Review eight (8) must know steps that will help you compare medical billing software for your organization.

PracticeSuite

#1 Review PracticeSuite’s Medical Billing Platform

Starting with the leading contender in the medical office solution space, it’s plain to see why PracticeSuite has wowed its customers to become the first choice of many practices and healthcare businesses. This cloud-based medical office platform is comprehensive in its product features, but is also very adaptive, so that you can use a single module such as the billing software, or utilize the entire platform as a enterprise-wide solution. Because it’s cloud-based, you don’t have to confine your use to office workstations. Instead, you can access patient data securely from anywhere, on any connected device.

The complete end-to-end platform supports 150 medical billing and 61 EHR software specialties, which makes it highly integrative and pragmatic. PracticeSuite can adapt to a wide range of practice sizes, from solo-practitioners to groups of over 100 doctors. Not only is it one of the most advanced revenue cycle management systems we reviewed, but it’s also one of the most affordable, which is why it deserves its five-star rating.

The real strength of this solution that we’ve found is its revenue cycle management workspace and dashboards. Here are a few more standard features that distinguish this practice management platform and make it unique:

  • Complex scheduling scenarios with multi-location/multi-provider/multi-specialty/multi-resource scheduling
  • Revenue monitors that alert managers when revenue leakage is about to occur
  • Configurable Key Performance Indicator (KPI) reporting dashboards that are customizable by office role
  • Granular security settings including days/hours that data is accessible to users
  • Patient engagement portal with CRM, online reputation, and social media management

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Review Pricing Options and Calculate Your Total Billing Software Costs

You don’t have to sign a long-term contract to do business with this vendor, and it is the only billing software vendor we found that will happily sign a non-compete agreement with the medical billing services using their software. Some specific functionality required by services include:

  • Completely web-based medical billing & Revenue Cycle Management platform
  • Single-sign-on to all practices
  • HIPAA compliant Inter-office communications with task assignment
  • Work rejections, denials, and post payments across all clients on one dashboard
  • Electronic health record – Integrated EMR in +61 specialties

PracticeSuite also has the highest customer retention rate of all the software companies that we’re covering today. (Read our full review here.)

Price
The basic version of the billing system is completely free — no gimmicks — and you can upgrade to premium features or EMR whenever you want or need them. Premium editions of the software start at $99 per month and go up to $395 per month for the entire platform, which includes EMR.

Customer Reviews
““As the owner of a medical billing company, I’ve been using Practice Suite now for about 5 years. I’ve used many billing software systems over the years (Allscripts, Mends II, Versyss, PCN, Sage, Brightree) and have never been as satisfied as I am with PracticeSuite. Their Free Edition is truly free and it includes support. It’s a great way to get started as a biller. I just can’t say enough about the support team – always pleasant, knowledgeable and efficient. You just can’t go wrong with Practice Suite.” Rita Tretter Cheyrige Medical Services, LLC (review via Clearinghouses.org)

“The most flexible and powerful billing program out.” — Roman Kniahynyckyj, Metrohealth (review via Capterra)

“I can bring on new employees and train them quickly since the system is so easy to use. Also when there are claim formats we need specific to our specialty or region they create what we need.” — Debbie Forde, MedSource (via Software Advice)

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What is Medical Billing Software?

#2 Review Your Understanding of Medical Claim Forms

Today, almost all medical claims to health insurance are submitted to payers for reimbursement on the CMS-1500 Professional electronic claim form for ambulatory (walk in, walk out), while the UB-04 claim form is used for non-ambulatory medical claims such as hospitals where patients must be admitted. State Workman’s Compensation uses the Professional claim form as well, but a few states like New York have their own claim form.

For years, medical billers typed these insurance forms up by hand on a typewriter and then mailed them to the payer, but as recently as 25 years ago software companies began to develop coding programs to speed up claim processing and to improve claim accuracy for faster adjudication. Today, almost all states require that medical insurance claims be filed electronically. And most are, but secondary and tertiary payments are still typically sent in as paper claims. In fact amazingly insurance payers still receive millions of paper claims a year.

The best billing software not only serves as the vehicle for healthcare organizations to transmit medical claims to insurance companies, but they also serve a to communicate critical information between the insurance company and the medical practice to improve practice management.

The best medical software solution gives physicians and office staff instant communication to see if a patient has insurance coverage – this is where electronic eligibility comes into play. It also gives electronic pathways for insurance companies to send electronic reconciliation files containing information about what claims were paid, how much was paid, and what claims they are not going to pay – this is where electronic remittance advice (ERA) comes into play.

