Billing for medical services is an integral part of every health care practice.
Yet for many practices, in-house billing is cumbersome. Practices with a smaller staff often consider outsourcing this key task. They turn to medical billing services or revenue cycle management (RCM) services to fulfill this need.
The 8 Best Medical Billing Services
- AdvancedMD
- AthenaCollector
- CareCloud
- Cerner
- CureMD
- DrChrono
- Human Medical
- Kareo
Effective billing is crucial to the financial stability of any medical practice. Medical billing services simplify the way healthcare providers submit claims to insurance companies.
The best medical billing services facilitate accurate and timely claims to insurance providers. By following the unique rules of each insurance company, it increases the chances that you’ll receive prompt and full payments. This ensures your practice will have adequate cash flow for operations.
Medical billing services also handle patient billing in addition to insurance billing. So you can appropriately collect the patient’s portion of the bill—without the burden falling on your office staff.
Everything is handled with the utmost care and accuracy. So you won’t have to worry about mistakes related to poor recordkeeping that could forfeit the revenue.
After extensive research, our team here at Quick Sprout has narrowed down the eight best medical billing services on the market today:
AdvancedMD
For medical practices that want the highest possible success with insurance claims on the first pass, AdvancedMD is a strong performer.
At 95%, it guarantees to deliver one of the highest percentages of success on initial claims submission in the industry. They also tout that they can exceed that number in real-world conditions.
The interface is straightforward and provides you with everything you need to make billing and invoicing simple and headache free.
AdvancedMD has an EMR system that you can use too, which helps with billing accuracy. However, the service does not initially code the claims, so you’ll have to do this part in-house.
Pros
- Extremely high first pass success rate
- Will search your claims for coding errors
- Works with denied claims for you
- Works with all sizes and types of practices
Cons
- Does not do the initial coding, so you’ll need an in-house certified coder
- Has some extra fees
AthenaCollector
AthenaCollector helps your staff handle the majority of the billing process with guidance.
It’s primarily an automated medical billing service that attempts to catch errors that your staff may make during the billing process.
It’s also incredibly easy to use. That means once you set it up, you can get started immediately.
Because AthenaCollector only has a 90-day minimum contract, you can try this RCM service to see if it fits your needs without a major commitment.
Pros
- Extremely easy to use
- Designed to help your in-house service
- Shorter than average minimum contract length
- Price point is a bit below average
Cons
- Not made for those who want a complete third-party billing service
- First pass success rate in claims is a bit lower than others
CareCloud
CareCloud is a solid choice when it comes to medical billing solution.
Where they really shine is how they tailor their pricing tiers to match your practice. It’s not one-size-fits-all. CareCloud adjusts its billing based on the complexity and frequency of your claims.
With CareCloud, you’ll receive a below average percentage cost, based on your monthly billing amount, but you will have to pay some hefty startup fees.
If you want to match your EMR software with your biller, CareCloud offers a strong EMR system.
Pros
- Multiple pricing tiers with competitive overall pricing
- Has a strong matching EMR system
- Offers a minimum contract length of one year
- Excellent coding results
Cons
- Startup fees are high for new clients
- Requires a minimum monthly guarantee
Cerner
Cerner is a great billing service for handling complex billing needs. It’s way more than a small practice needs, but hospitals and larger organizations will appreciate a system that is robust enough to adapt to their needs.
Some serious training is going to be required on the backend for administrators, as well as for staff.
Once you learn the ropes, Cerner is great for handling the entirety of the billing process from start to finish, including resubmissions of denied claims and account collections from patients.
You will get complete visibility into every part of your revenue cycle. Identify bottlenecks, breakdowns, find places to improve your patient experience, and make the day-to-day easier on your administrators.
Due to its complexity and the scope of their coverage, we highly recommend Cerner for companies that have outgrown simpler medical billing solutions.
Pros
- Multiple advanced features for large practices
- Handles all aspects of billing
- Will manage patient account collections for you
- Once you figure out how to use it efficiently, this is an impressive service
Cons
- Higher than average pricing
- Training process is long and involved
- Customer service has hit and miss results
CureMD
Are you a small practice that wants to use a medical billing service without shelling out a significant upfront investment? CureMD is the pick.
They offer a first pass success rate for claims at up to 98%, which is one of the highest in the industry. CureMD also handles all aspects of the billing and claims process, including generating codes, so it’s a full service option.
CureMD excels at generating helpful reports too.
Pros
- Low initial price for basic service
- Geared toward small practices
- No minimum contract requirement
- Very high first pass success rate on claims
Cons
- Has multiple add-on fees, depending on the level of service you need
- Will not support some uncommon specialty areas
DrChrono
DrChrono offers a full-service system. It includes EMR, practice management, and billing services that’s perfect for smaller practices.
(Note: You cannot be a DrChrono customer for medical billing services unless you also use its EMR software package.)
