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Medical providers and practices need to be aware of the legal requirements for their billing processes to ensure they are compliant with all payment transactions in accordance with applicable laws, minimizing any potential risks or liabilities. That’s why medical billing software online is so invaluable. Here we will discuss the advantages of this technology, how it works, best practices, and more.

But let’s back up and start by looking at what medical billing and coding are. Medical coding is a process of using codes to document and track patient care services and treatments. This helps medical providers, such as nursing homes, and insurance companies understand the services that have been provided so they can properly bill for them. 

Coding systems, such as ICD-11 (International Classification of Diseases) or CPT (Current Procedural Terminology), are used to provide a uniform way of describing diagnoses, treatments, and other services. It is noteworthy that ICD-10 served as the standard until it was replaced by ICD-11 in 2019, when the 72nd World Health Assembly voted to adopt ICD-11, which came into effect on 1st January 2022.

Once a healthcare provider has completed the medical coding, it becomes time to put together the medical billing, which involves submitting invoices and reimbursement claims to insurance companies or other third-party payors. The billing process requires accuracy and attention to detail to ensure that all payments are processed correctly. 

Accurate and compliant billing in long-term care is paramount, as it ensures:

Happy residents taking a photo in an assisted living facility that uses medical billing software online
Ensuring medical billing accuracy is essential for protecting the medical rights of patients and residents.
  • Financial protection: Medical billing software online solutions are essential for protecting medical practices from potential liability. A long-term care facility that does not have accurate medical billing procedures in place can be held liable for any errors or omissions in its medical billing process, which could lead to legal action or fines.
  • Resident protection: Ensuring medical billing accuracy is essential for protecting the medical rights of patients and residents. If medical coding and billing errors are present, medical providers can overcharge or undercharge a patient for their medical services, which could result in substandard care or improper reimbursement.
  • Future forecasting: Accurate medical billing procedures can also help medical providers forecast the financial health of their practice in the future. With the right medical billing software, online records will give nursing home administrators a better understanding of their revenue stream and financial overview, which can help them plan for future medical expenses and other costs.

Inaccurate medical billings can lead to expensive fines and delays in reimbursement from third-party payors. This can have a negative impact on the financial health of long-term care providers and their ability to provide quality patient care. That’s why it’s essential that any professional using a medical billing software system understands how they can remain in compliance while still performing the job effectively. 

The Role of HIPAA in EMR Billing

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law passed in 1996 that protects a patient or resident’s medical records and other health information provided to health plans, doctors, hospitals, and other medical healthcare providers. It also determines the rules for the internal use of medical information used by medical personnel. 

Unfortunately, some long-term care facilities do violate HIPAA guidelines due to willful negligence or improper CNA training. Some of the most common violations include: 

  • Failure of employers and educational institutions to offer adequate HIPAA training
  • Using electronic devices that are not sufficiently protected from cybercrimes, such as hacking and malware, which significantly endangers resident records
  • Having unsecured computers and relying on paper instead of digital records, which results in the leak of confidential medical information
  • Failing to adequately destroy protected health information by way of things like shredding documents or wiping hard drives
  • Unauthorized disclosure of medical records without authorization from the patient or resident
  • Unintentionally revealing the confidential information of a resident due to human error, such as a typo during records retrieval, an unfortunate mistake that can have serious consequences
  • Unauthorized disclosure of patient information in all informal settings, such as conversations with family and friends or among co-workers

HIPAA is necessary for EMR billing, as it sets the standards for medical services. Specifically, HIPAA applies to medical billing software by setting forth rules and regulations that govern how medical information is collected, stored, used, and shared. There are many medical billing software online solutions available to help medical providers remain compliant with HIPAA regulations. 

