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Case Study of Medical Billing Software

You can be the vehicle your clients drive for engagement, mobility, and patient experience while increasing their revenue, productivity, and workflow. Our medical billing solutions are primarily aimed at avoiding error rates & improving the claim-ratio. It enables the users to exercise better control over their revenue cycles & accounts receivables.

The Need for Medical Billing Software

The Clinic was looking for healthcare software development to simplify its billing process, which was then person dependent and allowed no control on stocked medicine, overstocking, pilferages, etc.

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The Medical Billing Software Solution

Dreamsoft4u’s Medical Billing Software helped to improve the medical store maintenance and their billing activity. It also improved the hospital’s Administrative Work by creating a pharmacy & medical billing software solution. The modules were aimed to improve the efficiency of the store operation by better control and monitoring of the inventory of medicines. The medical billing software module also facilitated in faster and better service to the patients thus improving the good will of the hospital in terms of service.

Case Study of Medical Billing Software

  • Software Product Design
  • Collaborative Product Discovery
  • Visual Design
  • UX Design
  • Automated Testing
    Opportunity
    The medical billing process is a complex interplay between doctors, hospitals, patients, and insurance companies. Our client facilitates that process for their medical practice customers. Parts of the billing process are performed manually, so our client engaged SEP to improve a key area of the process: the portal through which their customers pay and receive payment for patient bills. They process 80 million transactions per year, each with hundreds of pieces of data. The new web portal needed to increase automation so that our client’s customers have better insight into their billing workflow and spend less time manually processing payments.
    Benefits
    • The activities of bill generating become so fast, convenient and accurate.
    • The rate of generating the bills increased, which reduced the line of the patients.
    • The data record was managed of all the saleable/non-saleable store items, those issued to different sub-stations and those sold to patients; along with their prices, batch numbers, expiry dates, storage instructions, etc.
    • Appropriate alerts were generated when particular items in the hospital were nearing expiry or nearing re-order level.
    • The management were able to get a true picture about the profit/loss making position of the hospital from its stores activity
      Actions
      • The team at Dreamsoft4u replicated the customer’s onshore process to ensure a seamless transition to offshore operations
      • We provided the customer with a dedicated staffer to handle 7 to 8 patient demographics and charge entry files a month
      • By the 2nd month, we were able to process more than 150 files with an error rate below 2%
      • We also provided the customer with a QA team experienced in payment posting
      • This QA team audited all the charge sheets and processed files
      • We sent the customer regular status reports with details about the number of files in processing and the reasons for the delays
        Results
        We started our engagement with a series of Discovery sessions. Together, we distilled the needs of the new portal and built a focused backlog. To determine what parts of the billing process we would focus on, we used activities like event storming. It helped us understand where technology and human interaction bridge together through the process. We also facilitated Design Studios with key subject matter experts several times throughout our engagement. These discussions allowed us to deepen our domain knowledge quickly and ensure we were meeting stakeholder needs. These Design Studios solidified our project motto: improve clarity. Each time we improved clarity, we removed a lot of problems for our client and their customers.
        • The customer was extremely satisfied with our work and decided to outsource their entire medical billing process to us, including insurance calling, charge entry, patient demographics, patient calling and payment posting
        • The Dreamsoft4u team is now successfully handling all the medical billing operations for this customer
        • We now have more than 50 full-time employees who work on this project
        • We now process over a million files on a monthly basis, with an error rate of less than 2%
          CHALLENGE WE FACED.

          1. Privacy Restrictions Must Be Balanced With Usability Requirements

          CHALLENGE
          he development of electronic health records has made patient privacy a top concern of end-users, healthcare organizations, and governments. Governments have created laws (HIPAA, PHIPA) that impose penalties on organizations that fail to protect their electronic data from misuse. These laws are, in turn, applied to other organizations involved the electronic exchange of health information. In 2009, for example, the HITECH act mandated compliance with HIPAA for all covered entities.

          SOLUTION
          mplementing access control is relatively straightforward. Access control restricts actions such as viewing, editing or deleting data elements. Typically, access control is implemented by user role so that all users of a particular role all have the same privileges.

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          There are two basic design approaches for role-based access control:

          1. Access control policies are loaded per page or screen
          2. Access control policies are loaded once per user session

          The first approach requires more frequent database access but results in more dynamic access control behavior. Here, although user privileges can be revoked or granted instantly, the need for loading the access control policies can slow down the server especially when there are many concurrent users. The second approach suffers from a lack of control over access policies, since a user can have his privileges revoked but still be allowed to continue until the end of his session. Either of these policies, however, would be sufficient to address the access control requirements of HIPAA law and even CCHIT certification in the case of electronic medical records.

          2. Doctors Have No Patience For Software That Doesn’t Save Them Time

          CHALLENGE
          Software developers often create systems without considering the time restrictions healthcare practitioners face. In today’s hospitals, healthcare workers are dealing with growing patient waiting lists and need to be able to get their jobs done as efficiently as possible. They can’t afford to wait for software and will be unwilling to do so.

