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How to Develop a Medical Billing and Claims Processing Software

Paul Kovalenko Paul Kovalenko | June 1, 2022 | 10 min

Medical billing and claims processing is an essential part of any healthcare institution and yet, it is one that raises the most confusion. There are just so many patients to track and documents to organize – all while trying to do the other one thousand errands that always come up at the hospital. As a result, 80% of all medical bills have errors in them and mistakes cost $86 billion a year. Moreover, healthcare providers are affected by the complexity of the payment collection process as 77% of organizations report that collecting any payment takes more than a month.

However, it could have been easily avoided if billing automation was available. Hospital billing system development can help to avoid mistakes, speed up processes from estimating the costs to receiving the payment, and take the pressure off the billing department. Hospitals are already widely using medical billing and the market for the US medical billing services is expected to reach $8 Billion by 2026.

If you want to save your medical personnel and patients from crumbling under the paper bills, keep reading and learn how the hospital billing system works, how to develop a custom medical billing software, and learn about the benefits that come with a healthcare billing system development. 

How Does the Hospital Billing System Work?

Normally, the patient is registered and checked for insurance eligibility, a doctor runs all the necessary procedures, then the billing department tries to figure out what these procedures were, checking up on different departments, forms a bill, and sends it to the insurance, and hopes that the bill will be paid. 

With hospital billing software development, it looks a bit different:

  • Automated insurance eligibility check: you do not need a specific person or a whole department to run an insurance eligibility check, the system does it automatically in mere seconds and with fewer errors. Thus, healthcare organizations don’t make patients wait for a long time and can save time for the doctor too.
  • Forming a bill: hospital billing software is connected to an EHR\EMR system and, therefore, it accesses all the procedures and treatments that the patient has received. Based on that information, it creates a superbill that contains all kinds of services provided by numerous departments. The bill can also be shared with a patient so that they can check whether everything is correct and understand what they are charged for.
  • Sending claims: the claim goes to the insurance company. The software creates a file in a format that works for the insurance provider automatically.
  • Claims processing: the claim processing software receives and stores information about whether the insurance company covered the bill or whether the patient put in the payment themselves. It can also send reminders to the patients if their bill is still unpaid or when their insurance is about to expire. 

As you can see, everything is done nicely, cleanly and automatically. If you need to add an extra feature at any point, you can do so too. 

You can also develop a hospital billing system with the reporting feature: with the help of neatly organized graphs, you can see how many bills were paid or not, who your risk clients are, what your most popular operations are, your revenue, etc. The software can also give you recommendations for improvement and highlight what you are doing wrong. 

Main Steps on How to Develop Medical Billing Software

Medical claims billing software development is a complex process that requires a profound understanding of all healthcare-related processes, legal requirements in this sphere, and strong technical expertise. Keep reading to learn about physician billing software development in more detail. 

Planning

In order to develop a healthcare billing system smoothly, you will need to do a lot of preparation in advance. If you have a roadmap and a vision of your app, you can avoid changing the whole project midways and you are more likely to deliver the product faster if you have set tasks and deadlines. The solid plan of medical billing system development consists of several steps:

  • Defining needs: research the needs of end-users to understand what they want to see in the solution in terms of both design and functionality. If you create a tool for a specific hospital, make sure to profoundly analyze the particularities of their operations. 
  • Researching the market: take a look at popular medical billing and claims processing software and note how they are designed and what features they have that you might use based on the needs that we have previously defined
  • Creating a feature set and design requirements: make a final list of features and design ideas that you want to see in your custom solution
  • Choosing the best platform and tech stack: define whether you want it to be a desktop solution only or if you want it to exist in the form of an app for Android and/or iOS as well. Based on that and the feature list, the tech team would be able to define the tech stack that you will need
  • Finding a team: for patient billing system development, you will normally need developers who work with the chosen tech stack, web designers, and testers. You can also add project managers to let them handle planning and sticking to the roadmap. Consider working with business consultants as they not only know how to create a medical billing system software but also how to fully monetize your solution and reach your business goals.
  • Creating a roadmap: write down all the tasks, place them in the correct order and sprinkle it with deadlines
  • Planning budget estimation: you know the scope of work and team pay rates so you might as well analyze how much money you will spend. You are not likely to stay within the sum perfectly, but it will help you avoid getting out of it too much. 

