Medical Claims Billing Software
Selecting the Best Medical Billing Software

When shopping for Medical Claims Billing Software, given the amount of money spent, its important to know what questions to ask and features to look for.

Our thought process for selecting our medical claim billing software was probably not much different than most small practices or billing services go through.


We get a lot of questions on the site about medical claims billing software like:

  • Whats the best medical billing software or
  • What is a good cheap medical billing software or
  • What’s the best affordable medical billing software?

Gina defers the software questions to me - her husband - I guess because I’m and engineer and have a more technical background. So I thought I would share our thought process to compare medical billing software when we were starting a medical billing business.

I’m really only addressing software needs of a billing service or small practice. Large users are a whole different level and usually have IT departments and committees driving these decisions .

When we were looking at software for her billing business, I really didn’t know where to start. We had a lot of questions like:

  • How much can we expect to spend upfront?
  • What are the reoccuring costs?
  • What kind of hardware or PC is required?
  • Who are the reputable heath insurance claim software vendors?
  • What kind of set-up, installation, and training is necessary?

There are basically three platforms to consider when evaluating:

  • Server - many users and remote access - this is a centrally located machine that allows several users simultaniously.
  • PC - one or few users at one location
  • Online - access from a PC via a browser

As a business grows, the medical claims billing software platform has to transition from PC to server. Get help as this can be a complicated transition if you are not experienced in setting up a server and all the administrative stuff that goes with it.

What I looked for was how widely used was a software program and how long has the company been around - so if we needed support or had a problem we could easily find a solution. From what I could tell, most of the reputable medical claim billing software had a lot of the same features and capabilities.

Other Opinions
What did current users think - especially those with a lot of experience in the medical billing field. We asked other billing services, searched blogs, the internet, probed the software vendors sites - to get advice on the best software. This is probably the biggest influence when we decided on a software to commit to.

I downloaded several demo’s and we tried them to see how intuitive it was and the features. Most practice management programs are pretty intuitive and have a lot of the same features. After all they are really just a tool to access a database.

Clearinghouse Considerations
The ability to create electronic claim files in a neutral format that can be easily converted by a clearinghouse is important. This would be a format such as a print image or the ANSI 4010 (soon to be 5010) format. We spent a lot of time when upgrading our software to get the ANSI 4010 claim file fixed and acceptable to the clearinghouse. This is where good support is important.

One hing I noticed is some medical claims billing software programs - though they were cheaper - is they required you to use their clearinghouse. That’s something I would like the freedom to choose ourselves.

HIPAA
To comply with HIPAA, features such as password protection, ability to set user access, log user activities, and easily back up data files. It’s also important the medical claims billing software be compliant with the HIPAA 5010 electronic data formats - or have an upgrade path when it is implemented.

We ended up with AltaPoint and we’ve been pretty satisfied. We did go through a pretty painful upgrade with AltaPoint for upgrades associated with the new HIPAA mandated NPI number format a few years ago. It actually took months to get Medicare claims straightened out as they were the first to accept only claims with NPI number.

We also use Lytec because that’s what some of Gina’s clients prefer. I do like the ability in Lytec to make modifications to reports and claim formats - both paper and electronic. The also offered a very good self-paced CD training system.

Consider Online Medical Billing Software
If I was starting with a clean slate or contemplating a change - I would strongly consider an online (also called Software as a Service) solution.

I’ve heard a lot about Kareo and checked out their site. They have a lot of testimonials and I really like their pricing - I think they start at $69 a month with no contract.

They seem to be popular with billing services and small practices - so they may be worth checking out - they could be a real “Game Changer” with their pricing and features. I really like that they are priced per provider instead of per seat. You can access from any PC with a browser and they have the ability to post payments electronically from ERA’s.

When you’re just getting a billing service started, one of the biggest costs is the software and the hardware PC’s, Servers, etc. So having such a capable program for no upfront cost can save a lot of money.

To Summarize
So in summary....

  • Don’t be someones guinea pig - go with a tried and true medical claims billing software that is widely available.
  • Get others opinions.
  • Make sure an attractive low price doesn’t lock you into a certain clearinghouse.
  • Be aware of reoccurring costs and maintenance.
  • Try before you buy.

To reduce start-up costs consider an online medical claims billing software from a reputable service. There are several vendor such as AdvancedMD, Kareo, CollaborateMD, etc. that offer competitive reasonable prices on a per/month basis. You can save considerably up front costs and not have to worry about back-up and software maintenance.

If you purchase your own PC or server medical claim billing software, be prepared to spend on support for start-up, installation, and training (if not already familiar with the software). Especially if you aren’t experienced in network or server setup.




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