          SOLUTION
          To avoid the example scenario, designers of a new system would have needed to be aware of the doctor’s desire to get clinical paperwork out of the way as quickly as possible. The system should not have halted the data transfer when the clinical case was closed.

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          More generally, software systems in healthcare domains need to be very responsive and inform the user about what the application is doing. In a system with long-running tasks or data transfers, make sure to ask yourself the following questions:

          3. Validation Is Far More Important Than Verification

          CHALLENGE
          Developers often think application crashes are the most serious problem a healthcare program can exhibit. While a crash is obviously not an ideal outcome, hospital processes are well established to deal with software crashes. Of far greater inconvenience is an application that makes a clinical worker’s job more difficult while behaving as designed.

          SOLUTION
          Problems like those described above can be avoided if they are identified through a rigorous software validation process. This validation period must also be used to test all exceptional and rare (from a healthcare viewpoint) cases so the application can be sure to integrate into the environment in even the most unusual circumstances.

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          A good software validation process will catch these problems before too much development work has been completed. Moreover, an agile software development process can be appropriate for certain types of healthcare application development, such as patient management and EMR software development. With an agile process, the application can be tested and deployed at various milestones of the development cycle. An agile process allows for more opportunities to perform software validation and ensures it is conducted early in the project life-cycle.

          4. Input Validation Should Not Block Users

          CHALLENGE Many healthcare applications deal with data entry, and the methods through which data is validated are important software development considerations. In short, treatment cannot be withheld because of the requirements of a software application.

          SOLUTION
          Good healthcare applications keep the number of required fields to a minimum, ensure only the most important information is required, or give users the option to skip the input field. When a patient is undergoing a test or is sitting in a consultation room, information may not be known and the delivery of care must be allowed to proceed.
          To summarize, effective input validation in a healthcare environment should follow these input validation best practices:

          5. Hospital Processes Are Highly Collaborative and Asynchronous

          CHALLENGE
          Hospitals and clinics contain a large number of autonomous individuals all working to deliver healthcare. There is opportunity for collaboration, but work almost always takes place between caregiver and patient. When a difficult case presents itself, multiple staff members may participate to gain experience, but for common, routine cases work can normally be done without discussion.

          SOLUTION
          Traditionally, a piece of paper has been used to synchronize team members. If you had the piece of paper, it meant you were the one who had to work. However, since it would take a while before the paper arrived on your desk, getting the paper implied you had to do a lot of work, and as soon as possible. It is much more efficient to let people work when they want, and do as much work as they want.

          6. Supporting Interoperability Standards Is Tougher Than It Looks

          CHALLENGE
          Most healthcare applications need to interface with external systems. Since these interfaces are usually complex, standards have been developed to simplify the process.

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          Implementing code that adheres to the standards requires a lot of time, and is often a source of overruns and rework. It is crucial to ensure the design and implementation of interchangeability standards is carefully planned and estimated.

          SOLUTION
          The first step to ensure the interchangeability standards code is well-planned and well-estimated is to account for all the possible tasks that will be required of the software team during implementation. These can include:

          7. Not All Clinical Users Are Doctors And Nurses

          CHALLENGE
          Developers often focus on the needs of doctors and nurses since, traditionally; these are the most difficult groups to please. Doctors and nurses are most pressed for time, and their actions most directly affect the quality of patient care. There are, however, other groups of users who will directly or indirectly use a healthcare application. These include:
          Often, physicians are the ones who request the development of an application and are the only ones contributing to the requirements. When the software is released, however, it can fail to deliver an improvement in the hospital’s process because it does not deliver what is needed to all those who need it.

          SOLUTION
          Software teams need to be sure to not only satisfy the requirements of healthcare providers, but also of users who may not use the application directly but who still depend on it to get their work done. It is important to consider those who can benefit “downstream” from the data collected by the application. Be sure to have a usability expert with healthcare experience on hand who can help you ask the right questions, and obtain the right requirements from all the people affected by hospital processes. This process is known by usability experts as “stakeholder identification.”

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          A usability expert can help you model the people, groups, and institutions that contribute to or will be affected by a change to hospital processes. These experts can also identify the array of user personas within an organization to help you solidify your understanding of who, exactly, will use the application. With a solid understanding of all potential users and their needs, you will be better positioned to deliver relevant, useful software that solves the problems of the healthcare organization as a whole.

          Not only will this build your reputation as a trusted software development partner, it can help the organization justify its software development costs and ensure value is being delivered across the organization.

          Why us?

          We rely on our strong understanding of healthcare workflows to build robust and secure systems which are HIPAA & ICD-10 compliant. We can be your software development partner if:
          • You are a provider looking for an in-house software to gain better control over your billing cycle
          • Want to replace an outdated system or upgrade it
          • You are a specialist with specific functional requirements to meet
          • You are a third-party service provider
            Based upon your need, solutions offered can be either on-premise or web-based. They can also be stand-one or integrated with your Practice Management and/or EHR systems.

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