Health insurance software is intended to be the primary interface between the medical provider and the insurance company. Good health insurance management software assists medical billers and coders by compiling and organizing insurance information in a way that can be easily digested by the insurance company. Before you start dealing with health insurance software, you should understand a few key terms that will help you differentiate between types of software and the job roles of those who may be called upon to use the software.
Medical codingMedical coding is the act of transforming a doctor's spoken or written diagnosis into alpha-numeric codes, which are then used for ready access, compilation and categorization of information. A medical coder's job is especially important when dealing with insurance companies. If the wrong codes are put into the medical insurance software, the claim won't make sense to the insurance company and may end up being rejected.
Medical billerThe medical biller is typically the person who inputs and submits information into the medical insurance software. The medical billing agent or employee is responsible for aggregating and organizing the information that goes into an insurance form and making sure the proper form is used for each insurance company and insurance claim.
HIPAAHIPAA stands for the Health Insurance Portability and Accountability Act of 1996. This act provides federal protection for personal health information and furnishes patients with certain standardized rights concerning the management of their private information. If the health insurance software you choose doesn't comply with HIPAA, your company won't be in compliance and you could end up in trouble with the feds.
U.S. Department of Health and Human Services discusses the rights and protections that HIPAA grants.