Binary Spectrum, a Microsoft Gold certified partner and a member of the Sun Partner Advantage Program has years of expertise in designing and developing custom Electronic medical records software and HL7 integration solutions for Electronic medical billing software systems. In an effort to present our understanding and expertise in the Health care software development space we have prepared these articles. Don't forget to browse through our casestudies section and also our FAQ sections.

Medical Billing
The physicians on rendering their optimum care and treatment to their patients rely on the payment that comes from them, which would be in a form of an insurance payment or co-pay which is again determined depending on the patient being insured or not, (while the individuals in United States of America are insured.) Yet to claim the payment from the patient is a tedious process as the procedure to send, remind and claim from the insurance company is not an easy task.

Features
Billing is a part of the PMS which is integrated with the EMR to gain patient information containing their insurance details.

Billing is a part of the PMS which is integrated with the EMR to gain patient information containing their insurance details.

Some of the features of Billing that enable billing capturing and posting efficient are:

Facility details

Capturing the facility and configuring the facility details to manage and maintain patient information for claims and posting of receivables pertaining to the patient's utilization of the facility's resources.

Provider details

Patients visiting their preferred physicians need to be configured to the application in order to have their payments of their patients posted and paid accordingly.

Configuration CPT

Every patient or visit has a code attached to it that allows billing easy as each procedure code has a pre-fixed amount set by the insurance company.

Diagnostic codes

Pertaining to every disease prevalent they have a disease code and a treatment that is followed with it for which the diagnostic codes allow easy claims as the amount is pre-set.

Insurance details

This feature configures the insurance company and is given a code that makes it easier to identify to send claims and posting of receivables.

Claim configuration

Allows the posting of claims as the allowed amount is set for every insurance company the individual is covered and when the charges are posted the difference is notified immediately and this allows sending the remaining amount for claim from the secondary insurance company, tertiary insurance or co pay.

Functionality

When an individual utilizes the resources of the facility he is charged for the same, the process that goes along is as follows:
- The patient who intends to meet the patient would have to book an appointment where in he calls the front office desk and confirms an appointment (in case of an authorized visit the authorization is confirmed and the appointment is booked).

When the patient is done with the visit he is charged for it according to the procedure code that the physician has treated him at.

These details are captured by the front office desk and sent to the insurance company with details of his encounter with the physician. (the insurance company would be the primary insurance)

The insurance company in return would scrutinize the papers or information sent by the facility pertaining to the patient's visit, would have them sanctioned accordingly, as the insurance company has a set amount allowed for a procedure code and would make payment likewise.

The insurance company would send the payment with an explanation of benefits that explain the charges and references of payment denials if needed.

The facility on receiving the payment would have to post the payment details with the set allowed amount that would give a difference and the same would be sent for claim to the secondary insurance company or the patient would have to pay it themselves as co pay.

If the payment is denied the bill is sent for re-claim and the process followed is as explained.

Our role
Binary Spectrum develops application that allows easy configuration and efficient posting of claims and receivables. Billing is a vital part of any business that brings in the income of the industry healthcare being vast and the insurance companies making the payments have a lot of paper work that goes along with it, which is made easy and paperless with our application. Our application has features that help bill the insurance company online with limited entries as they are pre-configured making billing easy, the application also reminds the user of pending requests of payments and easy posting of claims.