Hospitals and health systems are increasingly recognizing the importance of auditing and billing compliance software. The prospect of exploring new software solutions can be overwhelming at best.
Navigating this decision is best accomplished by aligning software features with the organization’s unique needs. Capabilities should offer the basics of effectively streamlining revenue processes, minimizing the risk of errors, and simplifying the auditing of claims, providers, departments, and facilities.
Here are six tips to keep in mind when shopping for auditing and billing compliance software:
#1 Involve stakeholders across the organization in the decision-making process
Revenue cycle processes occur outside the billing office. Consider those who work in revenue integrity, clinicians, back-office staff, compliance, health information management, and clinical documentation improvement (CDI). When evaluating software, solicit input not only from each of these departments but also from the IT department as they will be helping with implementation and monitoring.
Expanding your search to include multiple parts of revenue cycle management (RCM) can help bring solutions full circle. Involving a wide variety of stakeholders in the initial discussion can help decision-makers prioritize the individual challenges and needs of the organization.
#2 Look for a platform with streamlined processes
How often has software truly improved your processes?
The reality is that users typically must adapt to new software, instead of the other way around. The goal of any software system should be to make life easier while saving resources and time. Look for solutions that are sophisticated, scalable, and able to perform heavy lifting. Billing and compliance software should automatically ingest historic and current claims and billing data daily.
Automatic ingestion saves time and ensures staff are working with the most up-to-date information. It also allows audit teams to concentrate on audits and educating staff — no more spreadsheets and manual processes.
#3 Understand a vendor’s client portfolio
Not all auditing and billing compliance software is the same, and neither are the vendors in this space. Are billing compliance and auditing an extension of some other product in a vendor’s portfolio? Can their solutions work across billing departments? How often is their software updated to reflect the effects of new regulations, workflows, or advancements in technology?
If billing compliance and revenue integrity aren’t central to a vendor’s experience, they might not understand the complexities and challenges that billers and auditors face. You also want a system that can work across the hospital landscape and into cross-specialties like oncology, orthopedics, radiology, pain management, radiology, etc. Consider the size of the organizations the vendor serves. Concentration in one segment could indicate that their solution is not able to scale up or down to meet unique needs.
Finally, ensure that any solution is compliant with HIPAA standards. Bonus points for any solution that is certified with the Health Information Trust Alliance (HITRUST) Cybersecurity Framework.
#4 A product demo is for YOU
Sales reps love product demonstrations; it’s their opportunity to pull out all the stops and show you every feature their software has to offer. However, many impressive features carry additional costs and unforeseen workflows.
Perform your due diligence upfront and involve stakeholders from across the hospital to develop a list of the features you’re looking for and the challenges you want solved with auditing and billing compliance software. Then, focus on an “apples-to-apples” comparison of those features. Pay attention to the return on investment (ROI) for the solutions this software can bring to the organization. Prioritize anything extra that catches your attention after necessary solutions have been identified.
Ask about future functionality and understand any costs involved. Understand how this software will fit into existing processes and what it will mean for trouble areas that require improvement. Finally, schedule the demonstration at a time when stakeholders from across the hospital can attend and ask questions.
#5 Look for actionable intelligence
While auditing and billing compliance software should allow your hospital to maximize revenue, the real aim should be to drive revenue integrity across the organization. You don’t want to merely fix errors in the “now,” you want to create a new mindset that centers on uncovering errors, discovering their root causes, correcting them, and educating providers and other staff to prevent the errors from recurring.
An ideal solution should feature robust reporting and intuitive dashboards that show high-level results in a digestible manner but also allow users to dig into the factors that are driving those results. Look for solutions that offer benchmarking capabilities against other organizations and industry-standard measures from the Center for Medicaid and Medicare Services (CMS). This will assist the organization in navigating future changes.
#6 Factor in implementation, training, and ongoing support
Just as you wouldn’t buy software without a demonstration, don’t sign a contract before thoroughly investigating implementation, training, and support. Request references from clients and ask them pointed questions about their day-to-day experiences with the software, including ease of use, initial and ongoing training, implementation, and support experience.
During the evaluation process, ask about how implementation and training are handled. Along with any associated costs. Does the vendor have a dedicated customer success representative who understands implementation and your goals? The ideal vendor sets clients up for success, with multiple training formats that include documents, videos, and live training.
Recognize that the vendor/client relationship doesn’t end when the contract is signed. Establish the framework with your vendor for a long-term, successful relationship. You deserve it!
Wondering how MDaudit compares as a vendor? Check out stories of customers who have successfully implemented MDaudit and transformed their compliance and revenue integrity organizations.
