How to evaluate billing software – Part 4

The first three installments of this series have enhanced your understanding of the complexities involved in successful revenue cycle management. To conclude the series, let’s look at the most important tool in billing: software. Even if you hire a biller, the product they use directly affects your profitability. How do you evaluate the various billing software that is available? Which is right for you?

This is information you need to have!

No matter how competent your biller is – YOU oversee your practice. Without a certain basic level of knowledge, you might be leaving money on the table and not be aware of it. 

I hope you won’t be disappointed by my first point:

There is no such thing as THE BEST billing system.

All software platforms have strong points and weak ones.

However, I’m not going to compare products or share my opinions about specific platforms.

Every practice has different needs.  

A system that’s inadequate for one practice might be exactly what another one requires. 

What are YOUR practice’s software needs? 

• Scheduling
  • If you’re a group practice: who schedules clients and how they will use the system?
  • Can clients schedule themselves?
• Automated eligibility/benefits
  • Will the results include mental health benefits?
• ERA/electronic remittance advice
  • Does the ERA process allow you to reconcile with incoming EFT deposits?
  • Automated? Or is it just as fast to post manually?
  • Is there an easy way to identify posting errors?
  • Are the denial & adjustment codes included in what you can view?
  • How (does?) it handle clawbacks?

• Patient Portal
  • How easy is it for clients to use?
  • How much time does it save?
  • Does it collect ALL the information you need?
• Payment processing
  • Includes e-check processing?
  • Support for health savings / flexible spending accounts?
• Automation of superbills for out-of-network billing
  • How much human labor is involved?
• Secure Messaging
  • Just between members of the practice? Or does it include communication with clients?
• Electronic secondary claims
  • Does the system support them?
  • Are they automated? If not, is it intuitive to use?
• Electronic patient bills
  • Text?
  • Email?
  • Reminders?
  • Ability to click to pay online?
  • Ability to self-generate receipts for FSA / HSA?
• Integrated clearinghouse?
  • If yes: will tech support help you with clearinghouse issues?
  • If not: can you choose which clearinghouse to use?
  • If no: how much will the clearinghouse cost? 
  • Can an integration be built to minimize how often you have to work in a separate portal?
• Are claims generated directly from completed clinical notes?
  • Saves manual data entry of claims
• Claim scrubbing
  • Will the system identify, prior to submission, errors that will cause a claim to reject?
• HIPAA-compliant document management/storage
  • Clicking on a document directly from your PM system can save time

• Print services (claims; letters; patient statements)
  • Yes, it’s an extra cost, but so is a printer, paper, toner, postage, and trips to the post office.
• Attachment submission (medical records)
  • Very important if you’re billing for work comp/auto liability claims
• Reporting MUST-HAVES:
  • Dashboard or reports that identify unpaid & underpaid claims
  • Track patient accounts receivable by factors such as amount, age, clinician, payer, procedure
  • Income reports/payroll reports for a group practice
  • Ability to customize reports & export in spreadsheet format

Critical features that often don’t exist:

• Payer configurability. How do you submit claims in these situations?
  • Insurance wants a “legacy” provider ID  
  • Payer wants a modifier attached to all claims, for example, the -HO/-HP HCPCS modifiers for Medicaid. 
  • Plan wants rendering information suppressed if it’s the same as billing. 
  • Configurability means that you would create a rule to fulfill one payer’s unique requirements – without having to edit every claim individually.
• Claim history
  • Will it save submission records for proof of timely filing?
  • How easy is it to identify & fix rejections & denials?
    • Rejections phrased in the language of electronic claims (known as ANSI) aren’t easy to understand.
    • A good clearinghouse will translate, in order to help you understand how to fix your claims.
• Policy History
  • Can you view old/inactivated policies, and reactivate them to rebill as needed?
  • Does rebilling an old policy require you to delete the current policy?
  • Is it easy to change the policy order if the Coordination of Benefits is updated?
• Payer / patient interaction record
  • Is there a place to document calls?
  • Date, user, and time-stamped?
• Can it hold multiple fee schedules?
  • Per clinician, license level, CPT, location?
  • Per payer, so that underpaid claims can be easily identified?
• Electronic claims status inquiry
  • Consider the time it takes your staff to call the payer or inquire manually in a payer portal.
• Automatic updates to CPT / ICD?
  • CPT updates every January 1
  • ICD updates every October 1
• Appeals submission
  • Some programs can walk you through generating appeals, submitting, and tracking them.

