Medical Billing Software Development: Steps & Key Features

Do you want to level up your healthcare service and improve the patient experience? Then, consider medical billing software development that can become a game-changer for your hospital or doctor’s office.

At the very least, automated billing solutions significantly speed up the workflow and free up time for doctors to receive patients. Case studies show that specialized software can handle claims, including posting payments and denials, in just two seconds. It is obviously faster than the manual process, which takes more than two minutes.

And at the most, medical billing software can raise the revenue of your healthcare organization. According to a recent CAQH report, automated medical processes increased the number of transitions by 28% and saved up to $22.3 billion.

As one of the leading experts in creating healthcare software, we want to disclose all the details related to building a medical billing app. Keep reading to learn its features, cost, and development steps.

We also share our experience implementing payment solutions for healthcare apps like HIPAA Telmed and MedRealtime.

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Features of Medical Billing Software

Before we dive into all the nuances of medical billing software development, let’s learn more about its features.

Medical Billing

This primary function simplifies the medical billing workflow. It allows doctors and hospital administrators to issue invoices, track payments for medical services, and quickly find the history of transactions if necessary.

Medical Coding

Correct medical codes are mandatory when invoicing patients. They denote the available services and procedures. Therefore, integrating HCPCS (Healthcare Common Procedure Coding System), CPT (Current Procedural Terminology), or other compliant code systems is integral to medical billing and coding software development.

Claims Management

This feature is crucial in claims processing to prevent financial losses. It can identify and address issues like claim denials and incorrect billing codes, providing notifications and facilitating smooth communication with relevant parties.

Insurance Verification

Insurance check is one of those medical billing software features that allows hospitals and clinics to avoid delayed payments and other issues in the billing process. Real-time eligibility (RTE) technology helps to check if the patient’s insurance is active and legal and covers the required services.

Secure Data Storage

Personal data, medical history, test results, images, and so forth are all sensitive information that must remain confidential. That's why reliable and secure data tools and technologies are a must for any healthcare software to prevent leaks and breaches. 

Reporting

Integrated intelligent analytics can generate real-time financial reports using patient data and payment history. This feature simplifies revenue cycle management, giving information on the money the hospital earns from clients and insurance companies.

Patient Data Management

Information management allows medical workers to store, organize, and change patient records if necessary. Moreover, this function opens possibilities for implementing telehealth practices in the everyday workflow.

These are the most popular functions that medical billing software can provide. However, it is up to you which features and advantages to include in your app. You know better what suits your use cases and your medical organization’s goals.

Challenges of Developing Medical Billing Software

Healthcare remains one of the most complex industries, subject to extensive regulations and compliance requirements. Thus, any software in this sphere must adhere to strict rules, standards, and security.

Due to this, let’s overview the main challenges that arise during medical billing software development. 

Data Security and Privacy

Patient data is highly sensitive and confidential. Developers need to ensure that the software complies with regulations like HIPAA (Health Insurance Portability and Accountability Act) to protect clients’ privacy and provide data security.

Integration with Any Device

Without seamless connectivity to external apps, billing software can disrupt rather than streamline medical practice processes, defeating its intended purpose. That's why providing a flexible integration interface is crucial for efficiently streamlining financial operations within EHRs and other systems.

Complexity of Medical Codes

There are five groups of medical codes: ICD-11, ICD-10-CM, ICD-10-PCS, CPT, and HCPCS. Each one includes thousands of units. Alas, no one is immune to human error, which can lead to claim rejection. However, high-quality medical coding software relies on up-to-date information and simplifies the search for correct diagnosis and procedure codes.

Data Inaccuracies

Misspelled names or incorrect birthdates can lead to numerous insurance claim rejections, causing significant revenue loss. Thus, during medical billing and coding software development, it is essential to set up automated patient billing with pre-submission checks to minimize the risk of errors and potential claim denials.

Integration with Payers

Lack of integration with different payment options may cause problems with receiving money on time. Adding the possibility to pay with PayPal, credit/debit cards, and others allows patients to settle bills for medical services conveniently and quickly.

Billing Errors

According to a recent Zelis and Hanover Research survey, 41% of patients are frustrated with the healthcarebilling process. Medical billing software can improve the customer experience with automated processes that provide accurate data and codes.

7 Steps to Medical Billing Software Development

By now, you have already learned about the medical billing software features. So, let's move on to how to make medical billing software properly and of high quality.

1. Requirements Gathering

Each development process starts with a detailed analysis of the client’s needs and expectations. Interviews with stakeholders and administrators help the development team understand the organization’s workflow, challenges, and goals.

During such meetings, clients also share their medical billing software requirements, such as:

• Functions the billing app should provide
• Regulations and compliance standards the app should adhere to
• Integration needs with external systems and devices
• User roles and permissions
• Workload the billing app should handle
• Desktop and mobile versions availability
• Interface suggestions and others.

This stage helps the development team define the scope and functionality of the custom medical billing software accurately. So, it is crucial to ensure open communication, provide as many details as possible, and ask questions.

According to a recent CAQH report, automated medical processes increased the number of transitions by 28% and saved up to $22.3 billion

2. Design and Architecture

After receiving all the necessary information, the development team starts working on the design and architecture. Medical billing software development may include the following steps at this stage:

• Designing the user-friendly interface concept that medical workers will interact with
• Mapping out the step-by-step processes involved in medical billing, from patient registration to claim submission and payment processing
• Deciding how to store and organize information within the software's database
• Determining how the billing software will integrate with other healthcare systems
• Designing security measures to protect patient data and financial information. 

