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Medical Billing Software: How to Close the Loopholes in Your Medical Claims Billing

Medical Billing Software: How to Close the Loopholes in Your Medical Claims Billing

Recent findings have proven that medical bills are among the leading causes of bankruptcy. But the high costs of staying healthy aren’t just tough for your patients – they can also be a financial strain on your practice. 

In this post, we’re outlining the best ways to close the loopholes in your medical claims billing by pointing out common errors and the best ways to prevent them by using electronic billing and tracking software, talking to staff, and more.

You can’t afford to skip this article. 

Tip 1: Stop Pushing Paper

It’s easy to make mistakes in your medical claims billing process when you’re doing things the old-fashioned way. Software can not only help to save you time and streamline the efficiency of your billing process. It can also help you to catch serious, costly errors. 

This automated process should begin with the scheduling of your appointments.  Look for software that sends out automated email reminders and other notifications when it comes to both the booking and billing process. 

You should also use digital forms and record keeping strategies to make sure that nothing slips through the cracks. Plus, you won’t have to waste your customers’ time asking them to fill out a form again if a hard copy gets lost. 

Your software should also be able to check your procedure codes, keep records of the services your practice provided that day. Also accurately keep track of all the costs to both patient and practice. 

Tip 2: Make Sure You’re Always Keeping Up With Regulations

Even if you’ve only been in practice for a short while, you’ve likely already experienced several changes to the medical claims billing process. 

These claims and the regulations surrounding them are changing all the time. To avoid problems and errors that cost you both time and money to correct, make sure you’re always keeping up with the latest regulatory news and standards. 

How can you accomplish this? Make sure that you’re always implementing new staff training programs.

Also, are you using the right technology and software to alert you when regulations have once again changed? Are you keeping in touch with other professionals in your industry?

Tip 3: Don’t Let EOBs Fall Through The Cracks

EOBs, or Explanations of Benefits, can be a lot to unpack. We get it: there’s a lot to handle and keep track of when it comes to your medical claims billing.

Still, just because a claim has been denied doesn’t mean it’s OK to move onto something else. 

Make sure that you’ve created a system to keep track of denied claims that works for you and your practice. Also, take the time to ensure you’ve followed up on any claims that come with EOBs. Always follow up!

Talk to your team about their ideas to improve this part of the medical billing process.

Then create a firm schedule and plan to implement their ideas.

Tip 4: Watch Out For Improper Coding and Payments For Services

Look, mistakes can happen when it comes to medical claims billing. But, they can also be very costly.

Always run audits as often as you can, and make sure that you’re not over-billing for the services your practice provides – or worse, under-billing. Also, scrutinize the bills you get for ordering medical equipment. Especially look at shipments of medical supplies. Vendors can make mistakes in billing, too. 

Especially if you’re on an automated order system, this is crucial to prevent a serious hit to your budget. Make sure too, that you’re accurately billing for each part of a service. Use separate codes for each service provided. Not just one overarching code. 

Anything you can do to cut down on errors is going to save you money in the billing process. Not to mention, prevent a lot of headaches for both your patients and your practice. 

Tip 5: Make Sure You’re Managing Your Staff Effectively

When it comes to properly handling your billing methods, communication is key. That should start with intraoffice correspondence. It should also cover a thorough examination of how your employees are communicating with your patients. 

To get a feel for how errors are happening, and the most common problems your staff are facing, start by talking to and surveying your medical billing staff. 

What are the parts of the billing process that are causing them the most headaches? What are their most frequent errors? What do they wish was easier to handle when it comes to the billing process? What are their ideas for improvement? 

Remember that when it comes to medical billing, one small error can often lead to several more. The cost to your practice can increase exponentially. 

Ask yourself and your staff how you can be more clear when it comes to the billing process. How can you reduce the number of claim denials you’re seeing? Are you being clear with your billing policies? Is your staff clearly communicating those policies to your patients?

Examine what your follow-up process looks like. Ask how you can shorten the timeline of the process. Do this by tracking the claims across the entire billing cycle. Also work with the healthcare payers to make sure that claims are quickly filled out and filed.

You’ve Got The Information You Need To End Medical Claims Billing Errors

In recent years, the margin of error when it comes to medical bills has been as high as 70%. No wonder so many patients are challenging their medical bills.

