medical billing software rcmA new trend has developed in medical billing software over the last two years, and it’s one that healthcare providers need to be wary of.

That trend is medical billing software companies deciding that they are also experts in medical billing, or revenue cycle management (RCM), as the companies like to call it.

Frankly, this is akin to Quickbooks deciding that they can handle your financial planning because their software manages money.

Developing software is a very different skill set from actually managing medical billing effectively.

Really good medical billers have spent years learning the intricacies of coding, denial management and appeals. They understand the unique requirements of different specialties, including those as intricate as podiatry, cardiology and OB/Gyn. They know how to negotiate the maze of denials and appeals that is different from insurance company to insurance company.

Over the last few years, we have heard multiple horror stories about practices turning their medical billing over to medical billing software companies entering the revenue cycle management arena. The problems include:

No follow up—One large medical billing software company marketed revenue cycle management at a low percentage, but neglected to mention that the service included only submission of the claim—no follow up. Anyone who knows anything about medical billing knows that this is like flushing a large percentage of your claims down the toilet. Without follow up, many claims simply will not be paid. Sadly for the practices involved, some were near bankruptcy by the time they figured out that no follow up was being done on their claims.

The best medical billing services track your claims and every cent of your revenue all the way through and relieve you from managing your practice’s revenue stream. When you outsource billing to your EHR vendor, you have many advantages, including the benefit of dealing with a single vendor.

Medical Billing Data is Tied to the Software—You may switch medical billing services several times during the course of your career because sometimes the chemistry or results just aren’t Free Video - How to avoid billing an coding errorsright. However, keep in mind that this is much easier to do when you’re working with an independent service; if you like the software but the billing service isn’t working out, you can simply look for another service that can bill on your preferred software. If you sign a contract with the software company for RCM and become unhappy, you will be stuck with the software of a vendor that you just fired for doing a poor job (uncomfortable). Remember it is a lot easier to switch billing services than software. Terminating RCM services with a software vendor almost always results in higher software fees and even worse, you could end up with a software vendor that you have an ongoing dispute with. Some providers have reported that upon termination they find that their billing data is being held hostage because of fine print that specifies that the billing data belongs to the software company.

Off-shoring healthcare billing services to India —Most of these companies are contracting with medical billing offices in India and shipping your claims overseas. This raises a lot of concerns including:

  • HIPAA—Data security is a very big concern with offshoring patient information, and laws regarding privacy are not the same in other countries. Keeping PHI secure is even more difficult when it’s shipped out of the country. And will a Business Associate Agreement (BAA) mean as much to those companies? Doubtful.
  • Understanding of U.S. Healthcare—Because this trend has been growing rapidly, these offshore companies are in aggressive hiring mode, which means a lot of untrained workers. And even if the offshore staff is well trained on codes and billing, their understanding of how U.S. healthcare and insurance companies work will be weak. And with ongoing regulatory changes in healthcare such as ICD-10, E&M coding, etc., understanding the system is even more challenging for billers located in another country.
  • Specialty knowledge—Particularly for more complicated specialties, understanding optimal billing procedures is difficult for off-shored workers. When it comes to understanding what can be billed in conjunction with a gastroenterologist performing gastrointestinal transit and pressure measurement, or the finer points of billing for a cardiologist doing a non-coronary thrombolysis, those are tricky enough for a U.S.-based specialty biller. Asking a minimally-trained biller in India to decipher those is wishful thinking.

Providing Healthcare Billing Services is a Distraction – Your medical software vendor should be focused exclusively on creating the best software to simplify your office workflows. Providing RCM services forces other vendors to take their “eye off the ball.” Stage 2 Meaningful Use and ICD-10 are delayed partly because of a lack of focus by greedy vendors with their fingers in too many pots. Stick with a vendor that is focused on software innovation that allows your practice to reach its full potential, one that is singularly focused on software and not RCM services.

If you are a medical billing company considering which software to use, you certainly don’t want to spend every day wondering if your software vendor is competing with you for your clients. Medical billing companies may not have lost clients to software companies yet, but it’s only a matter of time.

Revenue Cycle Management, Not a Core Competency for Medical Billing Companies

It’s relatively easy to understand why medical billing software companies are venturing into medical billing; it’s an additional source of recurring revenue. However, just because it’s profitable doesn’t mean it’s a core competency.

At HealthFusion, we are focused; our mission is to provide web-based physician software solutions and best medical companies that make the practice of medicine simpler.

And we will keep our eye on the ball for you, providing you with continuously improving, ever more efficient medical software.


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