Did you know that over 50% of healthcare providers reported an increase in claim denials in the US last year? When a claim is rejected or denied, the healthcare provider has to re-file the claim after making necessary corrections. Otherwise they risk losing revenue for services rendered putting a financial strain on the practice. And this re-filing comes in addition to the existing bills increasing the administrative burden.
Moreover, capturing every diagnosis, treatment, procedures, prescription, and administrative service for every single patient takes a lot of administrative manpower, which is where a medical billing software comes in.
A medical billing software automates the invoicing workflow and integrates with electronic health record (EHR) system of a hospital or practice. It captures all billable services right from the first point of contact to the super bill.
This article covers everything that goes in developing a medical billing software by top Java Software Development Company from the development process to the optimal tech stack, challenges, insights, and more. Read on to know more.
Understanding Medical Billing Software
Managing the revenue cycle of any business is essential to its survival. Medical profession, by nature, is subject to strict scrutiny and regulations that all entities involved in a patient’s care must adhere to. A healthcare provider has to provide care, take care of the administrative end of things, and get paid for the services rendered.
An automated medical billing software frees up the healthcare providers and the hospital staff to provide care to their patients and reduces the likelihood of human error. This not only increases the efficiency of the revenue cycle but also improves the overall patient experience.
Types of Medical Billing Software
Broadly speaking, a medical billing software can be categorized into two types; cloud-based and on-premises. But these types can be further classified based on their functionality and purpose.
1. Cloud-based software is accessible from anywhere, easy to maintain and scale, and typically has less upfront costs as opposed to on-premises software.
2. On-premises software offers complete control over data since it’s hosted locally, and is easier to customize. But it typically costs more than cloud-based solutions and requires in-house maintenance.
3. Integrated EHR and billing systems streamline the workflow by combining the functionality of EHR and billing systems.
4. Standalone billing apps focus exclusively on the billing cycle and can be integrated with existing EMR systems.
5. Specialty-specific billing apps take into account specialty-specific coding and regulations in addition to revenue cycle management to better serve the practice.
6. Mobile medical billing apps offer on-the-go functionality to healthcare providers and can be accessed on smartphones and tablets.
Key Components of Medical Billing Software
Owing to the high degree of customization, a medical billing software can include multiple components tailored to meet a practice’s requirements. Here are some of the most recurring key features of medical billing software often found in specialty medical billing fields like neurology medical billing.
- Patient registration and scheduling
The software manages appointment booking, sends reminders, and stores key patient information including medical history and insurance details.
- Claims processing and management
It automatically submits claims to the relevant insurance companies, tracks them, and helps in managing rejections.
- Payment posting and reconciliation
It ensures accurate financial record by recording payments from insurance providers and patients and verifying them against invoices and claims. This increases transparency for both the healthcare provider and the patient.
- Reporting and analytics
The software can also identify trends and patterns to help the provider make processes more efficient. And it can also generate detailed financial reports on billing, revenue, pending payments, and more.
- Compliance and regulatory features
Compliance with regulatory bodies like HIPAA and HITRUST in the US is critical to protect sensitive patient data. This also reduces the risk of litigation and increases data security. It also needs to comply with the applicable standards like ICD-10 and CPT coding for accurate claim submission and minimal back and forth.
Development Process
- Requirement Analysis
This essentially is a discovery phase where you conduct extensive market research involving your target audience and understand their needs, requirements, and pain points. In addition to this, you can study your competitors and identify areas of improvement in your app.
The software also needs to comply with all applicable regulations and standards to be viable in the healthcare industry. Once you have all the feedback and results, list down technical requirements for the medical billing app.
- Design
Your software will be used by humans, and that’s why you should focus on the user experience (UX). It needs to be intuitive, user-friendly, and capture the entire revenue cycle for healthcare providers who may not be tech-savvy.
The system architecture, on which the software is built, needs to be secure, robust, and scalable to handle large data sets. At this stage, you’ll sketch out the basic design and decide the objectives that you want to achieve with that design.
This is typically followed by designing a proof of concept (PoC) that includes basic functionality or at least a layout that mimics the final product. This is reviewed by the stakeholders and the feedback is incorporated to reflect the changes.
- Development
Once you have the basic framework, you’ll need to choose the right tech stack. Then the app developers, designers, and project managers work together to materialize the design. Here’s an example tech stack for starters.
| Development | Tech stack |
| Frontend | HTML/CSS, Javascript, React.js, Angular |
| Backend | Spring (Java), Django (Python), Express (Node.js) |
| Database | SQL (MySQL, PostgreSQL), NoSQL (MongoDB) |
| API | RESTful services, GraphQL |
| Cloud services | AWS, Azure, Google Cloud |
- Testing
The next step is testing out the product before launch to identify bugs and areas of improvement. You’ll need to create several use cases and test the software for performance and functionality. Moreover, you can ensure that your software is complaint with applicable regulations, standards, and privacy laws.
- Deployment
After you’ve thoroughly tested the software, launch it, and keep an eye on the engagement metrics. Since it’s a new platform, try including a user guide to help users make the most of your software. In addition to this, you’ll need to provide ongoing support to users in case they face any issues.
Challenges in Developing Medical Billing Software
Developing the right medical billing software that meets your goals is not easy. Here are some of the key challenges.
Compliance with healthcare regulations
Since the healthcare industry is heavily regulated, your medical billing software must comply with all applicable regulations like HIPAA and ICD-10. This also includes specialty-specific regulations or nuances that your software must take into account for comprehensive reporting.
For example, in obgyn medical billing, a complex gynae procedure might require additional codes depending on the technique used by the cardiologist, unlike a general check up with an assigned CPT code.
Data security and privacy concerns
Protecting patients’ data against data reaches and unauthorized access is crucial for any medical billing software. You can try implementing robust encryption and authentication, and conducting periodic security audits to ensure privacy.
Integration with other healthcare systems (EHR, EMR)
To make the software accessible and easy to use by a wide pool of healthcare providers, you need to ensure its seamless integration with other EHR and EMR systems.
Scalability and performance issues
Your software needs to be capable enough to handle large data sets and high user load without any comprise on functionality or user experience.
User adoption and training
Every new software comes with a bit of a learning curve. And you need to help your new users’ onboarding from other platforms to yours. Including user guides, tutorial videos, and frequently asked questions (FAQs) can help with the transition.
Conclusion
To reiterate, developing medical billing software is a mix of understanding the key components, leveraging the right tech stack, and navigating challenges such as compliance and data security.
Effective implementation of these elements can streamline the billing process, improve accuracy, and enhance financial performance for healthcare providers.
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