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Office Managers, Medical Billers and Medical Coders
Choosing the Right Electronic Health
Records Software and Billing System
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Choosing the right electronic medical software is very critical to any medical offices
and facility. You have to make sure it is the right electronic health records and billing
software. With the implemented HIPAA 5010 and the ICD 10 coming in 2014, the
healthcare industry especially that involves quality patient care, cost and
reimbursement become more stricter. And I think, with all these rules and guidelines,
we can rely on good technology to become compliant.

Being a Computer Engineer and as an Independent Consultant in Medical Billing,
Coding and Office Management, I have used and worked with many, many different
electronic medical software in my more than 10 years in this field.

And the truth is, there are too many companies out there selling and promoting
electronic medical software.

But let me identify the useful things that you need to consider in choosing the right
software. Assuming all these products strictly follow the HIPAA Rules, Guidelines and
Compliance. These softwares are fully compliant with the HIPAA 5010.

1. Medical Billing and Practice Management Software (either web-based or not)

Ready for ICD 10 codes (if possible!)

You can check benefits and eligibility for your patients as soon as you enter their
demographic information on the the billing electronic medical software

The billing software can scrub claims! (for example, it will not transmit the claims if the
diagnosis code need a 4th digit, an inpatient claim must have a date of admission,
your referring physician must have an NPI, etc).

Claims scrubbing is very important to make sure you are submitting clean claims!

Can generate all different kinds of useful reports

a) Practice Analysis Report (by month, by year, by comparison)

b) Daily, Monthly and Yearly Productivity Report (by provider, by facilitate, by CPT
procedure codes, by diagnoses codes)

c) Insurance Payment Analysis Reports (by insurance company)

d) Patient and Insurance Payments Reports (patient payments, primary insurance
payments, and secondary insurance payments)

e) Aged Accounts Receivables Report

f) Billing and Scheduling Reconcialiation Report (reconcile your schedule with the
billed services!)

g) Electronic Claims Transmission Reports must also be able to be printed from the
practice management software

It can create patient statements by date of service (let's say, DOS 01/01/2012 was not
paid, but the DOS 02/03/2012 was paid - it must be able to print patient statement only
for that paid DOS after the insurance which is the DOS 02/03/2012)

It can print claims by date of service as well. For example, if one date of service was
billed with a modifier 22 (Increased Procedural Services). And you need to send that
claim with an attached medical notes by mail! The billing software must be capable of
printing that particular date of service only without any problem.
It must be capable of attaching medical reports if you need to send claims by
electronic with an attached operative reports, pathology reports, etc. This feature is
very important for secondary insurance submission where you need to attach the
primary EOB. It is also very useful for your workers comp and motor vehicle claims.
It can receive and automate the posting of payments from the ERA (electronic
remittance advise)
The company must have a good client support (either technical issues or any updates).

2. Electronic Medical Records or the EMR

Ready for ICD 10 codes (if possible!)

It must be Provider-User-Friendly electronic medical software! (many providers find the
system very hard to learn, but I know they are willing to be trained!)

The EMR Company must be able to provide ample time for training the providers and
their staff. (providing support is also very important here!)

It can be easily integrated to your current practice management software (especially
the scheduling and billing portion of it!)

It can enforce the provider to enter documentation real time! Otherwise, the service will
not be billable not unless it is documented and signed out from the EMR

It can alert the physician if there are visits or services that was not documented

It can alert the physician if there are electronic documents that he or she has not
reviewed yet (lab reports, pathology, letters from other physicians, etc)

The EMR is already populated with the icd 9 codes, or cpt procedure codes, hcpcs
codes and diagnosis codes based on the practice medical specialty (would this be

The CPT Codes and Diagnosis Codes must have a useful feature of crossing over
based on the provider's specialty (this would also be awesome!)

The Provider must be alerted if the CPT Codes he or she chose would need a 4th or
5th digit.

Or if the Diagnosis Codes would need a primary and more specific diagnosis codes.
(For example, Code the wound site first, and then the stage severity of the ulcer)

The EMR should also have a very secured and efficient email system that can be used
within the company

The EMR should also have a very secured and efficient fax system (sending and
receiving reports by electronic fax that goes directly to the email system being
integrated on the EMR)

It would also be nice if the EMR can translate different languages besides english

It can be accessed on cloud

The EMR Provider should have a great client support (technical, training, etc)

Let me share it to you, when I was in my nursing school (yes, I did my clinical nursing!). I
did have some gadgets that I consider them as electonic medical software installed on
my PDA or on my SmartPhone. Before I go see my patients and do an assessment. I
look up diagnosis conditions, underlying conditions, reasons of the procedure or
surgery, meaning of lab reports, and even the nursing plan of care! I couldn't have
survived my clinical days without my useful electronic medica gadgets.