DrChrono claims a first pass success rate on insurance claims of up to 97%, which is extremely strong. This billing service delivers full service to its clients, regardless of size, including generating the codes for you.
Pros
- Geared toward both general practices and specialty providers
- Works with small practices with no minimum monthly guarantee
- Will handle the claims submission process from start to finish
- Offers a high percentage of success on first pass of insurance claims
Cons
- Must be a DrChrono EMR software client
- May not work as well for larger practices
Human Medical
Human Medical is an excellent choice if you’re looking for personalized, custom service. It is not a large company, but its customer service is strong. It is willing to work with its clients to come up with the best solution.
Human Medical does not offer other types of software, so it’s a nice choice for practices that already have EMR and practice management software in place and do not want to change vendors.
Its percentage charges are higher than average, so you will pay a bit extra for the flexibility you receive.
Pros
- Highly flexible service
- Handles all aspects of the claim generation process, including coding
- Great for smaller practices
- Very good customer service
Cons
- Has no EMR or practice management software option
- Percentage fees are a bit higher than average
Kareo
Current customers of Kareo EMR and practice management software will definitely want to use them for medical billing. You’ll receive an excellent price on the Kareo medical billing service.
Kareo gives you flexibility in how you use its billing services, as it can handle the entire billing process from start to finish, or it can handle any single segment of the billing service. It also handles resubmissions as required.
You will have to pay a setup fee and a monthly minimum with Kareo, but these amounts are reasonable versus some others.
Pros
- Competitive pricing
- Handles all aspects of medical billing, if desired
- Works with resubmissions
- Nice level of training options
Cons
- Must use Kareo’s EMR and practice management software
- Some questions about its customer service reliability
How to Choose The Best Medical Billing Service For You
Finding the right service for you can be tricky (to say the least).
Luckily, we can help.
Below is the exact methodology we used when determining our list. Use it for your own research process too.
Price
Cost is a significant differentiator among RCM services. As a start, the majority of medical billing services will charge you a percentage of the revenue they run through the billing process. Around 6% is average, but some RCMs charge as much as 9% or 10%.
But price isn’t the only factor. You also need to fully understand how the biller calculates the percentage. In addition to the amount of the insurance claims the RCM runs for you, the amount on which the RCM bases the percentage also may include:
- Any clearinghouse fees you pay
- Any copays you collect before the appointment
The RCM may charge you additional fees for extra features, such as the total number of claims you file per month and the number of different insurers you use. Be certain you fully understand the service’s fee structure before signing any contract.
The RCM also may have a minimum amount it will charge you each month. If you are a small practice that doesn’t generate enough claims to reach this minimum amount, it will end up costing you quite a bit more than a straight percentage vendor.
Contract
The medical billing service likely will want you to agree to some sort of contract length before it takes on your practice as a client. This is a common occurrence among RCMs.
A minimum contract length will be one year, but you often find billers that want you to sign up for a two- or three-year contract. Some even use five-year contracts. You can try to negotiate shorter contract periods, but success rates are hit and miss.
The good news with a contract is you will know what your costs will be for the length of the contract. The biller shouldn’t change the billing rate on a whim during the contract period.
Pay attention to any fees and penalties you must pay if you want to cancel the contract early. Should the medical billing service fail to meet the guidelines for performance spelled out in the contract, make sure the contract allows you to cancel the service without penalty.
If you need a particular service that might not be part of the company’s normal services, you should make sure that the guarantee of this extra service is part of your contract. Don’t just take a customer service representative’s word that you will receive the extra service.
Once you have a contract in hand, you likely will want to have your legal team or legal representative review the contract on your behalf.
Most of the time, any contract the medical billing service provides to you should be straight forward. However, you don’t want to sign a legally binding contract that misrepresents how you believe the relationship will work.
Guarantees on Coding
If you find a low priced medical billing service, it may be because the service expects you to take care of the initial coding on insurance claims. Using proper coding is a significant part of filing insurance claims properly, and incorrect coding leads to rejected claims. You’ll want a medical billing service that is able to achieve successful claim submissions at a high percentage the first time, which reduces delays in receiving payments.
If your practice struggles with making coding errors, you may want to find a medical billing service that handles all of the coding for you. Be certain that the service hires only certified coders, ensuring you receive the most accurate possible results.
The service needs to be able to handle the ICD-10 coding system, which most can. (And it should have plans in place for how it will migrate to ICD-11 after this system’s adoption in the near future.)
If you have someone on staff who has success with generating insurance coding, you probably can save some money with a medical billing service by generating the codes yourself.
Managing Denials
When selecting the best medical billing service, figure out how the RCM handles claims that the insurance company denies. Will the billing service fix and resubmit any denied claims?
Some services will not resubmit a claim if the mistake occurred on your end, not without charging you an additional fee. Others will fix everything as part of your base price, regardless of where the mistake originated.
Working With Specialties
If you engage in an area of specialty at your practice, your insurance coding can be a challenge. Before picking a medical billing service, make sure it has the ability to handle your specialty needs, especially if they generate some uncommon insurance billing codes.
