What is really essential in medical billing?

Every EHR touts different features for medical billing, but which are essential? Consider the following list, including why each feature should not be overlooked.

Super bill to medical claim

Even with many processes transitioning to digital, most practices will continue to use a superbill to prepare patient visit information for billing. An EHR should feature the ability to convert any super bill into a medical claim. For example, the hospital utilizing a barcode system scans the equipment and materials used during a patient's care. When all is said and done, the running list should then be able to convert into a claim, ready to be sent to an insurance carrier.

Integration

A big buzzword in any technology conversation is integration. Can your EHR communicate with other systems seamlessly? If not, you may not meet meaningful use requirements, particularly related to sending information to another medical provider or to the federal government. An EHR should allow you to also communicate with a clearinghouse, especially if you utilize an electronic billing feature.

Delivery platform requirements

Although not billing-exclusive, a practice should consider whether an EHR is in-house or web-based. For web-based options, practices can have medical billing specialists, coders, and others based elsewhere while still ensuring a secure environment for PHI and HIPAA details. A web-based version may also make it easier for medical providers to access patient files from wherever they might be, ensuring they can continue to upload dictated reports and other important billing material.

Electronic submission and status

Many practices require electronic submission, especially if they deal with Medicare or other increasingly electronic-bound insurance carriers such as United Healthcare. More importantly, can the EHR provide status information? Was the claim accepted? Denied? What is the claim number? Each answer is important for anyone following up on a delayed claim.

Reporting & BI

For billing purposes, reports are essential. A practice needs to catch what CPTs, diagnosis codes, etc. are denying the most. In addition, reports should be able to show practices what codes are underpaid, what claims are outstanding, and what insurance carriers may be causing the bulk of the issues.

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Electronic payment capabilities

Just as practices need electronic submissions, receiving payments electronically is equally important. Consider EHR options that also allow you to track payments, run reports, and house un-reconciled payments, recoupments, and other financials in a place where the billing department or payments team can review and analyze it.

Medical record coding capabilities

Smart EHR options should include coding capabilities, meaning they take the information from office notes or operative reports and convert the information into a medical claim, including diagnosis codes, CPTs, and units. Coding capabilities will make it easier on your coding team, particularly during a transition from one coding system (ICD-9, for example) to another (such as ICD-10).

Security

What options keep your EHR safe? A practice needs to think about this, particularly for billing compliance and HIPAA. One medical billing specialist should not be able to access another medical billing specialist's system access, especially if they work on different patients or providers. Password requirements is one method of security, but others should be considered, and should be provided by an EHR vendor.

Audit trails

Audit trails mean tracking who made changes to a patient's record. Having access to an audit trail is essential for your medical billing office, particularly if HIPAA compliance is threatened, such as one patient's information making it into another patient's account.

Claim edits

Finally, consider a claim edit capture feature. An EHR should anticipate the need to verify and accept claims that were automatically converted from superbills or created by internal coding software. If a practice bills large neurosurgical claims, being able to go in and ensure proper billing prior to electronic submission may mean the difference between denial and payment.

Bonus: customizable/configurable features

A practice is as unique as its medical providers and patients. Consider a practice that conducts clinical trials on a regular basis. An out-of-the-box EHR may not do everything needed by the practice. A good EHR needs to include the ability to adapt and be configured/customized to meet a practice's needs. For a practice conducting clinical trials, some way to mark each claim separately—especially if a claim needs to be billed somewhere other than the patient's insurance carrier—is imperative to ensure patient satisfaction and billing compliance.