WHAT DO YOUR DENIALS SAY ABOUT YOUR BILLING SOFTWARE?

Modern healthcare is driven increasingly by technology—from diagnostic tools to electronic medical records (EMR) management, our industry has demanded that medical professionals embrace their tech savvy side in the name of efficiency, accuracy and quality outcomes.

This is absolutely true when it comes to medical billing and revenue cycle management, where there are hundreds of software options, all promising to simplify your life in the business office. But how do you know which system is best, and how can you tell when a software is performing well for your facility?

Well, I’m not here to recommend one software over another, but I can tell you what to look for in the selection process, how to approach the setup, and what to watch for in your denial trends to know if things might be askew with your tech.

First things first: Software is not the end all be all

The best EMR and billing softwares will never be the final answer to all your business office woes. There is still manual work to be done in the setup and, yes, even in the daily management and execution. No matter how feature-laden and fabulous your software may be, it’s still only as good as its initial setup, which—honestly—should take some time. 

What’s involved in setup? Too much to detail here, but know that you will probably be working with a team from the software company itself to ensure that all data is properly input and the appropriate features are activated. (Yes, it’s possible to have a robust software but not know about or have access to all of its key features, so ask questions and solicit training for your staff when new softwares are set up!) It is during setup that you should be loading insurance dictionaries, diagnosis and procedures codes, modifiers, EDI (electronic data interchange) requirements and more. But if you find later on that that these things weren’t input properly, don’t worry—it can still be done later.

At Full Circle Business Solutions, we work with plenty of partners who arrive at our proverbial door thinking they need new software. But the vast majority of the time, we find that the system itself is fine; the setup is not. 

And don’t forget that the human element is still critical, even when you have robust software that is pristinely set up. You’ll want to keep an eye out for exceptions, and clearinghouses still need to be checked for rejections. Software is largely meant to ensure that your business office gets clean, accurate claims out the door; denials, appeals and reconciliation still requires good ol’ human intervention.

Tracking and trending denials—here’s what they can indicate about your software

Denials are a part of life in a medical billing office. The key is to quickly note any trends in those denials and then get to work identifying the source of the problem.

In truth? Sometimes a denial is baseless; it’s just a payor making you fight for your money. But even that is important to note! Otherwise, denials almost always have an identifiable root cause: Improper procedure or diagnosis codes, missing modifiers, inaccurate policy or payor details, etc. It’s this kind of error that will often lead to a trend of specific denials, and these can usually be tracked back to your billing software. In this case, your first line of defense is to double check that your programs contain the appropriate and most up-to-date data that I mentioned in the setup section.

Of course, not every denial will indicate a software issue. Sometimes you may be dealing with a simple registration error—things like missing numbers in an ID sequence or incorrect insurance specs—but these won’t usually appear as a trend.

As for those payors that might be causing headaches by making your fight for your money? An efficient, accurate and well-managed software system can help you win these battles, too, because it can help you maintain a reliable electronic record of the original claim.

Maybe you really do need a new software—what do you look for?

Okay. At the end of the day, your business office may truly require a software change. In that case, I have a few things to suggest.

• It’s true what they say: You get what you pay for. I’m not suggesting that you buy the priciest software available, because you could end up paying for features you don’t need, but this is definitely not the time for bargain basement shopping. A reliable software should last you a long time, so it’s worth it to not skimp on cost.
• Don’t sign on the dotted line until you’ve been able to interface with the software. Usability is everything when it comes to orienting staff to a new software. If it takes 99 clicks to reach the screen you need, staff (yourself included) will never make the best use of the platform. I promise you, the best billing softwares are user friendly.
• Ask about installation, setup and support. The best platforms will offer one-on-one training along with the opportunity to contact a real human being when questions arise. Be suspicious of companies that don’t seem to offer robust (and ongoing) support. 
• Know the scoop on updates! How often does the software provider issue an update? All softwares will be updated at least once a year, but a software that requires frequent updates throughout the year may not have undergone rigorous upfront testing.

Technology evolves almost as fast as the healthcare industry in which we all work, but there are always resources to help us adapt to and fully leverage the tools at our disposal. If software is feeling like it may be your weak spot, give us a call at Full Circle—we can help you reset and get back on track.