How to Develop a Medical Billing Software?

Right from the stage of appointment booking, the healthcare process goes through multiple people representing various departments. With many people involved, it is natural for manual errors to occur. Mistakes on medical bills cost hospitals a whopping $68 billion annually. Not only this, billing errors result in overcharges of 26% on average.

No wonder healthcare organizations are switching to medical billing software development to automate and streamline their process. While implementing off-the-shelf medical billing solutions seem a good choice, often this software fails to be compatible with other healthcare solutions, thereby not serving the purpose well. Custom medical billing software offers a solution here. But simply choosing a healthcare software development company is not enough. There’s more to it. Let’s discover various aspects of how to develop medical billing software in the following few minutes.

What is Medical Billing Software?

Medical billing software is a solution that automates healthcare invoicing. Healthcare organizations and billing companies deploy the software to improve reimbursement rates significantly, optimize revenue, and sustain the financial trends of the businesses. Medical billing software streamlines the operations in a healthcare organization in multiple ways, including:

  1. These systems are fully integrated with EHRs, which reduces the chances of manual error and presents data in a better way in a few clicks.
  2. Claim scrubbing functionality helps boost the first-pass acceptance rate by inspecting claims for edits before final submissions.
  3. Automated claim worklists help billers to stay focused on serving patients
  4. When integrated with the clearinghouse, billers submit claims to several payers using the interface and faster reimbursement.

Some of the challenges that you can solve with medical billing software include:

  1. Fragmented workflow slows down the overall process with billing errors and claims denials.
  2. Paper-based billing systems can slow down revenue cycle management.
  3. Lack of interoperability makes it complex to integrate with other healthcare systems and share data within them.
  4. Avoids bundled payments by providing episode-based payments for risk-based delivery.
  5. Inability to manage patient claims data securely and under HIPAA compliant billing system.

Get Started on Medical Billing Software Development with Custom Software Development Company

Once you have made your mind to build a custom medical billing software, it’s time to start looking for a custom software development company that can shape your vision. As all medical software must comply with international standards like HL7, HIPAA, etc., it is essential to ensure that the company you hire is aware of these and follows policies that help you comply. After checking out this, here are a few things that you must consider:

  • Industry experience
  • Technical expertise
  • Skills of the development team
  • Development process
  • Project management tools
  • Client testimonials
  • Post-deployment maintenance services

How to Develop Custom Medical Billing Software- The Process Matellio Follows as Custom Healthcare Development Company

While there are multiple processes specific to various organizations, Matellio follows a customer-centric agile methodology to ensure quality services. Let’s discuss how we build custom medical billing software for your organization.

We start medical billing software development while helping you uncover the hidden aspects required for building medical billing software. In the discovery phase, our business analysts perform the following actions to get into the details of how a medical billing software should work.

Step 1: Understand the Working of Medical Billing Software for Architecture Creation

Medical billing software is integral to the healthcare revenue cycle. This process involves multiple steps, including:

Step 1: Patient Insurance Validation

This step verifies the validity of the patient’s insurance coverage. The front desk operators carry it out before the appointment schedule. In this, demographic information about the patient including medical history with diagnosis, number of total appointments, previous billing information, and more.

Step 2: Charge Capture Records

These are the medical services provided to the patients and charges for the same. The doctors and their teams enter these.

Step 3: Medical Coding

Medical coding covers medical services, treatment procedures, diagnoses, and prescriptions into standard healthcare codes. These codes must be correctly determined based on the International Classification of Diseases (ICD-10), current procedure terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) standards.

Step 4: Claims Submission

This step audits and submits billable fees to the insurance companies for reimbursement.

Step 5: A/R Follow Up

Account receivable follow-up ensures that the healthcare providers can recover overdue payments. It involves tracking denied claims, checking partial payments, re-filling claims, and represents the amount that patients owe to the hospital for services provided.

Step 6: Denial Management

Denial management involves standard denial reason codes and highlights the gaps in billings, registration, and medical coding process. It also records this data to avoid future denials and ensure acceptance.

Step 7: Remittance Processing

This refers to the inspection of payments resulting from a bill for rendered medical services to determine the acceptance or denial of payments.

Step 8: Third-party Follow-Up

In this step, payments from third-party are collected. This is an essential step as healthcare organizations can only choose Medicaid or Medicare after other options have failed.

Step 9: Patient Collections

Patient collections collect all the copayments and non-covered charges from patients if the bill for healthcare services is partially insured.

Step 10: Reporting and Data Analytics

All the information is stored in the system for future use and analyzed to improve financial operations by extracting insights.

