Medical Insurance Billing Software: The Right Choice Among Custom Vs. Pre-built?

Most Desirable Features of a Medical Insurance Billing Software    

1. Pre-Registration  

When patients first get a medical appointment, they need to complete the onboarding process. It involves filling out personal details and other information to help prepare the electronic health record to help physicians make informed care decisions. The conventional way of doing so involves the patients getting a physical form to fill out while waiting for their consultation.  

However, a healthcare medical billing software with pre-registration can help patients fill out their details before arriving at the hospital. This helps reduce waiting times significantly and speeds up the workflow surrounding the entire patient intake lifecycle. Having a pre-registration feature is a first step in instituting best practices for medical records management.    

2. Patient Scheduling  

Managing patient appointments is a tedious task that requires a dedicated staff member to carry out. But a healthcare billing software with a feature for patient scheduling makes it very easy for providers to manage appointments.  

Accessing patients’ previous visits, missed consultations, and the ability to fix and re-schedule appointments with a few clicks are some of the benefits of a patient scheduling feature. Since it eliminates the need for additional staff, it increases revenues for providers. Integrated healthcare solutions that incorporate this feature within medical billing software systems improve the patient experience and allow doctors to devote more time to seeing patients.  

3. Reporting      

An application for reporting in a medical billing system software allows doctors to know about the business side of healthcare. Reports generated by platforms for medical informatics and healthcare analytics solutions harness actionable insights that’d help providers increase the medical organization’s efficiency and productivity.   

A feature of reporting increases the scope of an insurance billing solution. It analyses the entire coding, billing, claims, patient care, and medical histories. As a result, it highlights problem areas that providers can address and improve the overall patient experience and clinical outcomes.  

4. Eligibility Verification  

Insurance plans vary from person to person and also according to payers. Verifying if a patient’s plan covers a particular treatment and mistakes in verification often delays reimbursement or their cancellation.   

Healthcare billing systems with a feature to verify patient eligibility accelerate the process and reduce waiting times. This, in turn, allows doctors to begin treatments without delay. Healthcare automation solutions for verifying insurance plans reduce staffing requirements, optimize the process, minimize errors, and make it a win-win for doctors, patients, and payers.  

Numerous vendors offer a broad range of physician billing solutions. Additionally, such software could be pre-built or custom-made to match specific requirements. In light of this, it becomes vital to know what kind of platform to opt for to help maximize the productivity of your organization.  

Although all billing systems for healthcare are bound to be HIPAA compliant solutions, they’re bound to vary in specific functionality. So, it becomes crucial to know what kind of medical insurance billing software to opt for –  

How Should You Decide Between Custom Software & Pre-Built Software?  

1. Type of Medical Care  

Not every provider offers the same kind of care. There are dentists, physiotherapists, dermatologists, psychologists, psychiatrists, etc. Their professional management requirements would differ significantly.  

A healthcare billing system used by a mental health expert could also include a telehealth feature, while the same won’t be of use to a dentist. Similarly, a patient engagement system for a cardiologist would need to be different from that required by a physiotherapist.   

To sum it up, the kind of medical insurance billing platform depends upon the provider’s specialty. While a popular pre-built software might address most of the requirements of a healthcare organization, it’s always good to have a look at custom healthcare solutions.  

Customized medical billing solutions are tailored to suit the needs of specific hospitals, ambulatory care settings, and even single physician practices. They can be modified to match established workflows so that the staff needs little or no time to get used to the platform.  

2. Size of the Organization  

It doesn’t take an expert on market research to know that the healthcare billing requirements of a small clinic would vary vastly from that of a large hospital. Similarly, the volume of claims submitted and plans verified also differ between clinics in rural locations and those at urban locations.   

Billing systems for healthcare must be tailored according to the size and needs of an organization. But it might become rather difficult for healthcare administrators to know what suits their needs better. Given the lack of clarity in the available solutions, it is prudent to select a custom-built platform rather than choosing one off the shelf.   

3. Which Workflows to be Automated    

This factor is one of the most critical factors in selecting a medical insurance billing software. The automation requirements would be different from those of single-physician practices. Billing systems in healthcare that are suitable for integrating with a practice management platform could automate appointment scheduling and patient engagement, alongside medical coding, verification, etc.  

But a hospital would have different automation needs. It would target activities like scheduling tests, fetching results, electronic data exchange between many different EMR, and the usual billing activities.  

4. Future Plans for Scaling    

In some years, a small ambulatory care center might grow to become a large hospital, and practice with one or two doctors might also grow into a larger organization. In other words, a medical billing systems software must be open to scaling up or down as per an organization’s evolving needs.  

A platform that doesn’t do so would outlive its usefulness, forcing providers to purchase a new one and spend time on training the staff. In light of this, it makes more sense to go for custom software for patient billing in healthcare. A pre-built one might serve well for a time, but it might not scale as per organizational needs. The factor of potential scale in the future is vital for continued efficiency in healthcare management.  

5. Which Third-Party Application to Integrate   

Numerous third-party applications need to be integrated with a larger healthcare management software. In light of this, healthcare interoperability and cloud compatibility are important factors determining which health care billing platform to opt for.  

Different types of healthcare organizations have various services and goals. Accordingly, they’d need to work with varying third-party applications. Cloud computing in healthcare has allowed many platforms to be accessible from the cloud. So, applications must be compatible with them for streamlined operations. A pre-built healthcare billing software may or may not fulfill all the integration needs. But a custom-developed one will allow more excellent manoeuvrability to expand through integration.  

Conclusion  

The kind of medical insurance billing software you select would directly impact the care delivery and day-to-day operations. Medical software development has given rise to several types of insurance billing solutions. Considering so many options, it could get challenging to decide and feel confident about it.  

Customized platforms for patient payment in medical billing go a long way in helping providers streamline their workflows better. If a digital solution can virtually match a clinic’s working styles, it eases the administrative burden on the staff. Moreover, having a custom solution also allows greater adaptability, enabling better population health management in the long run. 

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