Software Used by Medical Billing Companies

What type of software do top performing Billing Services use?

Can the right Revenue Cycle Management software help Billing Services and Medical Billing Companies build stronger relationships with, and achieve spectacular results on behalf of their clients?

Business relationships aren’t all that different than personal ones—great communication is the best way to keep them healthy. For billing companies, that means a robust connection (both software and personal) with your physician clients and their office.

Some billing services work with practices regardless of the software the practice uses. They have a staff of medical billers and coders who are familiar with each software on their client roster, and they make it work. If the practice manager decides to change software, billing companies (also called medical service organizations) can usually accommodate.

This type of communication worked reasonably well for many years. But today, owners and directors of “gold standard” billing companies, who are essentially standing in the CFO role for their physician clients, are more demanding. And their results speak for themselves. This echelon of Revenue Cycle Management achieves higher levels of proficiency because they use software especially designed for RCM.

So what does software like this look like—an elite medical billing software that is purposely designed and built around the needs of top performing revenue cycle management companies?

A Central Billing Office

The ability to manage all of your clients in a single console and view consolidated revenue cycle KPI’s across your entire client base, which can alert you to problems before or as they arise

Dashboard KPI’s Mean More Efficiency

The first benefit is having a single dashboard that shows the status of every claim in the system (from every client), including claims that were recently posted, rejected, or denied. The efficiency from having all this data in one place is astounding, and the ability to apply a variety of filters makes it highly manageable. You can sort by provider, by practice, by patient, by encounter date, by claim status, and more.

Single-Sign-On (SSO)

Your billers don’t have to log in and out of each physician’s data—they sign onto the system one time and can access any account they need. They can post payments and work on rejections and denials right from their own dashboard.

Internal communication and task assigning are dramatically streamlined. Managers can create tasks or follow-ups that appear on the correct person’s to-do list on the day it needs to be done; billers can create follow-up tasks for themselves as well.

CCI Edits

Sophisticated billing software helps coders create claims that contain the highest level of specificity but don’t stray into upcoding. The software also has built-in edits that scrub each claim for coding compliance. Look for software that maintains the following edits:

  • Diagnosis code validation
  • CMS rules (CMS 1500 and UB04)
  • Age edits
  • Gender edits
  • Local coverage determination
  • National coverage determination
  • Medically unlikely edits (MUE)
  • Outpatient code edits
  • Correct code initiatives (NCCI)
  • CPT edits
  • Modifier edits
  • RVU edits (relative value units)
  • Advance beneficiary notice of non-coverage

Complete Visibility into All Billing Activities

Advanced RCM software makes in-depth reporting easy. It’s a win for everyone—physicians get exactly the data they want, and your billers spend less time creating reports.

Every customer wants to view their data little differently. Each practice has a set of priorities, and within the practice there may be several constituencies, some needing very detailed information and others wanting just a quick peek into a few key performance indicators (KPIs).

Here are some stats that are easily captured using high-end RCM software like PracticeSuite:

  • Net days in AR
  • Percentage of AR over 60 days/90 days/120 days
  • Clean claims rate
  • Denial rate
  • Cost to collect
  • POS collection rate
  • First-pass resolution rate
  • Adjusted collection rate, the amount you collected vs. what you should have collected (note that high performing businesses achieve 99%)

Your clients may also want help tracking the data they need to participate with government programs such as CMS’s MIPS (Merit-based Incentive Payment System) and APMs (Alternative Payment Models).

Keep Your Company Healthy: Internal KPIs and Deepening Relationships

In addition to all the data you’re tracking for clients, you must track key indicators of your own business’s health. For example, you’ll want to know which of your billers are the most productive, how long it takes (on average) from receipt of data to a submitted claim, and how satisfied clients are with your services.

Productivity tracking and client satisfaction surveys are an excellent start and deserve to be discussed, developed, and periodically reviewed. However, they’re no substitute for focusing on what clients ultimately want: to increase their bottom line.

Better Consulting

The data access you’ll have from an advanced billing system opens the door to moving from a bookkeeping role into an advisory one—a fractional CFO for your clients, if you will. You have the information and expertise to help your clients learn and implement financial best practices and shorten their revenue cycle. The more they work with you in this role, the more they’ll understand the value you bring to the business partnership.


  1. LaPointe, Jacqueline “Breaking Down the Top 5 Healthcare Revenue Cycle KPIs.” RevCycle Intelligence, 27 July 2017.
  2. “Finances and Your Practice.” American Academy of Family Physicians.
  3. Quality Payment Program,
  4. “Internal Performance Monitoring is Key to Client Retention.”

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