Have you looked into online medical billing software only to find unclear terminology? A vendor who calls their product “cloud-based online medical billing software with automated claims” may appear to be selling a hands-off option. However, you discover after signing that “cloud-based” software only backs up your data to a local server, and the included automation still requires your staff to click “Submit” for claims.
Online medical billing software, cloud-based medical billing software, and web-based medical billing software are terms vendors use to describe the same general category of products. They’re all billing software you access through a browser rather than install on your desktop. As you consider which software is best for your practice, understand the architecture, security, automation, and healthcare inclusions differ among these similar-sounding labels.
Cloud-Based Medical Billing Software vs. Web-Based vs. Online: What the Terms Mean
Vendors use numerous terms to describe and market their products. Being able to identify the features you need versus what the marketing is suggesting equips you to choose the right fit for your practice.
- Fully cloud-based software contains no local data components. All the data is stored and processed on a server managed by the vendor, who is also responsible for Health Insurance Portability and Accountability Act (HIPAA) compliance. If the software needs to update, it does so automatically.
- Web-based (hosted) software may require local hardware. While web-based medical billing platforms are accessible via a browser, they may still require your practice to use a local backup such as an external hard drive or server. Because some data is handled on your end, both you and the vendor may be responsible for security and HIPAA compliance.
- Online billing software is a term vendors use to mean any type of billing tool accessible through a web browser. You will need to examine the details further to understand how much functionality is handled remotely.
The choice between cloud-based and web-based billing software depends, at least in part, on your tolerance for security responsibility. If you want HIPAA compliance centralized in one location, a cloud-based platform achieves that. If you are willing to share security and trust a vendor with the aspects your practice can’t (or won’t) manage, a hybrid hosted platform is sufficient.
7 Questions to Ask About Web-Based Medical Billing Software Before You Sign
Question 1: Is There a Business Associate Agreement, and What Does It Cover?
A business associate agreement (BAA) is legally required under HIPAA for any vendor who handles protected health information on behalf of a covered entity. Before you sign a contract, ask for the BAA to verify it covers billing data, Electronic Remittance Advice (ERA) data, and patient payment information. A BAA that only addresses clinical records leaves your practice exposed to compliance issues.
Question 2: What Encryption Standard Is Used for Data at Rest and in Transit?
Advanced Encryption Standard (AES)-256 is the current best practice for data at rest, and Transport Layer Security (TLS) 1.2 or 1.3 work best for data in transit. HIPAA doesn’t specify an encryption standard for data, though it does require information to be encrypted. If your vendor can’t go into detail about the encryption in their billing software, assume they haven’t designed an encryption environment that will protect personally identifying information.
Question 3: What Is the Uptime SLA and How Are Outages Communicated?
A vendor’s uptime service level agreement (SLA) should demonstrate at least 99.9% and no less. An uptime of 99.99% is preferred. Outages affecting online billing software impact your cash flow if they occur during claim submission windows.
If an outage does occur, your vendor should be able to explain their remediation process and how they communicate with you about that outage.
Question 4: Does Automated Medical Billing Software Submit Claims Without Staff Intervention?
The term “automated billing” is not limited to a singular type of submission. It can mean your staff need to click a single button, or the billing platform could generate an automatic claim from completed clinical notes and submit the claim without human intervention. Ask the vendor what percentage of claims the software submits without manual input and what staff will still need to do within the billing workflow.
Question 5: What Is the Data Portability Policy If the Practice Leaves?
Due to HIPAA-compliant platform requirements, a vendor must make billing data available to you. If you choose a vendor who doesn’t provide access to historical billing information after you leave, you could face consequences during an audit.
You have the right to receive the full data set after contract termination, but data exporting comes with a financial cost. Ask your vendor who is responsible for that cost, how long you must wait to receive the data, and what format the vendor provides it in.
Question 6: Is the Platform HITRUST Certified?
Certification from the Health Information Trust Alliance (HITRUST) is increasingly required by large payers before they’ll offer credentialing. It is a rigorous third-party validation across multiple tiers, and your behavioral healthcare data security checklist should include verifying your vendor’s current HITRUST certification of either I1 or r2. HITRUST is a higher standard than HIPAA compliance.
Question 7: How Frequently Are Behavioral Health Payer Rule Sets Updated?
As payer policies change, your billing software will produce systemic claim errors if the product doesn’t maintain up-to-date rule sets for behavioral health. Ask your vendor who maintains these payer rule sets and how often they’re updated. The vendor should also be able to answer how those updates occur (whether via a manual software upgrade or an automatic deployment).
Frequently Asked Questions About Online Medical Billing Software
What Is Online Medical Billing Software?
Online medical billing software is a billing platform accessed through a web browser rather than installed on a local computer. It allows you to submit claims, post ERAs, and manage bills from any device connected to the internet.
Vendors use terms like ”cloud based medical billing software,” “web based medical billing software,” and “online medical billing software” interchangeably. However, the architecture beneath these products varies in how they handle data portability, automation, security, and HIPAA compliance.
Is Cloud-Based Medical Billing Software HIPAA Compliant?
A cloud-based medical billing platform maintained by a HIPAA-compliant vendor with a signed BAA meets HIPAA security requirements for billing data. In order to comply with HIPAA, a platform must have encryption both at rest and in transit, access controls, a BAA, and audit logging, regardless of whether you choose cloud-based, web-based, or local software. When validating HIPAA compliance for a healthcare billing platform, the HITRUST framework for healthcare data security is the most rigorous third-party standard.
What Does Automated Medical Billing Software Actually Automate?
Automated medical billing software should generate claims from completed clinical notes and submit them to the clearinghouse, post ERAs to patient accounts, alert billing staff when a claim is denied, and verify patient eligibility before every session. Vendors offering products with “automated billing” may only be describing partial automation, which means your staff must still manually submit or create claims. To determine what automation means to your vendor, ask about their automated claim submission rate.
See Valant Billing in Action
Valant’s fully cloud-based behavioral health electronic health record (EHR) handles billing data, clinical records, and patient communication securely under Valant’s HITRUST I1 certification for behavioral health data security. Schedule a demo to see how Valant’s billing features handle claim generation, submission, ERA posting, and denial management without requiring involvement from your staff.