Working With Your Software System
For the smoothest possible integration of your billing needs, look for an RCM that is able to connect with your EMR system. If the medical billing service can pull the necessary data directly from your system, this will reduce errors in submitting claims.
Some medical billing services have their own EMR and practice management systems. If you match the biller to the software you’re already using, it can deliver the maximum efficiency for your medical practice. In fact, some billers only will accept you as a client if you use the biller’s EMR and practice management software.
Additionally, the service also may be able to generate reports about the way your medical practice is operating, passing them directly into your practice management software. This helps you see which areas of your billing process may be hindering your practice’s growth and bottom line financials.
Working With Patients
Some medical billing services will be able to handle all aspects of billing, including working with patients on their accounts.
The service may take a variety of items off your plate, including:
- Sending statements directly to patients
- Monitoring the progress of patients making payments on a balance
- Working out a payment plan
- Turning over unpaid accounts to collections
- Operating a patient portal where patients can make payments on account balances
Understand that some medical billing services will charge you extra for these patient management options, while others include them in the monthly percentage fee you pay.
Privacy Guarantees
It is vital that any medical billing service is able to follow all HIPAA rules and guidelines. As the service will be handling sensitive patient data, it must have a process in place to guarantee the safety of the information.
If you are working with an American-based company, you’ll have a better chance of receiving HIPAA compliance than if you’re using a foreign-based company.
Customer Support
Make sure the medical billing service you select allows you to contact it using the method you prefer, whether that is via email, telephone, or live messaging.
Some services offer customer support 24 hours a day and seven days a week, while others only offer support during normal business hours.
The Top Medical Billing Services in Summary
Doing medical billing properly does take significant time. You may not have the staff available to handle this key task.
The best medical billing services will give you excellent and reliable results. These services keep you on track with your revenue stream and ensure you don’t fall behind on billing. When it’s done right, the only thing you and your patients have to think about is the copay.
As an AI with expertise in a wide range of topics, including medical billing and revenue cycle management (RCM), I can provide a comprehensive breakdown and analysis of the concepts and services mentioned in the article.
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Medical Billing Services and Revenue Cycle Management (RCM):
- Medical Billing Services: These are specialized companies that manage healthcare billing, ensuring that claims to insurance companies are submitted accurately and efficiently. They often use sophisticated software to handle the complex billing codes and regulations.
- Revenue Cycle Management (RCM): This is a broader term that encompasses the entire financial process of a healthcare facility, from patient appointment scheduling to final payment of a balance. RCM services include medical billing but also involve other aspects like insurance verification, charge capture, and claim submission.
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Medical Billing Process:
- The process involves submitting and following up on claims with health insurance companies to receive payment for services rendered by healthcare providers. This process involves several steps, including patient registration, insurance verification, service documentation, coding claims, claim submission, payment posting, and accounts receivable follow-up.
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Coding and Claims Submission:
- Accurate coding is crucial in the medical billing process. Codes represent the diagnosis and the procedure performed. The International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes are standard in the industry. Proper coding ensures that claims are not rejected by insurance companies.
- First-pass success rate refers to the percentage of claims paid on the first submission, indicating the effectiveness of a billing service in coding and submitting claims correctly.
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Integration with Electronic Medical Records (EMR) and Practice Management Software:
- Many medical billing services offer integration with EMR and practice management systems, which streamlines data flow and reduces errors. This integration allows for seamless transfer of patient data and billing information, improving efficiency and accuracy.
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Contract and Pricing Structure:
- Billing services often require a contract with healthcare providers. Understanding the contract length, termination clauses, and any associated fees is important.
- Pricing is typically based on a percentage of the revenue collected, although this can vary based on the service level and practice size. Additional fees may apply for other services like patient billing and reporting.
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Handling Denials and Resubmissions:
- Efficient handling of denied claims is a crucial aspect of medical billing services. Some services offer to rework and resubmit denied claims, often at no extra cost, while others may charge additional fees.
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HIPAA Compliance and Privacy:
- Compliance with the Health Insurance Portability and Accountability Act (HIPAA) is mandatory for any medical billing service to ensure the privacy and security of patient information.
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Specialization and Customization:
- Some billing services specialize in certain types of practices or medical specialties, which can be beneficial for practices with specific billing complexities.
- Customization of services to suit the specific needs of a practice, such as different levels of service or integration capabilities, can be a key factor in selecting a billing service.
Understanding these concepts is crucial for any healthcare provider considering outsourcing their medical billing or looking to optimize their revenue cycle management. Each service mentioned in the article, such as AdvancedMD, AthenaCollector, CareCloud, Cerner, CureMD, DrChrono, Human Medical, and Kareo, offers a unique set of features and services, tailored to different types of healthcare practices. The choice of a billing service should be based on the specific needs, size, and scope of the practice, as well as its integration capabilities with existing systems.
