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Medical Billing Software Alternatives? 40

Posted by Cliff from the displeased-with-proprietary-specialized-software dept.
irwinr12 asks: "Well, I've spent hours and hours and hours scouring though pages of google search results, trying to find a medical billing software package that will run on Linux. (Or Solaris or even Mac OS X for that matter) I've come out pretty much empty handed. Perhaps I'm just not looking in the right places, or perhaps such software does not exist yet? I ask this, because we are currently using MediSoft on Windows 98. We are very displeased with the service from medisoft, and the instability of Windows(MediSoft is partly to blame too) is costing us alot of money in downtime. We are a fairly small billing office, only billing for 5 doctors at this time, so some of the large 'hospital' billing systems want much more than we can afford for such a small operation. If anyone could send any information my way, i'd appreciate it." We did a similar story on Ask Slashdot over 3 years ago with very little in the way of definitive answers. Has the intervening time made any difference in the answers?
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Medical Billing Software Alternatives? More

Medical Billing Software Alternatives?

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  • Look at sumtime for mac.
    Although it may be only for mental health users.

    My parents have been using this for a few years on OS 7 and OS 9.
    sumtime [sumtime.com]
  • This sounds like an ideal place to apply some classic code reuse software engineering principles.

    What you are looking for may be a medical billing program. But note that a medical billing program "is a" billing program. Are there any billing programs out there for any of your target platforms?

    If you have a handful of developers, or even one, throw them at one of the general billing programs that are already out there. This is what open source is all about.

    You might also want to look into general DBMS's, as this seems like the kind of important data you'd want to take care of. It wouldn't take too much effort to throw a custom GUI and printing interface over a MySQL or PostgreSQL backend.

    • You know, just the other day I saw an unemployed open source programmer by the side of the road holding a sign that said "Will Program for Prescriptions"

    • Re:ripe opportunity for some OOP (Score:5, Informative)

      by foobar104 ( 206452 ) on Tuesday April 30, 2002 @04:55PM (#3438366) Journal
      But note that a medical billing program "is a" billing program

      No, it's much more. Medical coding and billing is a science in and of itself; they write textbooks on the subject. It's not practical to talk about adapting a general-purpose accounts receivable tool to use in health care.

      It wouldn't take too much effort to throw a custom GUI and printing interface over a MySQL or PostgreSQL backend.

      It's pretty clear that you don't know what you're talking about here. Just implementing an integrity checking scheme for the tens of thousands of medical codes would be a monumental effort. And that's just the very beginning.

      I'm sorry that I don't have anything positive to say. I just didn't feel right about letting this kind of misinformation get out there unchallenged.
      • I'm sorry that I don't have anything positive to say. I just didn't feel right about letting this kind of misinformation get out there unchallenged.

        You're being a little too harsh. I agree that the mentality of "Oh, throw some PHP and MySQL at it" is unrealistic-- even idiotic, at best-- but medical billing is not "rocket science", from a programming standpoint.

        (I've worked "integrating" medical, dental, and eyecare billing software into many practices. It's just software. If anything, it's software that actually DOES very little.)

        The hardest part I've seen, from the standpoint of watching Medisoft and others modify their software (over and over and over and over) appears to be getting the software to work flexibly enough so that offices "entrenched" in their antique "paper-based processes" are able to function with some degree of efficiency.

        Have you ever looked at the drivel that passes for billing software for small offices? All of Medisoft's DOS versions were just flat-file ASCII! Their new "client server" 'doze versions are based on the Extended Systems "Advantage" database engine-- but it's still not that complicated. I haven't seen a package for the dental or optometric field that's much more complicated (albeit most of those apps bring charting into the mix, too).

        For a small office, the "technology" isn't the issue. I would agree with your statement that medical billing is a "science in and of itself"-- if only because it's been made that way by idiotic regulation and the insurance industry-- but those are problems that need to be solved by a human operator-- not by a software application. The software part of the job just isn't that big of a deal in a small office. (Hospitals, very large practices-- there's a difference there).

