What’s included in medical billing and coding software?
Discover essential medical billing and coding software features you need to streamline revenue, reduce claim denials, and boost reimbursement rates.
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At a Glance
- Medical billing software streamlines revenue collection and reduces claim denials.
- Essential features include coding tools, claims processing, and EHR integration.
- Choose platforms with compliance auditing and real-time revenue cycle tracking.
For small practice owners and medical billing companies, choosing the right medical billing and coding platform can mean streamlined revenue collection, reduced claim denials, and higher reimbursement rates. On the flip side, not using the correct software could result in frequent errors, compliance risks, and administrative headaches.
Modern solutions support everything from insurance claims to automation and compliance auditing — all while being accessible and cost-effective for businesses and practices of various sizes. This guide provides a detailed checklist to help you evaluate and select the ideal platform for your needs.
Features checklist: What’s included in medical billing and coding software?
Here are the features to consider when selecting the platform that best fits your needs.
1. Patient and health information management
- Patient data access: Easy access to patient information, including demographics, medical history, and documentation. Quick retrieval and management of comprehensive medical records and histories.
- Data security: HIPAA-compliant systems to protect sensitive patient information and prevent unauthorized access or data breaches.
Optional feature that adds value: Role-based access controls that limits visibility of sensitive patient information based on user roles.
Why: Secure and efficient patient information management minimizes billing errors and safeguards against compliance violations.
“Secure and efficient patient information management minimizes billing errors and safeguards against compliance violations.”
| Power your private practice or billing company with Tebra's HIPAA-compliant, all-in-one medical billing software. Learn more here. |
2. Coding capabilities
- Built-in code libraries: Support for International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) codes, updated regularly for compliance.
- Coding tools: Tools to search for codes and coding rules.
Why: Robust coding capabilities ensure that medical services are accurately documented, coded, and billed.
3. Claims creation and submission
- Claims processing workflows: Automated workflows for claim creation and status updates for submitted claims.
- Integration with payers, insurance companies, and clearinghouses: Direct electronic claims submission (837 format) and automated eligibility verification.
Why: Streamlined claims workflows accelerate payments and lower the risk of rejected or delayed claims.
4. Claims scrubbing and denial management
- Pre-submission scrubbing: Uses technology like robotic process automation (RPA) to automate repetitive tasks such as claim scrubbing to check for errors, missing data, or incorrect modifiers before claims are sent.
- Denial tracking and resolution tools: Tools for tracking and resubmitting denied claims.
- Audit trails: Comprehensive logs for compliance and process improvement.
Why: Pre-submission checks and denial tools prevent revenue loss and keep the billing cycle moving efficiently.
“Pre-submission checks and denial tools prevent revenue loss and keep the billing cycle moving efficiently.”
5. Reimbursement and revenue cycle management
- ERA and EOB management: Electronic remittance advice (ERA) posting and explanation of benefits (EOB) tracking.
- Revenue cycle tracking: End-to-end visibility of the billing process, from claim submission to payment.
- Automated patient statements: Automated statements, reminders, and easy-to-use payment portals to improve collections and reduce support calls.
- Flexible payment options: Multiple payment options (online, text, or autopay) to improve the patient experience and streamline payment posting.
Why: Real-time tracking, payment posting, and integrated payment tools help maintain cash flow, support sustainable growth, and improve collection rates.
6. Integration with EHR and other systems
- EHR and practice management integration: Bi-directional data flow between billing, EHR, and practice management systems. This integration can allow for easy access to clinical notes and documentation, and support tasks such as populating claim fields using EHR data.
- Scheduling and eligibility sync: Integration with appointment scheduling and patient communication tools.
Why: System connectivity improves data accuracy, reduces double entry, and enhances care coordination.
“System connectivity improves data accuracy, reduces double entry, and enhances care coordination.”
7. Reporting, analytics and decision-making
- Business Intelligence: Reports that provide a clear view into claims, denials, and patient payments.
- Audit support: Tools to prepare for Office of Inspector General (OIG) or payer audits and ensure compliance.
Why: Real-time insights help identify trends, track performance, and make data-driven decisions that improve both compliance and revenue.
How to use this checklist in practice
- Download and customize: Use this checklist during software demos to compare platforms.
Tip: Always request a demo and trial period to ensure the software fits your unique workflow and integrates with your current systems.
- Identify must-haves: Prioritize features based on your practice size, specialty, and workflow needs.
- Evaluate integration: Ensure the software integrates smoothly with your existing EHR and practice management tools.
Invest in a complete billing and coding solution
Complete medical billing and coding solutions directly facilitate faster reimbursement, fewer claim denials, more accurate coding, and streamlined operations.
For small to medium-sized practices and medical billing companies, choosing the right solution positively supports every aspect of the revenue cycle — from patient intake to final payment — while significantly reducing administrative burdens and compliance risks.
Find out how Tebra’s medical billing software can help you improve cash flow and get paid faster with a free personalized demo.
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