How to Develop a Medical Billing Software?

Updated on Dec 18th, 2023

Right from the appointment booking stage, the healthcare process goes through multiple people representing various departments. With so many people involved in the process, the likelihood of a data entry mistake or some other mishap is pretty high. Mistakes on medical bills cost hospitals a whopping $68 billion annually. Not only that, but billing errors result in overcharges of 26% on average.   

No wonder healthcare organizations are switching to enterprise solutions like medical billing software development to automate and streamline their processes. While buying off-the-shelf medical billing solutions might seem like a good idea, often these solutions fail to be compatible with other healthcare solutions that a healthcare institute might have already implemented. Whereas custom medical billing software solutions are built according to the specific needs of your organization. But choosing a company that can build a healthcare enterprise solution is neither easy nor the only task you need to do. Before looking for flexible software development services, you must follow a series of steps to ensure maximum gain and quality results. And in this article, we will walk through all the steps you need to follow to develop your very own medical billion software solution.

What is Medical Billing Software?  

Medical billing software is a type of healthcare software that automates healthcare invoicing. Healthcare organizations and billing companies deploy these solutions to improve reimbursement rates significantly, optimize revenue, and sustain the financial trends of the businesses. Medical billing software solution streamline the operations in a healthcare organization in multiple ways, including: 

  • These systems are fully integrated with EHRs, which reduces the chances of manual error and presents data in a better way in a few clicks.   
  • Claim scrubbing functionality helps boost the first-pass acceptance rate by inspecting claims for edits before final submissions.  
  • Automated claim worklists help billers to stay focused on serving patients  
  • When integrated with the clearinghouse, billers submit claims to several payers using the interface and faster reimbursement.  

Some of the challenges that you can solve with medical billing software include:  

  1. Fragmented workflow slows down the overall process with billing errors and claims denials. 
  2. Paper-based billing systems can slow down revenue cycle management.  
  3. Lack of interoperability makes it complex to integrate with other healthcare systems and share data within them. 
  4. Avoids bundled payments by providing episode-based payments for risk-based delivery. 
  5. Inability to manage patient claims data securely and under HIPAA compliant billing system. 

Get Started on Medical Billing Software Development with Custom Software Development Company 

Once you have made up your mind to build a custom medical billing software, it’s time to start looking for a custom software development company that can shape your vision.  

While many healthcare organizations develop such solutions in-house, it is worth noting that in-house software development is significantly trickier than working with an outside development firm. To develop an enterprise solution in-house, organizations need to hire full-time talent and provide them with proper infrastructure, which is a substantial investment not every company can afford. That is why it is wiser to look for expert developers who provide cost-effective software development services for the healthcare sector. 

Read More: Complete Guide to IT Staff Augmentation for Healthcare 

As all medical software must comply with international standards like HL7, HIPAA, etc., it is essential to ensure that the company you hire adheres to these policies. Apart from compliance adherence, here are some other things to look for while looking for a development company to build your medical billing software: 

  • Industry experience 
  • Technical expertise 
  • Skills of the development team 
  • Development process 
  • Project management tools 
  • Client testimonials 
  • Post-deployment maintenance services 

How to Develop Custom Medical Billing Software- The Process Matellio Follows as Custom Healthcare Development Company   

While there are multiple processes specific to various organizations, Matellio follows a customer-centric agile methodology to ensure quality software development services. Let’s discuss how we build custom medical billing software.   

We start the process by helping you uncover the hidden aspects required for building medical billing software. In the discovery phase, our business analysts perform the following actions to get into the details of how your custom medical billing software should work.  

Step 1: Understand the Working of Medical Billing Software for Architecture Creation  

Medical billing software is integral to the healthcare revenue cycle. This process involves multiple steps, including:  

 Patient Insurance Validation  

This step verifies the validity of the patient’s insurance coverage. The front desk operators carry it out before the appointment schedule. In this, information about the patient including medical history with diagnosis, number of total appointments, previous billing information, and more is validated by the software.   

Charge Capture Records  

These are the medical services provided to the patients and charges for the same. The doctors and their teams are responsible for filling out these details.

Medical Coding  

Medical coding covers medical services, treatment procedures, diagnoses, and prescriptions into standard healthcare codes. These codes must be correctly determined based on the International Classification of Diseases (ICD-10), current procedure terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) standards.     

 Claims Submission  

This step audits and submits billable fees to the insurance companies for reimbursement.   

A/R Follow Up  

Account receivable follow-up ensures that the healthcare providers can recover overdue payments. It involves tracking denied claims, checking partial payments, re-filling claims, and represents the amount that patients owe to the hospital for services provided. 

Denial Management  

Denial management involves standard denial reason codes and highlights the gaps in billings, registration, and medical coding process. It also records this data to avoid future denials and ensure acceptance.   

Remittance Processing  

This refers to the inspection of payments resulting from a bill for rendered medical services to determine the acceptance or denial of payments.   

Third-party Follow-Up  

In this step, payments from the third-party are collected. This is an essential step as healthcare organizations can only choose Medicaid or Medicare after other options have failed.    

Patient Collections  

Patient collections collect all the copayments and non-covered charges from patients if the bill for healthcare services is partially insured.   

Reporting and Data Analytics  

All the information is stored in the system for future use and analyzed to improve financial operations by extracting insights.   