        Some of this is probably my angst built-up from actually working with people who administer and operate billing and coding operations. I've met people that were, effectively, trained chimps with a certificate from a community college that could just assure me that I couldn't possibly grasp the science that is medical billing-- as though it's simply beyond the capability of mortal men to understand. It doesn't, however, seem to be beyond the capability of middle-aged fat women in flowery gowns and white shoes.

        (It's times like these that a good ol' "salt the earth" Free software project sounds like such fun!)

        • (It's times like these that a good ol' "salt the earth" Free software project sounds like such fun!)

          Er... did you mean "salt the earth" or "salt of the earth?"

          Judges 9, verse 45: "And Abimelech fought against the city all that day; and he took the city, and slew the people that was therein, and beat down the city, and sowed it with salt."
    • actually, medical billing really is a whole 'nother ballgame... Its not a matter of coding hours or something like that. there is all kind of bureaucracy involved, between government regs, insurance approval, pre-approval, etc... that's why medical billing programs are so expensive. there's a veritable minefield of regulations to put up with.
    • There are other replies which point out existing med software, but if you want to write something you don't have to start at the raw SQL DB level.

      SQL-Ledger [sql-ledger.org] is open Perl Web acctg software using PostgreSQL (or other transaction DB).

      It doesn't have much for billing, but at least it has some accounting components to build on.


  • It's an invented, contrived category. The proper solution is a flexible, extensible generic financial system, which could apply itself to Medical Billing among many other things. You might ahve better luck searching for open source billing/financial software than "medical billing" and modifying it to taste.
    • The proper solution is a flexible, extensible generic financial system, which could apply itself to Medical Billing among many other things.

      Generic financial systems do not recognize concepts, such as "spleen", which are essential to the field of Medical Billing.


      • They also don't explicitly recognize any of the other myriad technical terms from hundreds of other special fields. The essential problems being programmed for in Medical Billing probably share 99% with those encountered in Random_Industry_X billing. There's no reason one can't write sufficiently extensible and flexible generic financial software.
        • I was being sarcastic, forgot the

          :)

          sorry. So, yes, I actually agree with you. Responses to this post of mine [slashdot.org] seemed adamant that Medical Billing is indeed different from normal billing, due to regulations and insurance and so forth.

          I would argue, as I believe so might you, that these types of issues due effect more than the medical industry, and that any sufficiently flexible financial system should be designed in such a way that it can be adapted to Medical Billing.

          What I suspect is that the construction of such a system, while technically feasible, may require so much legal advice to get all of the rules correct that a free implementation is not realistic.

          Not to mention, in the litigious health care industry, folks might shy away from a system whose README features "Disclaimer: IANAL"...

        • Except that by the time the rules are written, you have a special packages. Those with general accounting programs, rather than develop rulesets for docs (which vary by state), they develop, or at least market as, a separate program.

  • We did a similar story on Ask Slashdot over 3 years ago with very little in the way of definitive answers.

    You don't say.

  • The Medical Manager (Score:5, Informative)

    by Llama Keeper ( 7984 ) on Tuesday April 30, 2002 @05:04PM (#3438434) Homepage
    There is a company here [medicalmanager.com] that has a medical billing platform that runs on SCO Unux and they have successfully ported it to Linux. My company uses it exclusively for billing our clients (we are a billing office). The server has a windows client that is really just a glorified terminal emulator. I have used dumb terminals to connect to it as well. Its a very robust platform and their support is pretty good. The only problem is that it is, as most of these apps are, quite expensive.
    • My company uses Medical Manager as well. I'm not too familiar with the feature sets, but am with the operational issues.

      It runs on a 'customized' C-Tree 'database'. C-Tree is probably fine as is, but their customizations don't appear to have improved performance -- quite the opposite.

      We run a _really_ big shop, our database is about 13GB and growing, but running a purge of old data took well over a week (of exclusive 'no one else can access the system' type access). Their tech support is mostly clueless requiring global 777 file permissions, direct dial-in to the machine, and root access.

      I suspect it would work fine for a smaller shop, but beware if you have a lot of offices to deal with. If they claim a particular machine is about double what you'd need to run their app, quadruple the performance of that machine and you'll be in good shape. Biggest problem is disk I/O -- we are seriously considering a 20GB RAM drive to improve performance -- it's that bad when it gets big.