The best practice management systems also provide communication pathways between the medical office and the patient. These pathways give tremendous value by helping practices manage the portion of their revenue that comes directly from patients paying out of pocket or from health shared savings (HSA) or flexible spending accounts (FSA) for their co-pays, co-insurance, and outstanding balances.

The Types of Medical Billing Software

#3 Review Distinctive Billing Software Characteristics

There are different classifications of systems, ranging from how the systems are made, what type of computer infrastructure they run on, what types of computer devices can be used to interact with them, what specialty the system’s features cater to, and even what certifications the system must meet for regulatory requirements.

Best-of-class billing management systems for today’s modern medical practices involves the following:

Web-based – Available from Any Device. To be available from any device, the software needs to be cloud-based. Users can quickly and easily open an internet connect browser on a desktop, tablet, laptop, or smartphone and gain access to the software.

Features for Your Specialty. Many medical specialties have billing process and coding needs that need to be considered. Today’s best billing management software accommodate specialty-specific billing workflows and regulations.

Privacy & Security. With pressures to maintain strict confidentiality policies and meet HIPAA compliance guidelines, the best billing management solutions have advanced features to guard against improper access, track who accesses what and when, and gives security officers in the medical organization tools they need to manage vulnerabilities and HIPAA compliance.

Alignment with Your Care Setting. Like specialty uniqueness, the type of care setting or facility type plays a critical role in selecting the best billing software. Software requirements for ambulatory settings will differ from those in the in-patient, hospital environments. Likewise, compatibility of the software for surgery centers will differ from a mental health or community health center.

Services vs. Medical Office Settings

While “medical billing” itself might not change that much from the practice setting to that of a billing service, the scale, the complexity, and the need changes tremendously. Those companies who perform medical coding and billing processes on behalf of physicians, need different functionality than a medical office. Features needed specifically by a medical billing service include:

Denial and Appeal Management Tools:  Billing companies typically apply more rigor chasing down denied claims and filing claim appeals in situations where insurance companies have neglected to pay. Sophisticated denial and appeal management tools help quickly identify the cause of the claim rejection, streamline the path to correcting the claim information, and resubmitting the revised claim for payment.

Multiple Practice Single Sign-on and Workflow Tools:  Staff at billing services perform billing duties for multiple medical offices. Each practice has a secure account within the medical software.  Billing systems designed for services take the hassles out of navigating in and out of different practices. They consolidate work queues so that specific tasks across practices can be done quickly. And they also allow sectioning off labor so that the billing for several Dr. Johnson’s doesn’t get confused.

Enterprise Code Scrubbing Features: Due to the volume of data and medical claims a billing service manages, they need more automation in the revenue cycle process than a traditional medical office setting. For instance, if 10% of a billing service claims are denied that could be 50 – 100 times the number of claims that will ever be denied for a single practice. Therefore, a service needs tools that scrub their coding and claims before they are submitted to avoid denials before they happen.

Global Reporting:  As a business, the medical billing company needs productivity reporting across all of their clients (physician offices). They also need performance reporting capabilities for their staff.

Client Performance Reporting & Dashboards:  To keep their clients informed about their revenue, cash flow, and overall business efficiencies, billing services need to provide frequent updates on financial position to their clients. Real-time performance dashboards and reporting capabilities help them quickly showcase the value of their services to their individual clients.

The Best Software for Medical Billing Companies

Billing Software Pricing Models

#4 Review Medical Billing Software Pricing Options

Different from electronic medical records, when researching electronic medical billing solutions, there are countless combinations of pricing strategies to explore. The best software pricing strategy for you may differ from that of others, but here are several options that you will have available to you.

Free Software:  A small handful of software options will make a free version of the software available at no charge. This is a great way for medical practices to try the system, use the solution for daily workflow.  Depending on the practice’s needs, a free software solution may be all they need to handle their insurance billing.

Free Trials:  Many billing software options will include a free trail giving user the opportunity to setup a trial account, use the system for a set number of days or months, and then convert the free trial into a paid account.

Paid Monthly Subscriptions:  Almost all web-based software options give practices the opportunity to pay monthly for the software license. A set monthly fee will be paid by provider or sometimes by the number of actual users.

Transactional Pricing:  Depending on the medical billing volume, you may want to investigate the cost difference between a paid monthly subscription plan and a transactional pricing plan. In the transactional plan, you pay for the actual number or tier of electronic claim transactions. These plans make good financial since for organizations with a lot of medical providers or practices and it also is a good choice for high volume organizations to seek bulk pricing.

Increase Your Revenue by 20% or More. See if Medical Billing Services Will Pay Off!

