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Medical Billing Software vs. Real People

What’s the best way to optimize your medical billing? Can software do it all?

The short answer is no. Providers and practices need the power of real people to handle medical billing effectively. Read on to learn why.

The Power of People in Medical Billing

Medical billing software platforms are not billing companies. They provide software. To increase revenue, many of them now offer sub-par billing services.

You need a good medical billing platform from which you can submit electronic claims, but you need the power of real people to:

  • Invest in your success
  • Understand the nuances of your specialty and practice
  • Keep all providers in your practice properly credentialed and contracted
  • Make sure your claims are going out correctly the first time
  • Be well-versed in all the codes and modifiers needed to represent your care
  • Work with your front office staff to establish the correct protocols
  • Ensure your providers are documenting appropriately to back up the codes being selected
  • Aggressively follow up on every denied claim
  • Post payments accurately
  • Make sure there are no inappropriate write-offs
  • Submit effective appeals on your behalf
  • Ensure you are being paid according to your contract terms and rates
  • Renegotiate contracts for higher payment when needed
  • Make friendly calls to your patients to collect on balances
  • Analyze your data and help you understand the numbers

Software companies specialize in delivering software billing platforms. They aren’t going to manage your billing meticulously, accurately, and effectively like a medical billing company –– comprised of human experts –– will.

You need real people to work on your behalf because software and automation cannot replace a team of experts reviewing your billing and coding, touching every outstanding claim to push it to the next level, and analyzing claims to ensure your write-offs are appropriate. You can put metrics in place for these variables but need a powerful revenue cycle management team to oversee every part of the process. If one part is broken, it can drastically affect your bottom line.

A software company will not provide you with a team of people who understand who you are, the nuances of your practice, your specialty, and your demographic area. A software company will not be passionately invested in your success. If you sign up for a software company offering to bill, you will find that they do not deliver on the things they told you they would.

Many software companies outsource their billing work to overseas workers; these employees do not typically understand the nuances of your medical specialty. Moreover, if claims require more than minimal effort, these workers often write off more difficult claims and move on. Even worse are the software platforms designed to automatically write off claims that don’t pay the first time, hoping you are too busy with patient care to notice the lost revenue.

Bottom line: if you trust your billing to a software company and have no assigned billing experts reviewing everything, your practice will lose money. The human element is essential, and it cannot be replaced. Software companies give you a pitch for a one-size-fits-all software and billing solution: but it simply does not work. It will put your practice in a state of disaster and financial ruin.

The Two Categories of Medical Billing Software Companies

A medical billing software company isn’t a billing company. Their focus lies in software platforms, and they typically fall into one of two categories:

1. Practice Management (PM) Software Only

These companies provide a way to deliver claims to your insurance company electronically. They should provide adequate aging reports that enable you to follow up on all outstanding claims. They do not have an internal EMR (electronic medical records) platform. Some practice management systems interface with standalone EMRs.

2. PM Software Combined with EMR

In the same platform, you can electronically chart all your care and turn that charting into codes you send to the insurance company from the same system. Many practices look for an all-in-one system like this to manage charting and billing. Unfortunately, these systems are expensive, and often, they are highly inefficient systems that cause more trouble with your billing than they are worth. In addition, you still need real people managing the system (don’t let the software platforms convince you otherwise). At Larsen Billing, we have typically found that investing in an all-in-one platform is overrated. Depending on the platform, in some cases, the wrong choice can cause countless workflow issues and plenty of lost revenue. If you choose an all-in-one platform, find one that is less expensive, doesn’t charge you a commission, and doesn’t control your payments. Still, invest in a good billing team to oversee everything in the software.