3. Development

The development stage is a crucial phase where the actual software is built based on the previously gathered requirements and the designed architecture. It consists of several substages that we will describe below.

The time it takes to develop the software varies depending on its complexity and the features required. This process is divided into two-week sprints. Each one covers a specific task, which allows developers to complete it efficiently. Before the start of the new sprint, the team discusses the goals of the upcoming work with the customer.

Now, let’s learn about the development substages in detail.

3.1. Coding and Implementation

During this phase, developers write the code that turns the design and architecture into actual working software.

The tech stack used to create medical billing software can include the following:

• Back-end: Node.js, Python (with frameworks like Django or Flask), Ruby on Rails, or Java (with Spring Framework)
• Front-end: HTML5, CSS, JavaScript, React, Angular, Vue.js
• Databases: PostgreSQL, MySQL, Microsoft SQL
• Security: Encryption, including SSL/TLS
• Cloud services: AWS, Azure, Google Cloud.

3.2. Integration

Integration with healthcare systems and services is critical to guaranteeing proper software work in medical billing solutions. The development team should set up connections with the following:

• Electronic Health Record (EHR)
• Insurance providers
• Payment services
• Medical coding systems
• Electronic Data Interchange (EDI)
• Revenue Cycle Management (RCM).

3.3. Regulatory Compliance

As mentioned, healthcare is a complex sphere subjected to extensive regulations. That's why following and monitoring compliance requirements during development is crucial.

The healthcare regulations to follow depend on the region—for example, HIPAA in the USA, IVDR, MDR, GDPR in Europe, etc. 

4. Testing

Testing is an integral part of creating a high-quality product. QA engineers usually conduct testing and checks in each sprint. They detect medical billing software issues and prepare detailed reports that help developers fix problems quickly.

During medical billing software development, QA engineers also check whether the app complies with HIPAA and other obligatory regulations.

For testing software for billing solutions, QA engineers may use tools such as JUnit, Selenium, Cypress, Appium, etc. 

5. Documentation

The development team prepares written materials, resources, and records that provide comprehensive information about the software's features, functionalities, usage, configuration, and other vital details.

Some types of documentation for medical billing software include the following:

• User manuals
• Administrator guides
• Installation and setup guides
• Integration documentation
• Training materials.

6. Deployment

When the product is ready, it is vital to properly prepare the environment and install and configure software. If the medical billing app replaces an existing service, you need to migrate data from the old system to the new one.

The deployment stage also includes user training, where doctors and medical workers learn how to use the software effectively.

7. Maintenance and Updates

This stage can last indefinitely or as long as you use the software. It is important to stay in touch with the development and support team so that they can always make improvements to the product. After all, while using the app, you may notice something you have not thought about during development.

Moreover, since healthcare regulations and standards tend to change periodically, it is vital to update medical billing software accordingly. 

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How Much Does It Cost to Make Medical Billing Software

Medical billing and coding software cost depends on many factors. We can point out the number of functions, level of customization, delivery time, team location, and more.

To understand the approximate price, let’s find out what IT specialists you need and how much you need to pay for their work. The following table contains data on average rates within Europe and the USA.

Team member	Rate per hour
Project manager	$60-$80
Developers	$80-$100
UI/UX designer	$70-$90
QA engineer	$50-$70
DevOps	$90-$120
Technical writer	$30-$40
Business analyst	$70-$80

Sources: Indeed, Upwork, Clutch

Now, we can calculate the cost of medical billing software development per stage. Let’s take the average time for each one.

Stage	Time	Cost
Discovery and UI/UX design	280 hours	$11 200
Architecture and development	640 hours	$25 600
Testing	240 hours	$9 600
Technical documentation & Product Launch	40 hours	$1 600
Total:	1200 hours (6-7 months)	$48 000

Thus, the approximate medical billing and coding software cost is about $50 000. However, if you want to get a more accurate price, contact our team for a free quote.

Softermii Experience

Softermii is a trustworthy company with solid experience developing software for the healthcare sector. To avoid being unfounded, we want to introduce some medical apps our professional team has recently created.

HIPAA Telmed

HIPAA Telmed is a web-based app that allows doctors to conduct high-quality video conferences with patients. Besides video and audio calls, it boasts the following functions:

• Appointment management
• Screen and document sharing
• Electronic Health Records
• Payments for consultation online.

Our development team used and improved WebRTC technology to meet all the client’s needs. We also implemented TSL, TDL, and Role-based Authorization for login to ensure high-level security of sensitive data.

MedRealtime

MedRealtime is a state-of-the-art medical app providing web and mHealth booking & telecommunication platforms. Some of its core features include:

• HD-video conference and messenger
• Online and offline appointment booking
• Secure payments gateway
• Real-time synchronization with other internal office solutions.

NAT, Firewall, and encryption provide reliable data protection. The HTTPS protocol ensures a confidential way of sending patients’ information within the EHR networks. 

Conclusion

Medical billing software can enhance health services, streamline workflows, and boost revenues. Its core features, such as invoicing, claims, and personal data management, prevent payment delays and simplify the billing processes.

However, it’s crucial to implement integration with EHR systems and follow all healthcare regulations and standards.

If you need more details about medical billing software, feel free to contact our team. Softermii boasts vast experience in creating cutting-edge medical software. Our team includes 105 developers and 11 QA engineers. We follow all relevant security protocols and analyze industry trends to come up with the best solutions for our client’s needs.

Level up your healthcare service and improve the patient experience with medical billing software development