Not only does this affect the efficiency of your office and practice. It also makes you appear disorganized and even untrustworthy in the eyes of your patients.

It’s time to put a stop to costly, time-eating errors in your billing process.

Want more information about how you can prevent and correct errors in your medical billing process? What about the types of software you can use to make it happen? Get in touch with us today. Check out our website to learn more.

Make this the year you reduce your margin of error on medical billing. Make it the year that your patients are happier than ever.  

Posted in: Medical Billing Software

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Medical Claims Processing: How to Pick the Best Medical Claims Processing Software

Medical Claims Processing: How to Pick the Best Medical Claims Processing Software

By the year 2024, nearly $1 out of every $5 will be spent on healthcare in the United States. If you’re a healthcare professional or part of a medical association, you’ve likely struggled with the most effective way to handle your billing.

You’ve also wondered how to grow your business. 

The right medical claims processing software can help to streamline every aspect of your business. How do you know if you’re selecting the right option? 

Here, we’re sharing with you the top 5 things your medical claims processing software should be able to do for you.

1. Meet The Needs Of Specialty Practices

83% of adults have met with some kind of a healthcare professional within the past year. Of course, how to properly handle the billing, payment, and claims of these visits feels like a full-time job.

If you’re a specialty practice or office, these claims can often get even harder.

The right medical claims processing software needs to be flexible.

It also needs to offer customizable options that best fit with the operations and services of your practice. It needs to have the kinds of templates, options, and tools that save your employees time.

Let’s say you work in workplace risk/health management.

Can your software optimize travel authorizations, recall schedules, and also send out automated replies and notifications? 

Is your staff is spending several hours each week tailoring the software to fit their needs? If so, it’s not a good use of company time.

2. Make The Case For Why Their Company Is The Best Option

Your patients aren’t coming to you because your practice or organization was the first name they stumbled across in their phonebooks. They’re coming to you because you offer unique, specialized, and great services that your competitors or other nearby practices don’t. 

The same should go for your medical claims processing software. 

Make sure the options you’re considering are CMS-approved.

Also make sure they’re  in accordance with compliance laws.

This means that their price point is fair, that they’re committed to patient and practice security, and that they have lots of references from clients.

Also, make sure your software can spot medical billing errors.

If they don’t, you might need to pursue other options. 

3. Get A Firm Count of Licensing Limits

You could be looking at the best medical claims processing software in the world. But if only two of your employees can actually use it, then is it really that great? 

When you’re trying to decide which software option to go with, make sure you’ve had a serious conversation with the company about licensing limits. This will not only make sure that you’re not hit with any surprising costs. It will also tell you about the kind of customer service you can expect to get from your software. 

Don’t get strung along. Ask right up front how many licenses (basically, how many people or devices in your office will be allowed to use the software) are included in the total price you’re being given. 

If you need additional licenses, look around at different costs before you say yes to a software company. 

Finally, be sure to ask if the license is a “one time only” activation fee, or if these licenses are going to be renewed every year. 

Unfortunately, this is an area where a lot of software companies can increase the price and sneak in a few hidden operational fees. Make sure your practice isn’t getting fooled by these business practices.

4. Provide Expert Security Options

Hacking happens now more than ever before.

What is your processing software doing to protect you and your patients? 

Especially if you’re considering using software that’s cloud-based, you need detailed, point-by-point answers to this question. 

How does our software plan to guard against cyber attacks and information theft? If it does happen, what’s their plan of action? 

Ask questions about how frequently they update and install things like patches and fixes, and what kind of anti-virus protection they currently use.

Always ask if the software provider has been faced with an attack before, and how they handled the past breach. There’s no such thing as being too cautious or too detailed when it comes to protecting the privacy of your patients. Same goes for your employees. 

5. Include Training For Your Employees 

We get it: medical claims processing software can be difficult to understand. But when yours comes with so many customizable options, or if you’re transferring tons of data from an old system or even paper, figuring out the process can feel totally overwhelming. 

That’s why, when you’re in the process of selecting your new software, you should look for a program that includes support and training for yourself. Also make sure it helps your immediate staff and your operation as a whole. 

Make sure that your software also comes with the option of self-service, so your employees can get questions answered and problems handled as soon as possible.

