Medical Coding Software: Your Key to Billing Process Accuracy

The lack of efficient medical billing and coding software often leads to billing issues and high claim denial rates in healthcare facilities, resulting in costly errors of billions of dollars annually. Automating these processes could save the U.S. healthcare system around $16.3 billion. Furthermore, MGMA case studies reveal that software automation boosted patient bill payments by 154%, enhanced revenue by 24%, and accelerated claim processing times by 75%. Hence, the demand for medical coding software development is quite predictable.

However, finding an off-the-shelf solution that meets all functional requirements and system compatibility is almost impossible. Thus, it often must be developed from the ground to fit the organization’s needs fully. To start, let’s understand exactly what medical coding software is. Take a look; it certainly deserves your attention.

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What is a Medical Coding Software?

De facto, medical coding software is a complex program product that helps assign diagnostic and procedural codes to medical data without revealing personal information. Stakeholders like insurance companies, healthcare entities, and governmental bodies generally use these codes for precise documentation and billing of medical services.

While no software can replace a human medical coder (at least not yet), it can simplify the coding process to a few clicks, allowing them to hire fewer people without sacrificing productivity. According to Indeed, medical encoders in the U.S. receive $55,047 per year, which represents significant savings.

How does medical coding software work?

The typical medical coding solution helps in:

• Extracting patient details such as diagnoses, treatments, procedures, and equipment from electronic health records.
• Allocating relevant codes to every diagnosis, procedure, medication, and medical supply based on established coding standards.
• Ensuring the precision and thoroughness of these codes and resolving any inaccuracies or errors.
• Inputting these codes into a specialized database or software application.
• Transmitting this coded information to insurers or relevant parties for billing and reporting objectives.

Benefits of Using Medical Coding Software

Automated medical coding performs important functions within the healthcare sector, and its primary benefits encompass:

Precision and Efficiency

Automation streamlines or significantly accelerates numerous manual tasks, enabling medical staff to process more claims more precisely. Automated billing offers insights into which medical services qualify for reimbursement, helping to guide the selection of the most beneficial treatment options for patients. This provides:

• Minimized Errors, Maximized Reimbursements: Accurate coding ensures faster claim processing, reducing costly denials and audits. In turn, built-in code suggestions and compliance checks further tighten accuracy, maximizing revenue.
• Streamlined Workflow, Boosted Productivity: The software for medical coding automates tiresome tasks like claim and denial management, freeing up your medical staff for higher-value work.

Financial Advantage and Control

Due to suboptimal billing processes, the Pennsylvania Office of Rural Health estimates that U.S. physicians incur financial losses of around $125 billion each year. These losses predominantly arise from claim denials, services not covered by insurance, or patients’ inability to pay their share. Furthermore, according to a SIPP survey, approximately 12 million Americans are burdened with medical debts exceeding $2,000. But medical coding software programs help eliminate these problems by guaranteeing:

• Optimized Billing, Enhanced Revenue Cycle: Improved accuracy fosters faster reimbursements, leading to better cash flow. Reduced administrative costs add to the financial gain.
• Data-Driven Insights, Informed Decisions: With such software, you can analyze coded records to identify trends, improve quality initiatives, and discover new treatment patterns, giving your practice a competitive edge.

Adaptability and Security

Last time, we saw the introduction of a multitude of new codes, particularly those associated with COVID-19 treatments and testing, along with the expansion of codes for telehealth services. The difficulties in securing solutions are escalating, too – because healthcare is the sector with the most data breaches. Fortunately, the best medical coding software meets these challenges by offering:

• Scalability for All: An adaptable codebase means healthcare professionals can access the most recent and relevant coding information, ensuring they stay up-to-date with the latest coding requirements. In turn, сloud-based access and customizable features allow the software to cater to any practice size or specialty, from solo physicians to large hospitals.
• Rock-Solid Security, Peace of Mind: Solutions with robust encryption and access controls can safeguard sensitive patient data, ensuring full compliance with data privacy regulations.

Key Features of Medical Coding Software

The table below comprises medical coding software’s key features and their impact on effective healthcare operations.

Top 7 Medical Coding Software

As technology progresses, coding tools that support it multiply. And choosing between them can be difficult. This part focuses on the seven best medical coding and billing software currently leading the market.

Carepatron 

This is a cloud-based medical coding app suitable for small practices seeking affordability and ease of use. It offers mobile access and integrated billing features. 

• Strengths: Cloud-based, AI-powered code suggestion, robust reporting, and analytics.
• Weaknesses: May lack some features compared to established players and newer companies with shorter track records.
• Pricing: Starts at $49/month

3M Codefinder

This industry’s leading medical coding auditing software solution helps medical professionals stay up-to-date with the latest coding guidelines. This medical coding app integrates with various EHR/EMR systems. 

• Strengths: Comprehensive code libraries, ICD-10-CM and HCPCS compliance tools, and excellent customer support.
• Weaknesses: Can be expensive, and the interface can feel dated, not cloud-based.
• Pricing: Subscription-based, contact for a quote.

DrChrono

This all-in-one EHR and medical coding platform is perfect for growing practices. Offers a comprehensive suite of features with customization options.

• Strengths: All-in-one EHR and billing solution, user-friendly interface, mobile app for coding on the go.
• Weaknesses: May not be suitable for large practices, limited customization options.
• Pricing: Starts at $99/month.

AAPC Coder

This is an industry-standard software trusted by medical coding professionals. It includes extensive code libraries, programming tutorials, and a powerful community forum.

• Strengths: Developed by the American Academy of Professional Coders, trusted brand, reliable coding guidance.
• Weaknesses: Not a full software solution, focused on code lookup and education, subscription-based.
• Pricing: Available as a one-time purchase with annual renewal fees.

Kareo Billing

This is a cloud-based billing and coding solution featuring a user-friendly interface. It’s suitable for solo practitioners and small groups, offering appointment scheduling and patient engagement tools.

• Strengths: Simple and affordable, easy to learn, good customer support.
• Weaknesses: Limited coding features, not ideal for complex practices.
• Pricing: Starts at $79/month

Medicode

The product is a powerful software for medical coding equipped with advanced features such as automated code assignment and audit trails. It is well-suited for large hospitals and complex coding requirements.

• Strengths: Powerful and customizable, integrates with various EHRs, robust reporting capabilities.
• Weaknesses: Can be complex to learn and more expensive than some options.
• Pricing: Enterprise-level; contact for a quote.

Nuance Clintegrity

It is an AI medical coding software with natural language processing capabilities. It automates routine tasks and improves coding accuracy. 

• Strengths: Advanced NLP and AI features, automated coding, excellent accuracy and compliance.
• Weaknesses: The most expensive option requires robust hardware and IT infrastructure.
• Pricing: Subscription-based, contact for a quote.

Note. This list is not exhaustive, and the above solutions will often not be 100% suitable for your business needs. This is why custom development is so popular in the healthcare world.

Final Words

Developing the best medical coding software goes beyond just digitizing traditional codebooks with search and edit features. This is quite a complex process that requires awareness of the latest market trends (which change on the fly) and preparedness to overcome challenges specific to app development in healthcare.

But what if you lack the necessary technical expertise to manage these complexities in creating a customized medical coding system? Then, you have an alternative – hire a healthcare software development vendor like Relevant. We’re experts in innovations and have delivered reliable software for businesses for more than 10 years. Just contact us!