Author Topic: Claims processing question  (Read 2093 times)


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Claims processing question
« on: July 23, 2014, 06:04:46 PM »
Hi.  I've billed pharmacy for many years and recently added medical billing to my list of services.  All of my pharmacy clients use the same dispensing software that I recommended to them.  This software has a billing module attached to it.  I am curious what is normal in the medical billing world.  I'm thinking of partnering with a medical billing software company just like I do on the pharmacy side.  I've listed what I think are the various scenarios that I will encounter and wondered if people could tell me what is typical or if there's another scenario I'm not thinking of.

1) A practice already uses a pm/emr software program and they give me a login to that same software to adjudicate the claims.
2) The practice continues to use their own software, but I enter demo, insurance, and claim info into my software so I can adjudicate through my software.  (Do most people pick up charge slips or can they be faxed/scanned?)
3) I onboard the practice to my pm/emr software and everything is done through my software.

Thanks so much for anyone's help.


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Re: Claims processing question
« Reply #1 on: July 24, 2014, 10:19:14 AM »

I am reposting the responses on the other post (that is identical to this one)

From PMRNC:   

 My answer would have been much different a few years ago. Number 1 & 2 are typical for today I think. A few years ago I stopped using "A" Pm software solution all together because I was finding more and more physicians didn't want to go through the hassle and time to convert and most had a system they were confident in. I found when I started marketing a more diversified approach in that area, I got more responses when the practice realized they could outsource w/out changing or getting rid of their existing systems. For ones that wanted a change I was able to point them in the direction of a few companies and let them do the choosing :) I do NOT hold any expenses with software.. NONE. I have NO out of pocket costs with software at all and it was the best thing I ever did. I have clients where I log in to their system using logmein and then I have clients with web based where I have my own login.   I love this solution as it keeps my costs down, I don't have to worry about support contracts, and if terminating a client it sure makes for easy conversion/completion!!

From Michele:

We do a combo of both.  We also use logmein for some clients, we have our own logins for webbased systems, and we have our own PM system for those who do not wish for us to use their system.
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