Healthcare is a complex industry involving extensive administrative procedures. A lot of these processes revolve around the storing, using, and safeguarding of Personally Identifiable Information (PII), which is the personal data of patients that can be used to identify an individual. Given the sensitive nature of this information, governments worldwide are mandating rules to secure it from unauthorized access. There are many aspects to these regulations, and one of them is medical billing and coding.
What is Medical Billing and Coding Compliance?
Medical billing is the process where healthcare claims are submitted by the healthcare provider to the insurance company for further processing. The responsibility is on the healthcare providers to ensure that the claims are accurate and have the right codes for diagnosis, treatments, and procedures.
In this process, coding is a key aspect because there are standardized medical codes for treatments and procedures. These codes go beyond insurance claims, and are also helpful to monitor health outcomes, collect statistics, and for any other medical and nonmedical purposes. The commonly used code sets are ICD-10 for diagnosis, CPT for procedures, and HCPCS for medical supplies. Mistakes or lapses in adhering to these codes can cause processing delays and even non-compliance with established legislation like HIPAA.
However, given the volume of claims, it is difficult to process them manually, and this is where medical billing and coding compliance software come in. These tools can automate processes related to claims scrubbing, code validation, audit trail creation, report generation, and more. It also flags inconsistencies and errors, so you can fix them right away.
Due to these benefits, many healthcare providers are switching to automated medical billing and coding software. But, not all tools are built the same, so it’s important to select the one that best meets your requirements.
In this article, we will discuss the top medical billing and coding compliance tools.
AdvancedMD
AdvancedMD is a cloud-based tool for billing, EHR, compliance, and coding. It automates processes and streamlines workflows to meet the compliance requirements of legislations, while minimizing errors in billing and coding.
Source: AdvancedMD
Key Features
- Comes with a feature called Claims Inspector that validates codes against HIPAA and other regulations.
- Its integrated clearinghouse checks for eligibility in real time.
- The analytics dashboard monitors financial performance and coding accuracy.
- Supports EHR and practice management integrations.
- Centralizes document management for audit support.
Pros:
- Reduces claim rejections through validations that start before submission.
- Combines billing and clinical workflows.
- Its real-time dashboards are intuitive.
- Supports custom configurations.
Cons:
- It may be too complex for small practices.
Contact the customer support team for a quote.
Tebra
Tebra is an all-in-one platform for small and independent healthcare practices, as it combines practice operations, billing, and compliance into a single tool. It also offers marketing and patient engagement to create a holistic experience for every stakeholder involved with your organization.
Source: Tebra
Key Features
- Unified platform with billing, scheduling, and marketing tools.
- Supports claims scrubbing.
- Sends real-time alerts when there are mistakes or discrepancies.
- Integrated patient communication through its portal.
- Helps meet HIPAA requirements with its audit trail and centralized documentation features.
Pros:
- Streamlined interface for billing and patient interaction.
- Includes marketing and other support functions.
- Highly scalable, and grows with your business.
- Connects you to certified coders to improve the accuracy of your billing process.
Cons:
- It can be expensive.
Contact the team for a custom quote.
CareCloud
CareCloud is an AI-powered healthcare solution that takes care of all administrative aspects of your healthcare business. It also comes with a feature called cirrusAI that uses ambient listening and generative AI to automate note-taking.
Source: CareCloud
Key Features
- Advanced tools for claims scrubbing and rule enforcement.
- Generates audit logs for HIPAA and other regulations.
- Its dashboard is well-developed and includes KPI tracking.
- Integrates well with most systems.
- Extensively uses AI to streamline workflows and reduce administrative burden.
Pros:
- Customizable compliance settings.
- Strong analytical and visual reporting.
- Option to select the modules you need.
- Generates detailed and actionable reports.
Cons:
- It can be too complex for small practices.
DrChrono
DrChrono is an EHR, practice management, and medical billing and coding tool that increases productivity by handling the administrative tasks. Designed for both general and specialty practices, it can be used on the web, as well as on iPhone and iPad.
Source: DrChrono
Key Features
- Provides real-time updates on claim scrubbing status.
- Integrates EHR with billing.
- Generates audit logs for compliance.
- Checks payer eligibility and validates against specific rules.
- Scales well for multi-specialty practices.
Pros:
- Streamlines claims handling, end-to-end.
- Combines frequent code sets for better accuracy.
- Ideal for next-gen customers who prefer to use multiple devices.
- A dedicated billing team is available for Revenue Cycle Management (RCM) services.
Cons:
- Some features, such as RCM, may cost more.
CureMD
CureMD is a cloud-based EHR, telemedicine, and medical billing platform that comes with convenient features to support healthcare providers. In particular, its AI medical scribe feature can save hours of work for physicians, as it automatically generates the documentation. It also streamlines medical billing and coding to ensure compliance with HIPAA and other legislation.
Source: CureMD
Key Features
- Its intuitive dashboard displays information like copays collected, denials, and cash flows in real time.
- Checks insurance and benefits eligibility.
- Recommends the Evaluation and Management (E&M) code against all information.
- Outlines the missing data to reduce denials.
- Generates extensive reports and analytics.
Pros:
- Streamlined claim handling.
- Easy to set up and use.
- Supports mobile billing.
- Generates extensive documentation.
Cons:
- Fewer customization options.
3M CodeFinder
3M CodeFinder is a suite of health information systems that simplifies ICD-10 coding using sophisticated logic and decision-making. It also supports developers to keep pace with the changing regulations, including regulatory updates and classification guidelines. It is also known for its logic-driven code selection.
Source: 3M CodeFinder
Key Features
- Provides decision-tree coding pathways for CPT and ICD-10.
- Supports multiple international coding standards.
- Comes with pre-built coding logic for the most common workflows.
- Provides regular updates with compliance rule changes.
- Validates payer-specific rules.
Pros:
- Improves accuracy through its guided workflows.
- Reduces compliance risks.
- Supports international standards.
- Scales well for large hospitals.
Cons:
- Not suitable for non-technical people.
Contact the support team for the next steps.
Nuance Clintegrity
Nuance Clintegrity is an integrated solution that streamlines record management in healthcare settings. It also handles complete health information management to improve coder productivity and maintain compliance.
Source: Nuance Clintegrity
Key Features
- Reviews and analyzes patient interactions to reduce gaps in billing and coding.
- Enables complete and accurate reimbursement.
- Improves risk audit outcomes to reduce fines and penalties.
- Captures clinical and financial information for creating accurate workflows.
- Accurately allocates coding work assignments to the relevant staff.
Pros:
- Advanced analytics to understand trend patterns.
- Reduces reworks in submissions.
- Offers RCM and audit services at extra cost.
- Improves efficiency and productivity.
Contact the team for a custom quote.
Final Thoughts
To conclude, medical billing and coding compliance is an essential part of healthcare information management. Using the appropriate codes and standardized templates can reduce the administrative burden and speed up the process of receiving money from insurance claims. However, this is a complex process that’s prone to errors when done manually. This is where medical billing and coding compliance software come in handy. In this article, we discussed some of the best tools available for streamlining medical billing and mapping information with code to reduce errors. We hope this information acts as a good starting point for your further research.