Step 2: Finalize the Required Features for your Medical Billing Software with You   

1. Patient Preregistration  

Optimized billing workflow is crucial for the accuracy of medical billing data. While it depends on multiple factors, consistency of patient preregistration is one of them. This feature is also essential to foster better patient care and reduce waiting times. It collects the following data:  Optimized billing workflow is crucial to the accuracy of medical billing data. While it depends on multiple factors, consistency of patient preregistration is one of them. This feature is also essential to foster better patient care and reduce waiting times. It collects the following data: 

  • Patient medical history 
  • Insurance eligibility 
  • Medicare provider enrollment 
  • Patient’s details 

If the preliminary information is available at the time of registration, it is easier to address gaps in the future, and also, the information is displayed to the doctors in concern in a timely and accurate manner.  If the preliminary information is available at the time of registration, it is easier to address gaps in the future, and also, the information is displayed to the doctors in concern in a timely and accurate manner. 

2.Claims Management  

Claims processing for medical billing and coding is carried out through the credentialing feature. Claims management is one of the essential features of any medical billing software as it automates billing, saves time, and reduces inaccuracies. This includes other sub-tasks and corresponding features for: 

  • Claim processing 
  • Invoice creation
  • Claim submission  
  • Claim updates  

And more.  

3. Automated Accounting  

Automated accounting is vital to medical billing software. It is enabled by the combination of features like coding analysis and invoicing through medical codes, document management, insurance claims, A/R, Medicare and Medicaid coverage, and revenue cycle management. Automated accounting helps streamline the entire process with features that include:  

  • E-Invoices  
  • Payment Reminders  
  • Coding  
  • Claims management  

4. Data Exchange and Collaboration  

Throughout the cycle of medical billing, including invoicing, coding, appointment scheduling, data integration, or data sharing among various stakeholders, medical billing software should encompass all smooth data updates to ensure each user receives the latest copy of the data. Even a single gap in the data can lead to big mistakes that can be cost the organization handsomely.   

5. Patient Data  

A centralized patient data repository helps healthcare organizations to stay updated. It helps medical billing systems and other such software to collaborate seamlessly. When provided with accurate patient information, the medical billing process can be instant and uninterrupted. For this, the medical billing systems need to collect up-to-the-minute information from EHR/ EMR along with the following features:  

  • Medical records
  • Insurance eligibility  
  • Medicare coverage  
  • Prescription history  

6. Appointment Scheduling  

Patient appointment scheduling helps medical billing software to ensure accuracy in medical billing codes. The following features integrated into the application will help with simplified medical billing:  

  • Patient inflow  
  • Treatment details  
  • Appointment type  
  • Revisits  

 An easy-to-use UI/UX that can be a common platform for scheduling and billing is ideal for medical billing software.   

7. Compliance  

As explained earlier, compliance is an essential requirement when it comes to healthcare software of any kind. Without complying with the standards, you risk running into legal issues that might permanently ban your software solution. Billing software with compliance will take your software to the zenith of success.  

8. Reporting and Analysis  

To generate medical billing services, financial reports, patient documentation, claims management, and accurate reporting and analysis are vital. Ensure your medical billing software allows seamless workflow between the various nodes to gather information and insights required. Use an easy-to-use dashboard that offers visualization for the user to derive results.   

Step 3: Technology Stack that Would Best Suit Your Project Requirements  

Once we know what feature we have to integrate in your solution, it is time to decide the technology stack. The goal behind this process is to pick the right technologies to deliver the best possible solution for your organization and its unique needs. Furthermore, many organizations are going beyond norms and investing in next-gen integration as well. Matellio provides IoT development services, AI development services, chatbot integration, and many other services that can truly make your billion software feel next-gen.  

Here is the technology stack that our experts usually suggest:  

Front End Development 

Libraries  Vue.js, React 
Languages  CSS 3, JS, HTML 5 

Back End Development 

Server  Nginx 
App Frameworks  Laravel 
Databases  My SQL, Redis 
Hosting  AWS, VULTR 

Step 4: Finalize the Team Structure  

This brings us to an important step, helping you connect with the right people who will finally build your solution. Matellio houses a vast pool of talented developers, designers, and engineers and we make sure that we allot the right talent to the right project,  

Your team shall typically include:  

  • Project manager  
  • Front-end developer 
  • Back-end developer  
  • UI/UX experts  
  • QA and testing engineers  

Step 5: Custom Medical Billing Software Development and QA/ Testing  

Once everything is finalized, we’ll start working on the project to deliver the expected results. This, too, is broken down into multiple stages such as:  

  • SRS Creation: A software requirement specification (SRS) document is a vital first step towards developing any software. It captures the complete project description, including how a system shall operate and other technicalities. In this stage, a detailed view of the system is designed on paper, with each aspect explained in detail. Once the client approves the SRS document, the following phases of the document shall begin. Developers will consider the requirements mentioned here as benchmarks, so the client must ensure that all the requirements are specified.   
  • Software Development: Based on the SRS, the development work will start. It is mainly carried out in UI/UX development, front-end development, and back-end development. The project manager oversees the entire process to ensure cutting-edge delivery and shall stay connected to you to share regular updates.   
  • QA/ Testing: QA and testing experts design and run the system based on various use cases to ensure that the system works like it is intended to. This is a crucial stage to deliver software that not just meets your requirements but is also bug-free. 

Are You Ready to Begin with Custom Medical Billing Software Development?  

The right time to invest in a medical billing solution is right now!  

While developing medical billing software is anything but easy, it is lucrative given the benefits it offers. You can always begin with MVP development for budget constraints and keep adding features that you wish to based on upcoming needs and requirements.  

Matellio has provided excellent software development services to many healthcare organizations (among other verticals) for 20+ years in the industry. To begin, book a free 30-minute consultation with our team and explore. 

Enquire now

Give us a call or fill in the form below and we will contact you. We endeavor to answer all inquiries within 24 hours on business days.