This should include things like 24-hour online support, continued access to educational options, and live tech support. 

Also look to see if there are training videos and tutorials hosted by the software. Also ask about brief how-to ebook guides or postings. There should also be forums where your employees can seek answers from other users or troubleshoot.

Finally, be sure that the software company you’ve decided to go with is willing and able to help you install and set up the software itself. 

You’ve Got All The Information You Need To Pick The Right Medical Claims Processing Software

When it comes to providing the best services for your patients, you don’t take the easy way out. The same should be said of your software. Do your research, ask a lot of questions, and look into several different options before deciding on your final answer. 

For more information about medical claims processing, to get your questions answered, or just to educate yourself a bit more on what the right software can do for your business, check out our website or get in touch with us today. 

Posted in: Medical Claims Processing

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Medical Claims Processing: 5 Tricks to Easily Streamline Medical Claims Billing

Medical Claims Processing: 5 Tricks to Easily Streamline Medical Claims Billing

Is the medical claims billing process a painful one for your practice? It doesn’t have to be.

Taking a few simple steps to simplify medical claims billing can drastically improve your collections and even increase your practice revenue.

If you’re ready to make this process easier, check out the following 5 tricks below!

5 Tips to Streamline Medical Claims Billing

1. Take Inventory

First, take an inventory of where you are. This way, you can establish goals for, and periodically analyze, the progress and status of your accounts.

You’ll want to do a periodically analyze the progress and status of your accounts monthly or quarterly. Do this by tracking the following:

  1. Number of days in Accounts Receivable
  2. Percentage of net collections
  3. Aging of Accounts Receivable

With an idea of these stats in mind, you can then keep your eye out for ways to improve efficiency. This will then lead to increased and more timely collections.

2. Take Advantage of All Your Resources

There are plenty of resources and tools available to help you with your medical claims billing, so take advantage of them.

Give online tools, programs, and billing software a try. These can make a vast improvement in how effective you can bill. 

Instead of reinventing the wheel, make things easier for yourself and rely on these resources, which will have enough information to make your billing simpler.

An example of some awesome technology you can take advantage of as it relates to the collection process is an automated revenue management tool. Advantages of this tool include:

  • Automated payment reminder messages with convenient mobile or online payment options
  • Reduced amount of time you spend on sending out statements, trying to collect payments manually from patients, and also decreased billing costs
  • Integrated reports that will tell you how much revenue you are waiting on, and even how much revenue you have claimed. 

If you are struggling, however, experts are also available to help.

Medical billing companies can assist you by taking on the whole billing process for you. It doesn’t get much easier than that!

Also available are medical marketing companies, which can help you grow your practice. 

3. Use a Patient Portal

Have you implemented a patient portal into your practice management? If not, you’re missing out.

Using a patient portal can be a huge convenience to not only your practice but also your patients. Offering access to a patient portal will encourage your patients to take a more active role in their healthcare.

Benefits of using a patient portal could include the following:

  • Patients have the ability to view their complete account activity and submit payment information–all with the same security as online banking.
  • Your patients will have access to important documents. These documents could include digital x-rays or before-and-after shots, admittance forms, insurance documents, post-op care instructions, and any other documents you would like them to be able to view. 
  • By sending or receiving secure messages that can be archived to give you an added level of liability protection should the need arise, patients have the ability to communicate easily and efficiently with your practice. 

5. Create Policies and Procedures

Not only should you create policies and procedures for medical claims billing, but you should ensure that everyone on your team is aware of and familiar with them. 

To ensure a more cohesive understanding of expectations, discuss the guidelines and protocol regarding the process of collections with your team. Also, provide a manual for each staff member to use for quick reference. 

This will make it more likely that you will see an improvement in your revenue management over time. 

5. Be Informed 

Having an understanding of insurance coverage will help make medical claims billing easier.

Often, billers don’t know what is covered and what is not. This makes medical billing all the more difficult.

Understanding coverage will give you the ability to know how to bill for services better. Being informed about coverage will also allow you to understand who will be responsible–the insurance or the patient.

Checking eligibility may seem like a daunting task at first. However, understanding what’s covered and what isn’t covered is necessary for proper claim submission, as well as follow-up and patient billing. 

