billing medical software? This software is normally designed for doctors, dentists, medical billing centres and other healthcare professionals who intend to send electronic claims. A good quality billing medical software allows users to work on different modules simultaneously and have the ability to be used in a multi-user network environment. Entering patient details, diagnosis, issuing reports and scheduling appointments are all functions that can be done and are allowed to be done from different users at the same time.

Billing medical software is a must for highly geared medical centres nowadays. Many advantages can be taken from a well written and efficient software. The reduced time to process the work and paper involved, and the total organization of the medical process are just the highlights on which a billing medical software can focus and excel.

Sandro Azzopardi is a professional author who writes several articles on various subjects on his web site and local newspapers and magazines. You can visit information about this article and others on: http://www.theinfopit.com/technology/software/billingmedicalsoftware.php