Technology: How to (Safely) Change Your Billing System

The only thing worse than putting up with bad billing software is the prospect of changing billing software.

It feels so risky. What if something goes wrong and you lose all your billing data? That'll make collections a little tough. Suppose everyone learns a new system - and it isn't any better than the old one? It just seems safer to stay with the tried-if-not-exactly-true solution you already have.

Well, fear not. Changing your system does take some preparation, but it also can be less painful than you might imagine. Study your needs well, arrange for the transition, and throw out your old standby for the hot new thing. Here's how.

KNOW WHAT YOU HAVE

First, know exactly why your current system isn't meeting your needs. "The number-one reason people update is that their current software is outdated," says Sarah Drake, a partner at Rochester, Mich.-based EZClaim Medical Billing Software. "If their current vendor hasn't kept up ... it can become obsolete."

HIPAA compliance and EMR implementation have driven lots of conversions in recent years; old systems can't always accommodate the greater automation and integration now required. If this is the case for you, it may be cheaper to start over with a new program than to upgrade, Drake says.

But newness isn't everything. You have to make sure your new-fangled product solves your problems. Ben Tobin, an engagement manager for Beacon Partners in Boston, has seen countless billing transitions. When a client comes to him ready to switch software he asks, "Why? The first thing to do when you look at any billing system ... is to come back to what's going wrong now. ... Look at how or if a new system will help you."

For example, if you are losing cash because you aren't getting quality information up front, new software probably won't help unless you improve your verification processes.

But if you are constantly getting denials because your current system can't scrub for obscure, local medical necessity rules before sending claims, a new system with robust claim-scrubbing support could work wonders.

Marianne Dess-Santoro, chief operating officer for Yale Medical Group, advises physicians to review their work processes and personnel before abandoning an existing system. She says sometimes the problem lies in knowing how to get the most from what you already have rather than in flawed software. "You need to have the right people with the right background to get the information out and manipulate it," she says. Her group is still happy with a system it bought in 1998. It's reliable, she says, and it produces the data they need to run their business.

"If you are not fixing the problems, you are just spending money and going through an implementation you don't need or want," Tobin warns. "When you are talking to a sales person, say, 'I want to do this, this, and this. Show me how your system does it.'"

Look for outcomes you can measure. Software vendors should be able to prove that their package will provide a cleaner flow of information, help staff input claims faster, or reduce denials or days in A/R, says Kal Patel of Meditab SoftWare in Oakland, Calif. And consider your hardware as well as your software requirements, adds Bob Bridgeman, marketing director with American Medical Software in Edwardsville, Ill. "You need to determine what existing hardware and networking can be used and what needs to be replaced. In some instances, the previous software vendor may actually own some of the hardware," Bridgeman says. Ask the hardware person with your vendor about computers, printers, scanners, and networking equipment.

MAKING THE SWITCH

Once you find a winning system, prepare for the transition. It is typically cost-prohibitive to electronically transfer your billing data from the old system to the new one. You might be able to transfer some demographic information such as patient names and addresses, but the details on each account are tough to move.

That's what Jan Recek, manager of Fremont Medical Associates in Fremont, Neb., discovered. When her practice decided to implement an EMR, her old billing program had to go. But they had to do a little work to get a new one.

"It would have cost us $5,000 to have the old system integrate with the new system. We didn't want to pay for that. So what we did was print all the patient's records out and their balances, and put them in manually."

The surgical practice had about 800 records to transfer. Over a few weeks, staff typed in all the activity on each account, with part-timers taking on more hours. Everyone pitched in. "It didn't take as long as we had thought," Recek reports.

Most billing software changes require at least some of this type of manual work. "Things are so crazy usually, people want to just push a button and make it work," Bridgeman says, but you need to expect to put in some work ahead of time.

While you are hand-entering core data for your new system, you may wish to maintain your old system for a while, running the two side-by-side. Enter all new charges into the new system, but keep your old system up for two to six months more for collections and posting on old accounts receivable.

Be sure to find out if you can run both software systems on one computer or server. They may compete with one another and make your operating system go bonkers. Consider running them on separate hardware and software for the short-term, says Bridgeman.

Have a plan in place for each step of the transition - data entry, training, and closing down the old program.

"Select a realistic go-live date to implement the new system," Bridgeman suggests. If there is no plan, everyone will get frustrated. Setting a deadline keeps everyone focused on solving problems quickly. "System conversion should generally take about 45 days," says Basil Hourani, president of Pulse Systems. "This includes converting data from the previous product (conversion programs have been written for most competing systems and versions) with multiple rounds of data scrubbing to clean up old databases and years of neglect and misuse. This involves client review and comments on each round until a clean set of data is achieved."

IT TAKES GETTING USED TO

No matter how well you plan, a new system may seem awkward at first. "Despite what you loved or hated about the old system, it's a natural tendency when you get a new system to compare it to the old system," Bridgeman says. Allow some time to pass before you start comparing and complaining.

Many billers have already been through several software shifts in their careers, so another won't surprise them. But they will be disheartened if it seems like all their efforts aren't paying off. Managers can help by explaining exactly what problems will be fixed and how - and urging patience.

"Preparing the staff is essential to a smooth and successful conversion," says Hourani. "Building staff buy-in to the concept is achieved by involving them in the decision-making process and the codeveloped implementation plan. ... Sharing with the staff previous success stories gets them excited about the new solution and actually gets them to support the change."

Recek herself only realized how good her new system was after giving it a little time. "Everything is simpler, but for a while there I tried to make it more difficult than it was." She tried to force the software to require more steps than it did. "I thought, 'It has to require more than that!'" Now, she's happy doing less.

Changing billing software may intimidate some practices, but a good shift can pay off in spades. Drake compares the process to moving from one house to another. "It's a nightmare and something has to happen to make you change ... but once it's done it's well worth it.

Pamela L. Moore, PhD, senior editor of Physicians Practice, can be reached at pmoore@physicianspractice.com.

This article originally appeared in the April 2006 issue of Physicians Practice.