At the end of the day, being informed about and familiar with the different insurance companies your working with (including coverage policies, filing limits, coding edits, global policies, etc.) will make the medical claims billing process much less painful

Quick Tip: You should also keep a record of denial stats. This includes rates and reasons for denial and recurring denied claims in order to spot and prevent them in the future. 

Other Quick Tricks to Improve Your Medical Billing Collections This Year

  • Train staff to collect: Since collections begin at your front desk staff, it’s imperative that they are trained to get the cash before the patient is seen. 
  • Be transparent about pricing: Don’t leave your patients completely blindsided by costs that they have not budgeted for. This is one of the main reasons providers have a hard time with their medical billing collections, so to avoid this, be transparent about the expense.
  • Offer different payment options: Consider offering various payment options to patients who have to pay larger medical bills that they aren’t able to pay in full all at once.
  • Make paying easy: If you want your patients to pay their bills, you need to make the process as easy as possible. Online bill pay can be a huge help with this.
  • Incentivize your billing staff: First, you should recognize that it’s not a ton of fun for your billing staff to call patients day in and day out asking for collections on past-due accounts. Since this process can be frustrating and tiring, potentially leaving staff unmotivated, always show appreciation and offer an incentive program to keep them on track!

Which of these medical claims billing tips do you already use at your practice? Which tricks do you plan on implementing after reading those listed above?

Tell us how you plan on simplifying the process in the comments!

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Medical Billing Software: How Do I Spot Medical Billing Errors?

Medical claims can be difficult to understand. When a patient has a serious health condition, there may be several provider, specialists, and medical facilities involved in their care. Bills can be loaded with abbreviations and medical terms that the average patient may not be familiar with. It’s important to arm yourself with the confidence to question a potential billing error.  

Medical bill from the hospital, concept of rising medical cost, selective focus.  All data on the bill and form design are fictional, created specially for this concept.

The first step in questioning a medical claim received for services is to make sure you review each detailed charge. If you receive a summarized statement, you may need to request an itemized bill. Read through the dates of service, provider, and insurance information to confirm its accuracy.


Check for obvious duplications. If a service is charged multiple time, it is most likely a mistake. Also check for omitted or missing information. For example, you may receive a statement summary that does not indicate past payments made. It will not hurt to be certain all previous payments are accounted for before submitting your final payment.

Errors in coding services received in the bill can be more difficult to spot. If your bill contains any charges that seem suspicious, mark them so you can ask your provider about them later. It’s not uncommon for billing specialists to miscode a charge.  

Take your time with the call the provider and ask any questions you have about the statement. Your healthcare provider wants to work with you to make sure you are happy with the overall care you receive. Apex EDI helps doctors focus on healing by supporting them with the best technology for medical claims.

Contact Apex EDI to watch a free demonstration of our software today.

Posted in: Medical Billing Software

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Medical Billing Clearinghouse: What You Should Know Before Challenging a Medical Bill

Many patients have higher deductibles with their medical plans today than they did in the past.  This means they have an interest in paying closer attention to the medical claims they receive.  While many healthcare providers provide payment options intended to help the patient, before challenging a medical bill there are some key issues to keep in mind.

Asian businessman pointing at past due medical bill with dunning expression.  Isolated on white background.

First you will want to ensure that you clearly understand all the charges. This means you may need to ask for a detailed bill, showing every service performed by your provider. The line item bill should also clearly indicate others the provider relied on for services such as lab results.

When you don’t understand a charge, it’s time to reach out to the provider. Start with a phone conversation to see if the office staff or the doctor can explain all services indicated on the statement. In many cases, this conversation can resolve concerns quickly.

In more complex situations, it may be necessary to follow up with other specialists either by phone or in writing. In that case, make sure you have thorough notes about your initial conversation. Be sure to note the name of the person you speak with, their position, the date and time of each call.

While you should pay close attention to your financial ability to pay for the care you have received, you will want to arm yourself with clear factual information prior to disputing a bill. Most healthcare providers want to provide quality of patient care at a competitive price.

Apex EDI works with healthcare providers and insurance payers to manage medical claims efforts. Contact Apex EDI to watch a free demonstration of our medical billing software today.

Posted in: Medical Billing Clearinghouse

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