The team at Larsen Billing wants you and your practice to thrive. We have found that the best way to optimize your medical billing is to:

  • Find a reasonably priced EMR solution that gets the job done and meets the needs of your providers from a clinical standpoint; make this decision independently of billing software
  • Utilize a PM system that does not charge a commission; only pay software for the use of their platform, not to provide billing services to you; if the PM system is separate from the EMR, so be it – it is better to operate in two good systems than to operate in a terrible all-in-one.
  • Invest in a billing company that delivers the expertise and meticulous claims evaluation that gets you the compensation you deserve

What To Think About With Billing Software Companies

Don’t Pay Commission for Access to Your Software Platform

Some software companies will charge your practice a commission of your earnings for access to their platform. No provider or practice owner should pay a percentage of revenue to access software! For good billing software, you should pay a flat monthly rate per billing provider or a fee schedule that charges reasonable fees for electronic claims, electronic statements, etc. Suppose you pay a commission rate to anyone. In that case, it should be to a competent medical billing company that is motivated to partner with you in every way to ensure your success. Good medical billing companies earn their commission rate; software companies do not deliver the quality of service that justifies a commission rate.

Software companies are not motivated to ensure you receive the most compensation possible for your services. But your billing company is (or they should be!). The people on your billing team work very hard to ensure the success of your practice. Your software company doesn’t have the same motivation; almost everything software platforms provide is automated, and your practice needs much more attention than what automation can provide. Don’t pay commission for a company that isn’t personally and actively working on your behalf to increase your revenue.

Accounts Receivable Requires Human Expertise

Your Accounts Receivable (AR) will suffer when you trust your medical billing to a software company. A software company might provide a simple way to send claims to the payer, but your AR needs the expertise and oversight of real people.

Sending off a claim is only one step and doesn’t ensure payment for your practice. It would be best to have a team of real people to resolve claims denials, analyze your data, and ensure you are appropriately paid for all care you provide. Unfortunately, your software company cannot and will not manage these tasks for you. As a result, your claims will go unpaid, and you will ultimately lose much money. It’s amazing how many providers are losing a lot of revenue, and they don’t even know it.

At Larsen Billing, we’ve spent over two decades serving and talking with providers who have worked with various software platforms and have experienced these frustrating issues. As a result, our team has firsthand experience cleaning up these messes and delivering billing solutions that fairly and appropriately compensate providers for their services. This is why we offer oversight packages for any software platform; we pick up the slack in all areas where software alone is insufficient.

You need a good software platform that streamlines and simplifies sending billing to your payers without standing in your way. More importantly, it would help if you had a team of real people partnered with you and dedicated to ensuring you’re getting paid for all the care you render. A software company will not do that for you. Trusting a software company for your billing can devastate your practice.

Maintain Control of Your Payments

Be cautious of any software company that charges a revenue commission or takes control of the money from your payers. Money should never be directed to the software company’s bank account.

You should always have control of payments from your payers. For example, insurance payments must go to your practice’s account, not your software company’s or billing service’s account. Unfortunately, this creates unnecessary friction, red tape, and headache. It also creates a considerable expense for you when you decide to part ways; you will have to pay someone to contact all the payers to get their payments going directly to you again.

Low Commission Rates

Be careful of billing companies and software companies that pitch you commission rates that are too low. That may be strange, but a lower commission rate can be a red flag. Expect to pay 5%-8% for a good billing company that will assign a team of experts to your account. Smaller practices should expect to pay closer to 8%; practices with substantial revenue will see lower percentage rates. Be cautious of a company offering you great services for 3% – you get what you pay for. Most reputable companies cannot deliver the results discussed in this article for such a low commission rate. 

The Essential Nature of the Human Element

The human element is essential in your medical billing processes. You cannot replace real people who are invested in your success. A team of medical billing experts who you develop a relationship with is invaluable. A software company will try to automate everything; when that happens, too many things fall through the cracks, and you lose money.

Larsen Billing understands your practice needs real people handling, managing, and evaluating your processes. We work every claim every month until each one is processed correctly. We work with you and for you to ensure you get the most money from payers for the services you deliver.

Contact our team today to learn more about our medical billing solutions.