Clinical features:

• EMR included?
• Quality of clinical templates.
  • If the EMR is part of the product, what’s your opinion of the quality of the clinical templates?  (There are some systems that don’t include EMR…believe it or not)
  • Can you develop/add your own templates?
  • Does it feature validated assessment scales (PHQ-9, GAD-7, etc)
• If no EMR, will it interface with an external EMR?
• E-prescribe?

Don’t forget tech support!

• How is tech support handled?
• Live support line?
• Real-time chat?
• Are you on your own to figure it out from videos and/or manuals? 

Remember that support reps will teach you about the software. This is not the same thing as how to bill correctly to get your claims paid.

Should I use a billing service operated by the software company?

Wow, that’s a loaded question to ask an independent billing service!

In line with my commitment to honesty, my thoughts are:

• I do not (by definition) have experience with services operated directly by software companies. 
• I recommend you ask the same questions of the billing software company’s billing service that you would of any other.  For more info, check out the blog: https://psychbillingcoach.com/outside-biller/
• There could be advantages. The biller would be proficient in that product and hopefully achieve better results than someone who works across multiple platforms.

Follow the money. Who receives how much, and for what service? You need to decide where your limited resources are best spent. What is most critical for you?

Software-owned billing services might send work that requires a human to offshore services. I am not taking a stance about offshoring; that’s a political issue. I bring it up for awareness. If offshoring is a problem for you, you need to know before signing the contract.

Differentiate: is the billing service OWNED by the billing software company? Or just recommended? Some RCM services have partnered with various platforms but are independent. It’s more of a recommendation on the part of the software vendor: these are billers who use our platform and that our other customers have had good results with. Ask: Does money change hands between software and billing service? 

Other things to research (besides price)

Be wary of reviews on social media unless you can interview the reviewer. Anyone can say anything online. It’s not verified. You don’t know this person, their experience, or their motivation for posting their review.  

Ask the software company to connect you to a satisfied customer. This is not like an employer checking references on a potential new hire. In the context of your due diligence with a software vendor, what you want to accomplish is to talk to someone else who is a current or past user. Ideally, someone who is another biller or mental health professional who operates similarly to you.

You want to ask them:

• What do you like about the platform?
• What could be improved?
• What’s the onboarding process like?
• What was the easiest/hardest thing to learn?
• How has this product improved your bottom line?
• How has this product saved you time? Energy? Effort?
• Do you receive complaints from your biller, clinicians, and current/potential patients about features of the system?
• How does this system compare with other systems the user may have operated in the past or currently?
• What has the user’s technical support experience been? Good? Bad? 
• Were the user’s problems resolved? 
• Was the turnaround time acceptable?

Don’t be in a hurry to make a decision. Take your time. Software migration is NOT a fun process, so making a snap decision now could land you in the same position next year.

Consider your business goals. Will this platform help you achieve your goals within the next year? Five? Ten? While no one has a crystal ball, if you can see yourself outgrowing the product within 3 years, you might want to keep looking. Don’t stumble over a dollar to save a dime. Ideally, what you choose should accommodate you as far into the foreseeable future as possible.

Take advantage of their demo system. Spend several hours interacting with it. All software platforms have (or should) demo modules. If they don’t…why not?

The problem with a free trial: this is LIVE BILLING. Which includes EDI enrollments, if required. You’re loading live patient data. If you then decide you don’t like the product, now what? Software migration!

Ok, price. How much should you pay?

There are multiple models, which can make it hard to determine what you will pay.

• Per user, per month. How many people can be logged in simultaneously?
• Per rendering NPI.
• $X for the basic monthly subscription, $Y for each additional provider, $Z (or free) for admin/billing. Possibly includes a tier system including more (fewer) features & adjusting the cost accordingly.
• Tier-based systems. Fewer options = lower price.  
• Basic monthly subscription is not dependent on # of users or providers, then separate costs for whatever add-ons you choose.

Any good software sales representative will work with you to help you evaluate your practice’s numbers and how this will translate into your final monthly bill.

In conclusion, I’ve thrown a TON of information at you, more than is usual in an average blog post. Hopefully, you can now get a sense of how complex a decision it is to choose a billing/EMR system that works well for your practice. I wish it were as easy as using whatever your suitemate uses!

Feel free to reach out if you need some help sorting through the complexity.