How to Develop Web Based Medical Billing Software for Hospitals?

Health professionals agree on one thing: billing information must be clear, precise, and accurate for medical providers, insurance companies, and patients. If the billing system breaks down, providers do not receive payments on time, patients are frustrated, and insurance companies are always seen as the culprit.

Medical Billing Software: Key Information

Medical Billing Software comes in all shapes and forms, but currently, the most popular forms are web-based or cloud-based solutions. Moving the billing process to the cloud has made life so much easier for health care providers, as it relieved them from the need of handling their own on-premise IT departments. However, all medical billing software developers should keep in mind that patient information should receive the utmost protection, as it is an attractive target for hackers and identity thieves. All high-tier medical software should be compliant with the strictest of security standards like the GDPR or HIPAA.

There is a lot to consider when developing a medical billing software since the market for it is growing each day.

When the System Does Not Operate Smoothly

When billing claims seem too expensive or involve too many codes, a medical director within the insurance company usually steps in and sends them back. In situations like this, the healthcare provider must resubmit the rejected claims until the issues are resolved.

Such lengthy “back-and-forths” between providers and insurance companies, as well as errors in the ANSI and CMS files, are usually the result of the complex Standard Medical Billing and Coding System. It is estimated that up to 50% of all claims are returned for revision and resubmission. This is inefficient and takes medical providers’ attention away from their main focus – patient care.

Finding the Answers for the Right Medical Billing Software Development

There must be separate software for the entire Claim and Billing Process for it to operate smoothly. This software must be based not only on ANSI and CMS standards but also on the specific needs of the health care provider.

General Needs of Providers (hospitals, small practices, clinics, etc):

• A custom electronic medical billing system that fits the unique needs of the institution and meets the demands of insurance companies as well as national standards.
• Web-based medical billing software development – a product that can be accessed remotely and on multiple devices. For smaller practices, clinics, and hospitals that lack the budget to hire full-time employees to perform billing activities, outsourcing the billing system can be a perfect, budget-friendly solution. This solution, however, requires the internal accounting staff to communicate with the outsourced employees in the cloud.
• Medical billing systems must incorporate strong security measures. Hackers are targeting medical billing systems because they have access to huge amounts of personal information of patients (names, addresses, birthdates, social security numbers) and all that information gathered in one place makes medical billing software an attractive target for wrongdoers. All healthcare billing software developers must provide security measures that leave no “bread crumbs” for cybercriminals to find.

“Canned” healthcare billing system solutions, which are available on the market right now, are just that – easy and unreliable, “pre-packaged” solutions. They cannot provide all of the best practices in healthcare billing services.

How to Create Medical Billing Software – Best Practices

Healthcare professionals are in the business of providing exceptional patient care. And when not treating patients, they are learning – studying the most recent technologies, new procedures, etc. so they can provide better patient care. When they are bogged down by an inefficient billing system, patient care can suffer as a result. Best practices in medical billing, consequently, require that the software is efficient, easy to navigate, and incurs the least amount of time possible.

Large hospitals have IT departments, of course, but the workload of those departments is significant. And unless they have specific software engineers to develop billing software, healthcare billing services will suffer. Uniquely trained software developers are needed for this task, which certainly brings the cost of billing system development for hospitals, clinics, and practices to fairly high levels.

Two Solutions

1. The first available solution is to outsource medical billing from a company that does exactly that. Their engineers develop software that is then applied to all of that company’s clients. The problem is that not all of these companies are “created equal,” and expensive mistakes can be made if a medical facility enters into a long-term contract with a company that simply “goes through the paces” with little flexibility for unique needs of its clients.
2. The second solution is to sign a contract with a company that looks at each client as an individual and that engages in web-based billing software development based on each client’s needs. Such companies employ teams of software engineers who are exceptional coders and developers, and who can determine individual needs and develop the billing software accordingly. This is a large part of what is known as “best practices.” A medical provider that can find such an agency is indeed lucky.

Ongoing Review and Revision

This is another component of best practices in software development. When a hospital or clinic uses the right software development company, it will have the continual long-term service solution to provide regular review and revision. This is how that looks like:

• When a new process can save money and increase productivity and efficiency, then it should be incorporated into the existing software. A software developer or development company that values its clients will keep abreast of the improvements and make recommendations.
• Best practices involve a plan to provide a regular review of current software – a plan that is developed together by the agency and the client. Such reviews can ultimately reduce billing time, increase insurance and company’s acceptance, and keep patients more satisfied. And more important, it can provide critical security upgrades that health providers must have.

