Healthcare Software

Written by Kimberly Clark
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The healthcare industry is a booming business. In fact, this sector of the American economy is growing faster than almost any other. Not surprisingly though, the predicted growth within the healthcare industry is expected to be outpaced by the rise in demand for software publishing companies and technical consulting firms.

These quickly expanding markets are a perfectly matched mix when you stop to consider all the federal regulations pushing for electronic claims processing. In addition, the rulings are seeking to standardize the set of medical codes used to prepare and transmit healthcare claims. Finally healthcare providers have to implement certain privacy and security procedures to protect the integrity of their patients' medical information.

Working with HIPAA Regulations

The laws primarily dictating how the healthcare industry prepares and files a claims can are outlined in HIPAA. HIPAA stands for the Health Insurance Portability & Accountability Act of 1996. Within that ruling are specifications, which clearly define how medical claims are to be submitted.

With that in mind, the enterprising software industry has developed several HIPAA-compliant software packages to help the healthcare industry meet their regulatory challenges. Some of the more widely used healthcare software products are those that facilitate the healthcare providers' billing, claims auditing, document management, and patient care activities.

Billing software is encoded with all the codes the healthcare provider needs to properly prepare and electronically transmit a healthcare claim. There are currently over 400 proprietary diagnosis and procedural codes in use by various software vendors, providers, and healthcare plans and insurance companies ("payers"). A good billing software program would have a system in place to handle these legacy codes, while also ensuring that they get automatically updated to the legally compliant format.

Other Types of Healthcare Software

Unfortunately, the buck does not stop nor begin with sending the payer the claim, thus claims auditing software was developed to track the status of a claim. The software alerts the user when the payer has received the claim. It also notifies them if the claim has been accepted and when they can expect payment, or if the claim has been denied.

The amount of paper the healthcare industry has to contend with is enormous. What's more, the government has mandated that access to information regarding patient care have be severely limited and protected from inappropriate use. However, using document management software in their facilities allows the providers to securely store all their medical records in one place.

Patient care software is an invaluable tool for healthcare providers. It allows the physician to instantaneously access everything regarding their patients' care. With a click of a button, the doctor is now able to view things like family medical history, preexisting conditions and the current medications the patient is taken.

Healthcare Software for Consumers

Healthcare software is also heavily marketed to consumers as a low-cost, easy to start up, home-based business. The responsibility then falls on the budding entrepreneur to locate doctors or other healthcare providers that are willing to outsource their billing and claims management to them. However, most providers decide to either purchase commercial software for use by their in-house staff or they contract their business out to large firms that specialize in managing the administrative tasks of healthcare facilities.


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