Medical Billing Software Gets More Complex | Risks & Opportunities

Risks & Opportunities Of Increasingly Complex Medical Billing Software

Risks & Opportunities Of Increasingly Complex Medical Billing Software

Medical billing software systems have grown more complex in response to increasingly complex medical billing procedures. Bill Gilbert of AdvantEdge Healthcare Solutions says this has created a situation “that is ripe for misusing these tools to not only accidentally over-reimburse but to submit false claims-with the attendant risks and penalties.”

This concern is not new. Back in 2000, The Department of Health and Human Services ordered its Office of The Inspector General to survey the different types of medical billing software to identify how the Medicare reimbursement process could be adversely affected. The Office of Inspector General surveyed four types of systems that existed then to identify their strengths, weaknesses, and potential for abuse.

HHS concluded that commercial grade medical billing programs “pose little risk of producing erroneous or false claims.” They considered proprietary software, on the other hand, to be more “black boxes” with a higher risk of misuse or fraudulent use. In all systems, the likelihood of human error greatly outweighed the chances of software error.

Since the HHS released this report, the medical billing industry has seen the emergence of EMR/EHR systems. “These systems generally make it easy for providers to pick procedures and diagnostic codes (e.g. from a drop-down menu),” says Bill Gilbert of AHS. “If these products encourage providers to overuse particular codes, there can be substantial risk to the practice.”

This increased complexity in medical billing software has led to an increased demand in trained medical billing workers.

The training and certification of medical billers and coding specialists is typically strict,” says Bill. “For example, many medical billing companies require their billers to be CPC (Certified Professional Code) certified, and such certification requires formal class work followed by a certification process from an industry-recognized institution.”

In short, Medical billing software is only going to get more complex going forward and the demands on medical billing providers is going to increase, but for those with the right training and experience, their employment future is looking bright

(Source: What is Medical Billing Software & Who Are Qualified Medical Billers?)


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