Medical Providers Must Ask the Right Questions

Any medical provider – hospital, clinic, private practice – must know which questions to ask when considering employing a custom medical billing software provider and justifying the cost of the billing system development. Here are the most important questions to ask:

• What programming languages are best suited for custom medical billing software? Which language does that particular provider use? Why? Java for medical software development has great potential, and developers who use it are generally able to code more efficiently, cutting the development costs.
• How often are the software providers going to meet with me for a comprehensive review? How often are they going to give recommendations that will impact both our bottom line and the level of patient care we provide?
• How often will they review our security systems and make recommendations based on the latest research and practices? How often will they test our security systems?
• How much initial and ongoing training will the software developers provide our staff with?
• Will they routinely resolve coding issues and update the software according to standards and insurance company requirements?
• Will they upgrade the software based upon our changing specialized needs and provide carefully planned and developed solutions?

Understanding The Activity And Communication During The Billing Process

1. The patient visits a medical provider.
2. Patient’s medical record is updated with the diagnosis and treatment information and then electronically recorded.
3. A five-digit code is assigned to the procedure and entered into the database; another code is assigned to identify the diagnosis. These two codes are the critical pieces that are used in processing medical billing – both for the insurance company and for the patient.
4. Codes are transmitted to the insurance carrier and/or are transcribed for a patient bill. In most instances, both types of communicators are developed, so that the patient has an understanding of the costs of each item – office visits, tests, details of hospital care, dispensed medications, etc. Patients with insurance will receive these statements from the insurance carrier, along with an explanation of the paid benefits.
5. When codes are sent to insurance companies, they are usually transmitted using an ANSI 837 file, and the claim is then processed for payment. Likewise, Medicare and Medicaid claims are transmitted via the CMS 1500 file.
6. If claims are coded correctly, the pre-negotiated payment amount is then paid to the provider, and the patient is billed for the costs left unpaid according to their insurance plan. There are six steps that comprise the billing process:

Medical Billing Software Development: Key Product Features

Romexsoft’s medical billing software developers suggest implementing the next key features to optimize your business processes:

• Smart Claim Processing. To streamline all communication and activity during the billing process mentioned above, our developers can create an automatic claim validation mechanism with code-check to verify all data before any claim is sent. This will help you reduce the risks of unpaid claims and save your staff time on dealing with rejected/incomplete claims.
• Eligibility Verifications. Certain customers may be unaware of their lost insurance status. This product feature will allow you to obtain the current patient’s insurance information and to make the needed clarifications with the patient before an appointment. In this case, both your facility and the patient will avoid frustrating confrontation.
• Auto-backups. To avoid any data loss your solution should be enabled with scheduled data backups, which would either download the critical data on hard drivers or send it to the cloud.
• Electronic bills. Custom electronic bills, which would include comprehensive information on the scope of services provided to the patient, can be personalized/modified in a few clicks. Different doctors can choose to create custom forms for charge slips that are processed online. Again, this will save your staff hours on sorting out the bills.
• Payment reminders. You may want to incorporate a set of soft reminders on overdue payments, which could be automatically sent to the patients in the set amount of days after the payment was due. This feature could save a lot of time on making personal calls or sending letters manually.
• Customizable report functionality. Your web app will organize all billing data in the format you specify. It could also be sorted by different values for easier monitoring. Additionally, you can have a smart analysis tool, which will compare billings for different periods, make financial forecasts and provide all types of insight at hotkey access.

In addition to that, you should consider enhancing your solution with easy and streamlined UX and UI, so that your employees can operate it quickly and efficiently.

One of the definitive advantages of the medical billing software we create is 100% HIPAA compliance with all the data being encrypted according to the latest security standards.

How Much Does it Cost to Create a Custom Medical Billing Software?

After you have done your research and decided on the key features of your end product, comes the time to put together a cost estimate with your software provider of choice. Here are the key points that are going to make up the bill:

• Functional requirements. The more features you want to cram into your software, the longer it will take to develop, and the more it will cost.

• Development team. There are many significant differences between hiring freelancers, in-house developers, or an outsourced development team, and the cost is one of them.
• Technical stack. There are going to be three components for developing your software solutions, and those are the frontend, the backend, and the storage. Different technologies require different levels of specialization. This is also going to influence the total costs.

Most software development companies charge by hour, though charges may differ from project to project. Nonetheless, your software provider should discuss the costs with you thoroughly, fully explaining each line of the invoice if so requested.

Romexsoft Can Be Your Solution

We are a Web App Development Company specializing in healthcare, fintech, and media & entertainment. For over 14 years we have been providing software solutions involving over 100 projects for new and existing clients.

It does not matter whether you need a cloud-based online billing solution for a startup or a major hospital that needs a complex billing service in place, Romexsoft developers have the skills, the experience, and the commitment to provide you with the best solutions on the market.

Written by Romexsoft on November 24, 2018 (edited 2020)