      Final note of warning about medical manager is HIPAA -- they don't do it, or at least it sounds like they are not going to upgrade the medical manager system to directly support the various HIPAA-approved transaction formats such as the '837'. Instead they offer themselves as a clearinghouse service and charge $0.50 give or take per claim to do all of the necessary HIPAA translation. In itself, this is a good way to extract more revenue from existing customers, but I would see it as a warning sign to new customers.

      Good luck.
  • From what I've heard, high-test medical software runs on mainframe-type machines. You may need to go with something from IBM, just because that is the platform the software is designed for. Medical computing is old enough that its roots really are in the mainframe era, not the relatively new UNIX/Linux era. Keep in mind that you won't need a big mainframe, just a desk-side model.

    Also, I don't know if it was MediSoft, but I knew someone who worked with a Windows based billing program at one time--and hated it. It was down more than once every day; the the lost productivity probably made it much much more expensive than just shelling out the cash for a real mainframe. Just think of it, a whole medical lab stopped in its tracks while one person argues with tech support over the phone. Terrible.

  • I don't remember its name, but a while back I saw a freshmeat posting for free software that helped to run a veterinary clinic. I think it handled scheduling and perhaps simple billing.

    But other posters are correct: a general MySQL database really needs a lot of work to hone it into something that front office people can use productively.

    I've seen my dentist's office use some kind of Windows based software that nicely integrates patient records (show teeth and point out cavities, X-ray images), examination records, appointments, billings, sending out reminders of appointments, helping to concoct the right insurance claim submission. Very impressive.

  • try http://www.freemed.org

    It utilizes apache, php, and has a light html frontend. That about fits the bill.
  • I have no use for it at all, but did an apt-cache show odontolinux [debian.org] and it might be worth investigating. Vaguely related to the medical field, etc. And if you can't find Free (libre) software to do what you want, you can invest money or pay some coders to write it for you.

    --Robert

  • The Physician's Computer Company (Score:4, Informative)

    by maggard ( 5579 ) <michael@michaelmaggard.com> on Tuesday April 30, 2002 @07:04PM (#3439135) Homepage Journal
    Disclaimer: I know one of the principals.

    Check out The Physician's Computer Company [pcc.com]. They've been around 18 years, run on Red Hat (they handle it all for you), specialize in smallish offices like yours, having met some of the staff socially they're folks I'd like to do business with.

  • I ask this, because we are currently using MediSoft on Windows 98. We are very displeased with the service from medisoft, and the instability of Windows(MediSoft is partly to blame too) is costing us alot of money in downtime. When it comes to my health (or life), I wouldn't depend on a system that is known to bluescreen. Receptionist: Well, until we can finish reformatting our system, we cannot bill your Insurance, so you must pay your bill in full today!
  • MacCentral has run a bunch of Forward Migration Kits for different industries. They ran one about medical management software about two years ago -- kinda dated, but it should give you a starting point:

    Part 1 [macworld.com]
    Part 2 [macworld.com]
    Part 3 [macworld.com]
    Part 4 [macworld.com]
    Part 5 [macworld.com]

    --Paul
  • if you find something, let me know. this medical billing is a real nightmare. i'm a physican, and have been out of residency for a few years. it's frustrating to find out how things work out in the real world.

    for example, lets say i see a patient in the office, diagnose a problem, perform surgery, and follow up post operatively. i then submit a bill to the insurance company. they look at it, and will say my services were worth 1/2 of what i billed for, so here's the money.

    i can also be sent to jail if i UNDERBILL the federal goverment. congress can also get a bug up there rear end, and change the medicare/medicaid laws, and retroactively audit your records with the new laws. you could have been within bounds with the older law, and could go to jail with the new laws.

    mean while, i have my rent, and staff to pay. i've hired a person just to take care of my billing. nothing to do with medicine at all. my malpractice premium is doubling at the end of next month too. of course, the student loans are pending.