Step 2: Finalize the Required Features for your Medical Billing Software with You

1. Patient Preregistration

Optimized billing workflow is crucial to the accuracy of medical billing data. While it depends on multiple factors, consistency of patient preregistration is one of them. This feature is also essential to foster better patient care and reduce waiting times. It collects the following data:

  • Patient medical history
  • Insurance eligibility
  • Medicare provider enrollment
  • Patient’s details

If the preliminary information is available at the time of registration, it is easier to address gaps in the future, and also, the information is displayed to the doctors in concern in a timely and accurate manner.

2.Claims Management

Claims processing for medical billing and coding is carried out through the credentialing feature. Claims management is one of the essential features of medical billing software that automates billing, saves time, and reduces inaccuracies. This includes other sub-tasks and corresponding features for:

  • Claim processing
  • Invoice creation
  • Claim submission
  • Claim updates

And more.

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3. Automated Accounting

Automated accounting is vital to medical billing software. It is enabled by the combination of features like coding analysis and invoicing through medical codes, document management, insurance claims, A/R, Medicare and Medicaid coverage, and revenue cycle management. Automated accounting helps streamline the entire process with features that include:

  • E-Invoices
  • Payment Reminders
  • Coding
  • Claims management

4. Data Exchange and Collaboration

Throughout the cycle of medical billing, including invoicing, coding, appointment scheduling, data integration, or data sharing among various stakeholders, medical billing software should encompass all smooth data updates to ensure each user receives the latest copy of the data. Even a specific gap in the data can lead to big mistakes that can be worrisome.

5. Patient Data

A centralized data of patients helps healthcare organizations to stay updated. It helps medical billing systems and health information systems work in collaboration. When provided with accurate patient information, the medical billing process can be instant and uninterrupted. For this, the medical billing systems need to collect up-to-the-minute information from EHR/ EMR along with the following features:

  • Medical records
  • Insurance eligibility
  • Medicare coverage
  • Prescription history

6. Appointment Scheduling

Patient appointment scheduling helps medical billing software to ensure accuracy in medical billing codes. The following features integrated into the application will help with simplified medical billing:

  • Patient inflow
  • Treatment details
  • Appointment type
  • Revisits

An easy-to-use UI/UX that can be a common platform for scheduling and billing is ideal for medical billing software.

7. Compliance

As explained earlier, compliance is an essential requirement when it comes to healthcare software of any kind. Without complying with the standards, you risk running into legal issues that might permanently ban your software solution. Billing software with compliance will take your software to the zenith of success.

8. Reporting and Analysis

To generate medical billing services, financial reports, patient documentation, claims management, and accurate reporting and analysis are vital. Ensure your medical billing software allows seamless workflow between the various nodes to gather information and insights required. Use an easy-to-use dashboard that offers visualization for the user to derive results.

Step 3: Technology Stack that Would Best Suit Your Project Requirements

Once the work is precise, our analysts, along with the certified technologists, figure out the technology stack that would be the best fit for your project requirements. Here is what our expert suggests.

Front End Development

Libraries Vue.js, React

Languages CSS 3, JS, HTML 5

Back End Development

Server Nginx

App Frameworks Laravel

Databases My SQL, Redis

Hosting AWS, VULTR

Step 4: Finalize the Team Structure

This brings us to an important step, helping you connect with the right people who will finally build your solution. Your team shall typically include:

  • Project manager
  • Front-end developer
  • Back-end developer
  • UI/UX experts
  • QA and testing engineers

Step 5: Custom Medical Billing Software Development and QA/ Testing

Once everything is finalized, we’ll start working on the project to deliver the expected results. This, too, is broken down into multiple stages such as:

  • SRS Creation: A software requirement specification (SRS) document captures the complete project description, including how a system shall operate and other technicalities. In this stage, a detailed view of the system is designed on paper, with each aspect explained. Once you approve the SRS document, the following phases of the document shall begin. Developers will consider the requirements mentioned here as benchmarks, so the client must ensure that all the requirements are specified.
  • Software Development: Based on the SRS, the development work will start. It is mainly carried out in UI/UX development, front-end development, and back-end development. The project manager oversees the entire process to ensure cutting-edge delivery and shall stay connected to you to share regular updates.
  • QA/ Testing: QA and testing experts design and run the system based on various use cases to ensure that the system works like it is intended to. This is a crucial stage to deliver software that not just meets your requirements but is also bug-free.

Are You Ready to Begin with Custom Medical Billing Software Development?

The right time to invest is now. While developing medical billing software is easy, it is lucrative given the benefits it offers. You can always begin with MVP development for budget constraints and keep adding features that you wish to based on upcoming needs and requirements.

Matellio has been serving many healthcare organizations (among other verticals) for 20+ years in the industry. To begin, book a free 30-minute consultation with our team and explore.

Founder & Board Member at Matellio — Technology enthusiast with enterprise solution design & development expertise