Medical Billing Software

Top 10 questions to ask when you are looking for a Medical Billing software vendor:

A good sales person will make a software demo presentation look great and will try to establish a rapport with you because we do buy from people like yourself.

Look beyond the demo, how much you like or dislike your sales rep and learn about the questions you need to ask.

Medical Billing Software

What are my options?

Functionality   (communications, task, ERA, Electronic Remittance Advice tools, word processing, patient engagements, patient portal, patient kiosk, electronics prescriptions, electronics statement, appointments confirmations, ERA (electronics R A) un-billed claims/visits trap, Inventory control, and dashboard.

Where Can I send my electronics claims?

Electronic Claims: Is the software able to send electronics claims with any clearinghouse or is it locked to one option?

Can I reduce my claims rejections?

Can the software do Claim Scrubbing before it goes out to the clearinghouse or your printer? Claim Scrubbing is a tool that cleans your claims before submission to improve denial rates

What is the accounting type am I getting?

Is the system open accounting or closed accounting? Open accounting let you add, modify or delete the data of the transaction  at any time. (Open accounting has it is positives and many negatives, because any one can doctor transaction which causes inaccuracy and financial risk Closed accounting once you save the transaction you can’t add, modify or delete without a accounting trail.

What type of claims do I need?

What type of billing is the software designed for? Professional (837P) CMS 1500 2-12 format, Institutional (837I) CMS-1450 (UB 04), DME claims, pharmacy, ambulance or labs.

Some systems may offer all of the options by using add-ons and third party software.  Others may have strengths and weakness in different areas.  Microwize can help find the right solution for your needs.

Is the Database all in-one?

Database: Are the electronic medical records if needed using the same database or different database? Is the look and feel of the EMR is the same of the medical billing portion or not?

Can I use the software for more than one practice?

Is the software multi tenant? This is when the same install of the software can handle different practices with different names, tax ids and financial accounts. This is helpful with billing services and independent practices sharing the same server and software.

Which pricing model are you getting in?

Pricing model: Is the pricing by provider or by seat (AKA user)? Depending on your type of business or size this can make a difference.

Do I have the reports I need?

Reports, do you have the reports you need to mange your practice? What are your options to copy a report from a market place or another practice you know. What is needed to customize a report? How about reports related to incentives such as meaningful use, PQRS, RVU, CCM etc…?

Is it Fat, Thin, Browser or Cloud Connections?

Technology: Is it a fat client, thin client, browser base or cloud base? A fat client is a computer (client) in client–server architecture or networks that typically provides rich functionality independent of the central server. The name is contrasted to thin client, which describes a computer heavily dependent on a server’s applications.

A fat client still requires at least periodic connection to a network or central server, but is often characterized by the ability to perform many functions without that connection. In contrast, a thin client generally does as little processing as possible and relies on accessing the server each time input data needs to be processed or validated.

Learn about Standard Industry Terminologies for Healthcare.

Just in case you need to know what any of these terms mean:

Acts as an intermediaries who forward claims information from healthcare providers to insurance payers. then it will preform a claims scrubbing, clearinghouses check the claim for errors and verify that it is compatible with the payer software.
Examples of  clearinghouse companies: Healthcare, Capario, Emdeon, Gateway, Greenway, Ability, etc…
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Relational Database
A digital database which  organizes data into one or more tables (or “relations”) of rows and columns, with a unique key for each row. Generally, each entity type described in a database has its own table, the rows representing instances of that type of entity and the columns representing values attributed to that instance.
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Multi-tenan Software
Multi-tenancy is an architecture in which a single instance of a software application serves multiple practices. Each practice is called a tenant. Multi-tenan software convenient to allow same server and software to be used for multi practices. It is something that billing  companies must use when looking for a medical billing software.
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SaaS Software
Software as a service (or SaaS) is a way of delivering applications over the Internet—as a service. Instead of installing and maintaining software, you simply access it via the Internet. Eliminates the need of a server onsite to run your software. Cloud base software also exchanged  for software running without a server onsite.
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Ambulatory Care
Health services rendered in a hospital outpatient facility, a clinic, or a physician’s office; often synonymous with the term outpatient care.
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The International Classification of Diseases (ICD) is the standard diagnostic tool for epidemiology, health management and clinical purposes. This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems.

ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in World Health Organization Member States as from 1994. The implementation date for ICD-10 is October 1, 2014.

There are differences between ICD-9 and ICD-10 are significant, including a sizeable increase in the number of new codes to address specificity. Physicians will need to move quickly to educate themselves and their staff about this major change so they can meet the October 1, 2015 compliance deadline.

Benefit Assignment
A method under which an insured person requests that his/her benefits, under an insurance claim, be paid directly to a designated physician or hospital
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Allowed amount
Amount an insurance carrier will allow/approve for a billed medical procedure. Insurance carriers will sometimes limit their coverage to a portion of the approved/allowed amount (i.e. a carrier might pay only 80% of the allowed amount, with the remaining 20% due from the patient or subsequent carrier). Typically these amounts vary on an annual basis. AKA – Reasonable and Customary
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A practice management term used to describe a negative (debit, positive) payment listed on a bulk remittance from an insurance company. Larger insurance plans will “take back” a previous payment for various reasons (duplicate payment, error on first payment, patient not covered by the plan at the time of service). This type of “chargeback” affects the total amount of the paid claims (check amount) by this “chargeback” amount. AKA – Take Back, Recoup or Auto-refund
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Testimonials & Clients

Everybody likes to hear that he/she has done something good or right, or helped someone, and is appreciated because of this, it is good for your self esteem, even if it already is rather inflated.
I always made a point to thank the person(s) who helped me by whatever they did, especially assistents, co-workers and the like, because that will motivate them even more whenever I would need their help again, because I showed appreciation, and everybody from time to time needs help, don’t we?
Dr. Richard Filipek
Garfield, NJ

We are very fortunate to have such prompt service. Thank you for all you do to make our processing easier. A special thanks to Vaida who has been there to assist us. We are aware of her busy schedule and she has made herself available to us especially with numerous changes taking place this year.

Maria Stark, MD
Physician Scottsdale, AZ
Andrew is excellent and well spoken technician.He Finished in the time frame he gave, and resolved the issues we had with our computer . Andrew represents everything that good character and skill can afford a company to be . Microwize is doing something right if they have Andrew and techs like him.

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