Anyone who is shopping for medical billing service software has a tough decision on their hands. You are trying to not only make your own business successful, but also those of your clients. Here are a couple of important things that you should look for in practice management systems.

Ease of Insurance Verification

For successful claims processing and payment, it all starts with the proper verification of insurance coverage and benefits.

The indicated payer(s) are contacted and the answers to these questions build the basic benefit profile:

1. What are the effective dates of the current policy?
2. Are they any pre-existing conditions limitations?
3. What out of pocket expenses are the benefits for the anticipated service?

a. Does a deductible apply or only a copayment?

b. If there is a deductible, how much is the deductible and how much is met?

c. After the deductible, what is the co-insurance amount?

d. How much is the copayment?

e. What is the annual out of pocket maximum and how much is met?

f. Do the deductible and copayments apply toward meeting the out of pocket maximum?

With technological advances, you should only consider a practice management system that has an integrated insurance real time eligibilityfunction that can do most of this work for you. Using this basic information an electronic request can be sent to the payer:

1. First and last name of patient and the subscriber (if other than the patient)
2. Patient's date of birth
3. Policy number as shown on the insurance card

Within seconds the electronic response is received directly into the software and most of those necessary questions have been answered. No phone calls to the payer required.

Ease of Collecting Your Charges

Once your patient account has been created with accurate benefit information, you have a solid foundation to creating clean claims.

Since medical billing services are offsite. They have additional challenges when establishing their process for collecting charge data. Many must rely on receiving charge data via charge slips or superbills. Once received, staff must also spend time keying in the indicated charges into the patient accounts.

You can eliminate this tedious step by using a practice management system that can integrate with multiple EHR systems.

Ease of Preventing Claim Denials

A claim that contains CCI edit conflicts guarantees a denial by the payer. Verify any software you are considering has the capability to identify services/procedures may conflict with others or be bundled together according to NCCI (National Correct Coding Initiative) edits.

It is a bonus if the system also provides a customizable claim scrubber. This will give you the ability to create any special rules that apply to your provider's unique practice scenario.

These a few of the invaluable tools that guarantee a reliable cash flow for you and your clients.