Practice Management Alert

Computer billing software can make or break your practice. When chosen correctly, software can improve your billing and collection efficiency, and help you manage your practice. When chosen poorly, it can be a time-consuming, costly headache. So, how do you sort through the vendor's sales hype and find the right software for your billing department? Ask yourself and your software vendors eight questions:

Define what you want your computer billing system to do and look for that, advises Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., a billing and collections consulting company in Lakewood, N.J. Buying new billing software can be an opportunity to obtain a tool that does more than just launch claims, she says. "You have to realize that your billing system can do more than generate claims and keep track of your accounts receivable (A/R)," Cobuzzi states. "Your billing system is your management information system. All the data you collect for billing give you management information. It can help you when you're doing your collections. It can give you reports and information that help you manage your entire practice, including marketing and benchmarking internal performance."
 
Defining the practice's business problems and finding the software package that will provide information to help address those problems is often the most difficult part of the software selection process, admits Peter P. Legorburu, president of Brickell Research Inc., a medical practicemanagement software company based in Miami. He says, "The biggest step you can take is first asking, as a business, what are the operational requirements? What are the goals? The basic operational requirements would be to generate a claim in an efficient and timely manner, and submit it as quickly as possible and get paid. Then, if there's a need for additional information and follow-up, handle it in an efficient manner so you can bring the claims and payment process to closure. You need also to be able to study what is happening in your practice. But, you need to be able to assess your payers, compare the plans you contract with, and generate reports that allow you to see what's actually going on financially."

Although practice-management software can do more than generate and file claims, there are practices with physicians who care only about submitting claims and getting paid. "Some doctors want reports to analyze their practice, and some doctors could not care less," observes Donna Jones, CPC, administrator for Metropolitan ENT, a two-physician and one-audiologist practice in Alexandria, Va., and owner of Innovative Business Solutions, a medical billing and management consulting company. "If all your doctors want is their money, then you don't need to spend money on a billing system that gives you all the bells and whistles. Be reasonable about what you are buying, and get a system that does what you want."
 
Ease of use is a top consideration for Jones, who notes that all billing systems will get claims out the door. "To me, each billing system will basically do the same things. But, the question is, how easy is it to use? Is the program efficient?" she asks. For example, if the program makes you use the mouse instead of function keys on the keyboard, forcing you to move your hands from the keyboard to the mouse and back, that's wasted time, she says.
 
If tasks such as generating a new CMS 1500 form to resubmit a claim require several steps, keystrokes, or movement through screens, the program is inefficient, Cobuzzi adds. "If you have to go through extraneous screens to get where you want, or you have to look up reference numbers and write them down for use on other screens, that is not a system you want. What you want is quick movement. The program should be easy to navigate, and you shouldn't have to memorize shortcuts."

What Is the Total Cost?

Billing programs can cost from $500 to $1 million, Jones says, and that's just the up-front charge to buy the software. Many vendors also charge monthly fees to keep the software up and running in your practice. Make sure your practice knows the total cost for whatever it is buying, she suggests.
 
Cobuzzi warns that practices will "get what they pay for" in billing software. "The first thing a simple, inexpensive system will do is launch claims to get paid. How you manage your A/R in such a system is that you enter claims, print a paper version, and make follow-up phone calls with no further support. These have no ability to put in comments, to track results, or create reminders," she says. However, there are inexpensive programs in the $2,000 to $6,000 range that offer reports that can help you manage your practice. "You want reports like, how often am I doing all my procedures. That's something inexpensive systems can give you. How often your practice uses each E/M code and their distribution can be reported from inexpensive systems," she says.
 
The more sophisticated but still inexpensive programs can, for example, help a practice decide whether it should continue contracting with a particular insurer, Cobuzzi says. The program could supply information for decision-making by generating reports on how many patients are covered by that insurer in the practice, how much current revenue that insurer represents, exactly which patients have that insurer, and how many of those patients have an out-of-network benefit so they could still visit the practice if it drops out of the contract.

Check that the reports the billing software generates will supply you with information you want and can use. Better yet, Cobuzzi and Jones recommend, look for software that lets you create your own reports. For example, an A/R report that states the practice has $50,000 pending from insurance and $20,000 pending from patients doesn't provide actionable information. "With insurance, I don't just run a report of the insurance balances and start calling on them. I want to be able to sort that information and separate it out. So, I run high-balance reports, and work on those. I run reports on our biggest payer based on claim age and dollar amount, so I can work on those," Jones explains.

Most billing and practice-management software programs have levels of security in which certain people in the practice can access certain kinds of information in the system, Jones says. For example, a program may have different screens accessible by clinical staff, the front desk, members of the billing department, and administrators. "What happens if you have a person who needs a little extra access, but doesn't fit into one of those categories of access? I want 'by person' security, so people have access to the data they need," she adds.

Software based on computer coding or database structures that are proprietary should be avoided, Cobuzzi says. The problem with such programs is that they will not integrate with software from other vendors, forcing you to buy only products made by the same proprietary software maker. "That gives the software vendor monopoly power and pricing. You can't shop around," she says.
 
If you want to be able to shop around and buy electronic claims processing from any clearinghouse, don't buy software from a vendor that forces you to use that vendor for electronic statement printing and distribution, she says. Similarly, if you buy a billing and practice-management program now and want to link it later to an electronic medical record program, think about the platform on which that software is based and whether you're likely to find a variety of add-on programs to choose from. There are more computer programs based on the Microsoft Windows platform than there are on other platforms, Cobuzzi notes.

Software salespeople will gladly bring a demonstration program to your office and show you how it works. Seeing it demonstrated is not the same as using it. "Don't ever base your decision on seeing the demo because it will always look easy and fast in the sales presentation," Cobuzzi warns. "You should insist on trying the program yourself. Have the billing staff enter charges and payments for a day. Have the front office try taking patient registrations. That's how you judge the software," she says.

Consider how much training and assistance you will get from the software vendor in setting up the program in your office, Jones advises. "What kind of training and support will your staff receive during implementation and for how long? If someone is going to implement a new system with me, and help me convert from an old one, I want that person to have medical billing background. I don't want a salesperson. I want a software vendor that will teach me to deal with its system, and teach me how not to have to call for help," she says.