Prices Vary So Drastically – Why?

#5 Review Monthly Software Pricing Ranges

Billing software prices range from absolutely free $0 to over $800 per provider per month, not including an electronic health record application. There are three factors that typically drive pricing for medical practice management software.

The first factor is the feature set. But, the tricky thing with today’s software choices is that low cost doesn’t always mean reduced features. Different practice management software vendors have different ways of addressing critical workflows. Some vendors use tools that they embed in their products from other companies. This might drive the price for that specific capability up compared to a vendor who engineered their product without having to pay someone else.

Secondly, price is often a derivative of what type of technology platform is being used. Older medical practice management technology architectures have historically cost more. Companies with these infrastructures often find themselves covering these costs as well as covering the costs for developing new products on new practice management platforms. The combination could keep the price of their software higher than other competitors. In sharp contrast web-based medical billing can be more affordable for the average doctor office.

The final point on pricing variance involves the type of healthcare provider license that is being purchased. Full time providers and/or physician based pricing is often higher than part-time providers and/or other clinical staff licenses such as therapists, nurses, and other clinicians. Billers help manage cash flow by coding patient encounters for their providers.

Software Check List

#6 Review the Top Specifications for Billing Software

There are countless features that today’s best software programs offer.  Let’s review the top 18 billing requirements you should expect to see in each software program you are considering.

  1. Offer multiple ways to identify or look-up patients
  2. Secure and encrypted credit cards on file (with consent)
  3. Create flexible payment plans that track date, and amount, of the last payment
  4. Report and track any unapplied monies
  5. Create customized letters to payers, work-comp, attorneys, and patients
  6. Monitor and control write-downs
  7. Create charges and easily associate procedures and diagnoses
  8. Review charges and perform initial claims validation
  9. Manage claim rejections and claims status at the clearinghouse level
  10. Work denial & perform claim appeals on unpaid items
  11. Post Payments and adjustments
  12. Receive and post ERA’s – Electronic Remittance Advice (electronic E.O.B.)
  13. Claims Performance Dashboard
  14. Perform necessary facility-based UB04 billing
  15. Managing patient payments and collections
  16. Patient statement processing
  17. Electronic patient payments
  18. Benchmark reporting of key performance indicators

We gave 18 requirements to look for in a top notch health care billing system, but these are all back-office (billing) functions. Here are some front-office items that are also part of the best billing management solutions––such as appointment scheduling.

  1. Check eligibility manually or in batch from the patient appointment calendar
  2. Easily enter patient demographics and insurance info from scheduling
  3. Easily view open patient balances from appointment scheduling

And EHR, But In The Context Of  Medical Billing

In a typical medical office you have a front office staff, clinical staff, and back-office (billing) staff, each having their own separate software modules.

Front office staff answer the phones, set patient appointments, verify insurance benefits and collect payments such as co-pays. After checked in, a medical assistant takes the patient’s vitals in preparation for the doctor visit. During this time vitals and reason for the visit are entered into the clinical EHR awaiting the attending physician’s review. Upon exam, the doctor will arrive at a diagnosis and enter it into the EHR, which the billing department will then code and submit to insurance for reimbursement. EMR are separate applications from billing software but they work hand in hand, and in the best EHR systems the coder can easily view the medical notes to make sure the procedure is codded correctly. Each EMR application has its own pros and cons, but to make health records electronic, they are a medical necessity.

Software Vendors

#7 Review Popular Medical Software Companies

We are glad you have visited PracticeSuite and hope you stay on our website to learn about the great value we can bring to you. However, we know that you have lots of choices and that not every medical billing software option is right for everyone.

Also, testimonials directly from customer who use the medical billing software options are great ways to get a feel for how the software works. Just like online reviews of any sort, you know that some reviewers will have great things to say about the software and the company. Others will have terrible things to say. You will have to balance out the reviews against your experience with the company and product to make a decision you feel good about.

Below is a list of companies who make medical billing software that we respect (listed in Alphabetical order) along with a link to publically available customer reviews.

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Software Purchasing Resources

#8 Review Helpful Resources As You Weigh the Pros and Cons

Below are three resources that have proven extremely helpful to those evaluating medical practice software over the years.

3 Things to Consider When Choosing Billing Software

Does Your Billing Software Include These Features?

Will the Right Medical Billing Software Make Your Practice Profitable?

Now that you have the straight information about each of these medical billing software companies, you can make a more informed choice with your own practice’s cash. If you’re looking for a reliable billing solution, sign up for our full-featured free edition and give us a whirl without spending a dime.