The best senior care software platforms are designed to protect medical information while simultaneously providing medical personnel with automated tools used to efficiently and effectively process medical billing data. Some of the important features that EMR and EHR-compliant software should contain include:

A nurse entering information into an EMR billing software after securely logging into the system.
Logins ensure that only authorized users have access to the medical billing software, online records, and other sensitive information.
  1. Login details: Logins ensure that only authorized users have access to the medical billing software, online records, and other sensitive information. This helps protect the privacy and security of personal and medical information.
  2. Audit trails: An audit trail is a record of activity that shows who has accessed the system and when as well as any changes that have been made to data. In some cases, audit trails may be required by industry regulations or standards, such as HIPAA, to ensure that appropriate protections are in place to safeguard patient and resident data while enabling system audits.
  3. Editing capabilities: Editing capabilities enable users to correct errors or update information as needed, ensuring that the data stored in the system is accurate and up to date. It also allows users to add missing information or fill in incomplete records, ensuring that the data stored in the system is comprehensive and complete.
  4. Secure printing: This ensures that only authorized users can access printed documents and that the documents are printed in a secure manner using authentication or encrypted communications. This helps to protect the privacy and security of personal and medical information.

Overall, medical providers must be aware of HIPAA regulations and ensure that their medical billing software is compliant with them. The right medical billing software online can help medical personnel remain in compliance while providing the tools they need to efficiently process medical data. 

Contact us here if you would like to test drive long-term care software that is designed to help teams remain compliant.

How To Choose Compliant EMR Medical Billing Software

Choosing the best  EMR medical billing software that is also compliant with long-term care regulations can be a daunting task for long-term care administrators. To help you choose compliant medical billing software for your practice, look for the following long-term care software components before making a purchase:

Nurse administering medication after ordering it using the facility's EMR medical billing software
ePrescription allows healthcare providers to electronically send prescription orders to pharmacies, thus saving time and effort.
  • Customizable templates: This can be a valuable feature when choosing from a list of medical billing software online because the right templates allow users to effectively create and modify documents, reports, and other materials. Additionally, nurses can save time and effort by creating standard documents that can be easily modified and reused rather than starting from scratch each time.
  • 24/7 access and reporting: Another critical aspect of EMR billing is the ability to access medical records from any location with an internet connection. This allows medical staff to review medical files and generate reports from existing data whenever necessary. In addition, it enables physicians to quickly access resident information necessary for diagnosis or treatment decisions in order to provide better medical care. 
  • Provider-to-provider communication: Nursing homes and their external service providers need to be able to easily communicate with one another. With medical billing software, medical staff can quickly send documents, messages, or other information back and forth electronically, which reduces time spent calling or faxing information. This helps improve the efficiency of senior care while also streamlining communication. 
  • Scheduling: Scheduling appointments, managing schedules, and tracking nurse availability are all important parts of running a Skilled Nursing Facility (SNF). Scheduling capabilities can save time and effort by automating the process of scheduling and managing appointments and by providing tools to optimize the use of time and resources.
  • ePrescriptions: ePrescription—also known as electronic prescribing or e-prescribing—can be a valuable feature to consider when negotiating your EMR price. This technology allows healthcare providers to electronically send prescription orders to pharmacies, thus saving time and effort by eliminating the need to manually write and transmit prescription orders. It also enables real-time prescription management and tracking.
  • Resident and family portal: Long-term care residents and their families want to have secure access to their healthcare information and related resources. Resident and family portals can provide them with access to healthcare information, such as appointment schedules, test results, and treatment plans, enabling them to be more informed and involved in their care
  • Integration: A crucial capability that modern senior care software must have is the ability to exchange data and interact with other systems and applications. Integration capabilities can save time and effort by enabling the automatic exchange of data between systems, eliminating the need for manual data entry and reconciliation. Also, elder care software integration capabilities can facilitate coordination between different systems and applications, enabling the sharing of data and resources and supporting the meshing of processes and workflows.

All of the above are necessary components that one must choose when looking for compliant medical billing software online. With these functions in place within a single system or platform, medical staff can save time while providing better quality service to their patients. Investing in the right medical billing software online can go a long way toward improving patient satisfaction as well as streamlining operations at a SNF.

Best Practices for Using Medical Billing Software Online 

As we conclude, it is worth mentioning some best practices that long-term care facilities should consider when using medical billing software online: 

  • Build and train an effective team to use the medical billing software
  • Simplify payment processes
  • Submit claims to payors before deadlines have elapsed
  • Track your revenue cycle
  • For denied claims, analyze why that is the case and re-submit after the error is fixed
  • Create a team culture that encourages constant improvement. 

By applying these best practices, medical staff can ensure that medical billing software is being utilized in the most effective and efficient way possible. 

For more on recent trends in long-term care, read our blog and subscribe to the LTC Heroes podcast.

Elijah Oling Wanga
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