Creating an MVP

Whether you develop a tool for a small practice or for a large enterprise, medical billing software is a complex system consisting of numerous elements. However, while creating a minimal viable product (MVP) make sure to include the core functionality only.

Taken from: https://gearheart.io/articles/how-much-does-it-cost-create-custom-medical-billing-software/

Test the MVP with small user groups to see whether they like the feel and look of it and let the end users give feedback. If you go through this stage, you will be able to define whether your plan was a good one and make quick adjustments before it is too late. 

Need help building a medical billing and clames processing software?
Reach out to Langate

Development

If you wonder how to develop physician billing software, one of your most important tasks is to find the software development team that has profound expertise in this domain. You can choose between hiring an in-house development team, outsourcing certain tasks, or working with a technology partner that would take full ownership of the process.

Testing

Testing helps to ensure that the software doesn’t crash once your business operations fully rely on it as well as that your medical billing software is compatible with your other solutions.   

In most cases, businesses need both manual and automation QA engineers:

  • The first ones manually execute test cases to detect bags and validate the key feature. 
  • The second ones utilize automation tools and run scripts that check the performance and security of the software in various simulated scenarios.

Launch and Maintenance

After testers have reviewed the product and all the bugs have been fixed, you will be finally able to launch the software. However, make sure that you start the right way: teach the end-users to work with the software and make a smooth transition between paper-only and digital billing. It will avoid unnecessary stress and even more mistakes than usual. 

Maintenance is a huge part of your development process as well. You should update the software with new security patches, fix the bugs, and add new functionality if needed. Otherwise, the solution will become obsolete and dangerous very soon. 

Benefits of Implementing Billing Software for Medical Organization

Are you still not convinced that you need to develop software for medical billing? Or do you need just a little push before starting the development? You may want to take a look at these benefits that no one can resist. 

Minimized Mistake Possibility

Since 2020, the amount of denied insurance claims has grown by 11%. Moreover, 86% of all claim denials are considered to be potentially avoidable which means that the usage of the right medical billing tools to minimize the mistake possibility could have solved the problem.

Humans can be tired or stressed which influences their ability to work dramatically. That is why errors in medical billing occur so often and then patients start arguing with the hospital and bring the issue to social media where they ruin your reputation. Automation has no room for such errors: the software operates perfectly well 24/7 without falling sick or becoming a victim of pressure, amount of work, and burnout. It is also more likely to collect all services from all the departments which humans fail to do due to the high amount of data to sort out. 

Reduced Administrative Costs

If you do not make errors in your bills, you are less likely to spend money on lawsuits from distressed customers and reputation clearance. However, it is not the only cost reduction that comes with billing software. 

90% of healthcare providers still rely on paper documents and manual processes for payment collection. With automation tools, you will not need as many employees to run the billing and confirm insurance eligibility. You will also be able to manage unpaid bills and unresolved insurance claims better since the system will send alerts to all the parties involved. 

So even if you need to make an investment for software development upfront, you will not have to wait long for the full return of investment. 

Improved Efficiency

Automation does mean efficiency and productivity at all times. Billing software will prove a patient’s insurance eligibility in seconds, it does not need much time to create a superbill, and it is able to track claims all at once. It will make both patients and admins happier. 

Need help building a medical billing and clames processing software?
Reach out to Langate

Our Projects

Langate has years of experience in healthcare technology and offers great attention to the unique needs of hospitals while finding quick solutions to common problems. We know exactly how to develop claims processing software. That is why our client, Approved Admissions, turned to us to create an insurance eligibility verification system. We optimized their platform and made sure that eligibility checks run smoothly, even when data from various companies and hospitals come in different formats. As a result, the company was able to streamline its processes and grow its customer base up to 700 healthcare organizations. 

Do you want experienced developers to help you grow and optimize your processes too? Do not hesitate to reach out to Langate and learn about the services that we offer. We can develop medical billing software from scratch if you need it. 

Final Thoughts

Custom medical claims billing software development is an absolute must if you want your financial operations to run fast and mistake-free. You can check a patient’s insurance eligibility in no time, form an accurate bill within a few seconds, and let the machine keep an eye out on unpaid bills. 

If you are willing to access all the benefits of medical billing and claim processing software, let’s talk. We can figure out a unique solution that will perfectly fit your hospital’s needs. 

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