    (seriously, if there is anyone out there thinking about medicine... think really hard. i love taking care of my patients, but the business side really sucks.)

    the tough part of medical billing is to somehow distill the information in a medical record and provide the appropriate code to the insurance companies. medical records are now a financial document, rather than a medical or legal document.

    of course, i thing the insurance companies want it to be confusing so they can milk every penny from both provider and patient. until that gets fixed, i see no solution.
    • What is your specialty? Doc who reads slashdot? Looking for a job? Contact via email:)

      I didn't become a doc for similar reasons (medical business displaces medical practice). So what do I do now? Run the business end of a medical practice:)

      I'm glad you noticed that it is just as illegal to underbill as overbill. We had a few docs (now gone, thank goodness) who thought they were safe by underbilling. Right now, I think we have a decent bell-curve distribution of level 1,2,3,4, and 5 visits. Pediatrics is shifted a little high, but those people write so damned much, an audit wouldn't be too bad.

      And yes, insurance companies are serious bastards. They deny a certain number of claims out of hand. In a batch (if you submit electronically) an average of 5% are automatically bounced, sometimes for flagrantly false reasons (ie, bad DOB. The system won't let us enter a patient without one. You got the freakin' DOB Aetna, piss off)

      If you're not too entrenched, may want to try doing one of those things out west. Visiting reservations and the like. Potentially more rewarding with less hassle than urban/suburban practices.

      • heh.... i'm actually very farwest, at the edge of the oregon coast. belive me, we have our share of the less fortunate.
        i was idealistic a few years ago and created an ob database using postgresql/php with a web frontend. i even presented it as a poster at a national conference and offered to "GPL" it. no response from anyone important, of course. i've come to realize that medical record part isn't nearly as hard as the billing part.
        i do sound bitter, but i still enjoy delivering babies. sigh, i wish that's all i had to concentrate on.
    • (Disclaimer: this is shameless self-plug)

      Why bother doing it yourself at all? It's a nightmare. Let somebody else do it for you.

      As per another poster, I would check out AthenaHealth.com [athenahealth.com]. We aren't just a billing system, but more of a practice-management system. We have been working on alleviating frustrations exactly like the ones mentioned above--and we've been succeeding, by most accounts.

      Medical billing really is a complex mess. It's true that it's not rocket-science for programmers mathematically, but the problem is that the regulations you have to adhere to as a practice have far more exceptions than rules. You are not going to just "slap a GUI over a RDBMS", since it would take decades of man-years just to sort through the details, and at the end, you'd have to have a whole team of programmers to keep it consistent with all the changing laws and Insurance policies.

      AthenaHealth is a web-based _service_ that aims to help doctors spend their time with patients instead of with computers. We do code-checking, payment-posting, and even can generate detailed reports that you can drill down into to nearly any level of detail you like, so you can actually see what is happening to your money. We do the work of keeping abreast of all the changing rules so our clients don't have to.

      Anyway, I could sing our own praises for hours, but that would look silly. Instead, if you are looking for a better way to manage medical billing, check out AthenaHealth, and see if we fit your needs.

      --Georgi

  • We used Medisoft--the Client/Server version (with 5 workstations and 1 server), and run it under Windows 2000 on all the PC's. This combination is very stable. Windows 95/98 is one of the major reasons for instabilities. The file sharing version of Medisoft is also not as stable as the client/server version.

  • &nbsp&nbsp&nbsp&nbsp&nbsp You can find an enormous amount of open-source, medical software at the VISTA and Hard Hats site [hardhats.org]. Some of the software [hardhats.org] apparently pertains to billing (see "integrated billing," about half-way down the page), but I cannot attest as to its quality or applicability to your needs.

    Nearly all of the VISTA software is written in the Mumps programming language, with which comparatively few programmers are familiar these days (that's my impression -- I could be wrong).

  • They're a company [lowescomputer.com] based out of Louisville, KY. I have a friend who works there. The software's pretty good from what I understand -- however, my view could be a bit biased. Call (800)542-0594 and talk to someone there.
  • The medical billing chunk of my company has grown over the years. We have developed a custom application with a Java front end and a Perl backend running on top of MySQL. The Java client provides progress note view and entry, treatment plan, prior authorization, patient chart, electronic billing, rebilling, etc for both online and offline mode. We were very careful to make sure all communication and even the offline data file is strongly encrypted. I know I wouldn't want MY medical data floating around the internet in the clear.

    James

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