Medical Coding and Billing


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Medical Billing Software Sales Tactics

Via our Medical Billing Community Forum

Steve is a well known and respected certified medical biller who holds CMBS, CEMCS and CMSCS billing certifications, and Certified Practice Manager-Medical Coding Specialist (CPM-MCS) through the
Physician office Managers Association of America (POMAA). He said:

medical billing softwarMany people starting out ask about medical billing software. There are many out there, like cereal boxes where once all you had was Corn Flakes. You have many choices:

  • You can use internet billing programs such as ZirMed®, which I've used and required very little training.
  • You can use Remote Access®, which comes with MS Windows so you can use the internet to log into the doctors system and use his software remotely. I did this with one client.

You can buy software, which can become expensive!

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«On: February 23, 2009, 08:37:27 PM Steve posted:»

Some can go for a few hundred dollars and I've seen it as high as $250,000. Some are windows based and some can be Unix based. I found the ones I used to be very easy to use because I am sort of a computer geek and software comes easy to me. One thing I found is that I don't trust software dealers. I find the ones I worked with to be at the same level as that of a used car dealer. I found the ones I worked with would tell me anything they thought I wanted to hear and they would sell their mother to make the deal.

look One dealer told me his software could only work on a computer he wanted to sell me for $25,000. This was a computer you could buy today for $300 at Walmart. When I said no to the computer, his response was, well, if it isn't on my computer, we cant fix any problems you have. No problem, no sale. After the $25,000 computer, I was told it would cost me $25,000 per provider for the license. $25,000 x 120 is alot of money.

Then I would need an additional program and hardware to use the program in windows. It was worse than buying a car. I could buy the chassis, then pay extra for tires, seats, brakes, trunk, radio, and steering wheel. Not to mention a pay for each mile driven.

Technical support was $25,000. Then an upgrade to Y2K would cost $75,000. The program came with 10 books. None of them colored in yet. I also had to pay for a technician to be on call at the tune of $50,000 per year. I want claims to print on paper, that was extra. Then extra more to program my printer in the program.

  Basically, I look for simplicity.

  * I want an easy to navigate demographic screen
  * I look for charge window where I can enter dates of service, CPT codes, and modifiers
  * I look for an insurance screen where I can enter the patent's primary, secondary or tertiary insurances
  * I look for a CPT and ICD-9 and modifier database
  * I look for a provider database that is unlimited with ease of entry
  * I look for a payment entry screen where I can make easy changes if necessary
  * I want to be able to make easy changes to statements and claims forms
  * I want to be able to make notes
  * I want to be able to create reports using any internal data
  * I want to be able to export data in ascii format
  * I want to be able to bill a parent if the patient is a child
  * I want to be able to add separate practices without any extra costs
  * if any upgrades are made due to Federal Law requirements, I want to know how much the fee
  for the upgrade is going to be
  * I also want to be able to import data in ascii mode
  * I want to be able to send multiple accounts to a debt collection agency rather
  than one account at a time

  * It has to produce AR reports on demand
  * Individual insurance reports
  * Individual account report
  * Monthly payment report
  * Monthly overpayment report
  * Monthly adjustment report
  * Monthly time payment report
  * Debt collection report

Again, I want to be able to use any database to create a report, for example, if my provider wants to know how many kids from 7-12 he treated or how many Medicaid patients he treated, or how many 994 patients with Medicare he treated.

lookI hand out a questionnaire of "can it do this...?" and I want the answers they provide to part of a contract if I agree to buy the software.

look I also call technical support at lunchtime to see how long it takes to get through. If it takes forever, that may also happen once I buy the software. I don't have the questionnaire anymore.

lookLast, I want a list of local users I can visit. I don't want people i can call. I visit the users and check out the software. I ask them question as to any problems they have. If I find the dealer lied to me, I walk away.

I want Software that Does what I Want... Not What a Dealer Thinks I Want!

Does the medical billing software:

  • allow customization of the superbill?
  • create specialty codes for products, or services not otherwise covered by ICD, CPT or HCPCS codes?
  • allow a complete search for ICD, CPT and HCPCS codes for medical claims?

I also don't want to be nickeled and dimed on extras that may not be needed. I know this may make some software dealers mad, but I've researched many types of software for myself and my providers. This had helped me weed out the bad from the good. I've never used or played with Medisoft. I've used Versyss, Lytec, Medical Manager, Unisys, Centricity, and Zirmed.

It is Important to Ask about Clearinghouses

When selecting a clearinghouse, make sure you find out how many insurance companies they send claims to. Are you required to use their software, or one of your choice?

You also want to know can you send claims directly to an insurance company such as Medicare, Medicaid, Aetna. Blue Cross, Cigna, Humana, United Health care. Also if you send directly to the insurance company do you get a confirmation of receipt of claims report. You want to find out any initial costs and are these costs per provider.

How much will it cost you per claim to send to the clearinghouse? What reports will you get? Will you get a confirmation of receipt of claims not only by the clearinghouse, but also by the carrier? Will you get a claims adjudication report? If the claims were sent to the clearinghouse and the insurance company says the claim is not on file (NOF), what will the clearinghouse do to rectify this? Do they resend for free, or do you get a refund? Make sure your contract has a no-penalty termination clause and you can terminate for any reason without penalties.

I hope this has helped answer some questions about what to look for, and which questions to ask when buying medical billing (and practice management) software. -- Steve Verno, Certified Biller

About the Author: Steven M. Verno is a Certified Master Medical Coder and Certified Master Medical Biller and Medical Coding/Billing Instructor. He also is the co-owner of Lucrum Consulting, LLC, which provides training in medical coding and billing issues and helps physician's practices in areas such as A/R recovery, appeals and staff training.

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