Business Guide to Medical Billing and Coding

If your business is in the healthcare industry, you may need to implement a medical billing and coding system. These systems track patient records, insurance reimbursements, and more, which helps the office staff remain organized and up to date with billing. Without medical billing software, you may have a greater chance of encountering troubles, such as mishandled claims and lost or mismatched files. The software can benefit your business in many ways; however, it does not come without potential problems. A thorough understanding of its benefits and pitfalls will help you decide if it is worth the cost for your facility.

Benefits

Medical billing and coding is a vital part of the operations of any healthcare business or organization. Using medical billing software can make the process easier.

Organization

Implementing specific software and procedures for medical billing and coding helps keep your medical facility organized. Having a standard system of medical codes and tying them to specific billing procedures ensures that you won’t accidentally forget something important.

Error reduction

Medical billing and coding software can help reduce errors in billing. This can include errors caused by simple mistakes, as well as those caused by employee or insurance fraud. The Medical Billing Advocates of America found that up to 80 percent of all medical bills from hospitals contain mistakes, so reducing errors is an important concern for any business in the medical industry. In addition, 3 percent or more of all medical spending is lost to fraud, according to the National Health Care Anti-Fraud Association.

Patient satisfaction

Patients who feel comfortable that they won’t be overcharged for medical services or be given unnecessary procedures feel more satisfied with their medical experience. Having medical billing and coding procedures in place makes it easier to look up what procedures were done and continue the course of treatment effectively. It also allows patients and doctors to coordinate care between different providers, such as between a primary care physician and a specialist.

Compliance

Using standard medical billing and coding procedures and software ensures that you are in compliance with regulations in the industry. Most modern medical billing software is compliant with HIPAA, a national standard enacted by Congress in 1996. By adhering to the HIPAA guidelines, you can assure patients that their personal data is secure and encrypted. These guidelines also keep things simple by granting each medical provider a single identification number, instead of having a different number for each insurance company.

Pitfalls

Medical billing and coding are related processes that determine how medical providers get paid. These processes are combined into the medical billing software that many insurance companies require medical offices to use to process payments. There are a number of issues of concern with the medical billing and coding system that can lead to denied claims and reduced payments for services already rendered.

Inaccurate information

The biggest problem by far is inaccurate coding. If the individuals who process the medical bills and transfer the information into the medical billing software code a procedure improperly, you will not receive the payment you were expecting from the insurance company. Other information-processing pitfalls include recording inaccurate file information and double-billing for procedures that were already coded into the system.

Confidentiality

Many medical offices outsource their medical billing and coding processes to third-party vendors. These vendors can be located domestically or work remotely from foreign countries. One of the issues that can cause problems for your medical office is a loss of confidentiality in the transfer of information. When you transfer confidential patient information to outside entities for processing, the possibility exists that information may be released to unauthorized parties or used for unauthorized purposes. This can be a source of liability for your business.

Translation

Medical billing and coding relies on the ability of a person to decipher the handwriting of numerous doctors. If you cannot convince your doctors to write legibly, you may see an increase in coding errors. The willingness of your doctors to conform their habits to the needs of the medical billing software will often impact your profit margins.

Reliance on technology

The medical industry has moved in the direction of using medical billing software to bill insurance companies and patients. If you experience a technology failure, you can lose the information stored in the system. Also, once you transition your office to this type of billing system, you may become unable to run your office unless the system is operational.

Pricing

If your business is expanding and you are finding it difficult to keep up with important areas of your administration, medical billing and coding software can help you cope. Using this type of software is a relatively inexpensive solution to your growing business needs. Most basic medical billing and coding software packages are compatible with any Windows-based operating system. Basic software will allow you to enter personal patient information, log payment details, and send claims to the relevant insurance companies. If your needs are basic, this type of software will be suitable for your business. According to MB-Guide.org, single-user medical software costs around $1,300.

If your business needs are more comprehensive, you will need to purchase software compatible with more users and with several different add-ons. Comprehensive medical billing and coding software for 10 users is approximately $5,000. You can purchase software designed for an unlimited number of users, which will cost you approximately $11,900. There are various add-ons available, such as patient scheduling, that can also add to the cost of your overall medical software package.

Conclusion

Confidentiality is critical in the healthcare field. While you may find that outsourcing your medical billing and coding work can save some money, you should consider incorporating medical billing software into your own office. This helps you ensure that your files are in compliance with HIPAA. The possibility exists that you would still encounter problems due to malfunctioning software, electricity outages, and computer failures, so you may need back up files as well. As with any new program, your staff may have difficulties getting used to the software. Providing manuals and training can quicken the process, though. Researching the different types of software and selecting one that fits well with your business can help you avoid the potential disadvantages of using it.