by Juan Robin II
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Operating a medical practice is a challenging process on a variety of fronts. Caring for patients’ health is the top priority, of course, but multiple other items are important. You need to schedule patients properly, schedule nursing and support staff, order supplies, manage patient records with HIPAA guidelines in mind, and create transcriptions of case file notes.
Ultimately, you do all of this to make money. Caring for patients is of utmost importance, but if you cannot turn a profit, you won’t be able to properly care for patients very long. Keeping on top of your billing process is the key to keeping the profits growing and the lights on at the office.
For quite a few practices, in-house billing is a serious chore. Instead, practices may consider outsourcing this key aspect of running a medical practice to one of the best medical billing services, or revenue cycle management (RCM) services.
The 8 Best Medical Billing Services
Medical billing involves submitting claims to health insurance companies for the care you’ve provided to patients. In modern health care, insurance payments are the key to maintaining a financially viable medical practice.
A medical billing service will file the insurance claims in a timely manner with the proper coding. By following the submission rules the insurer has, the chances increase of receiving a timely payment, giving your practice the cash flow it needs to operate.
These services often will handle the billing process with patients. After the insurance company pays its portion of the bill, the RCM may offer a service where it bills the patient for the remaining balance.
The best medical billing services also will help you avoid making mistakes in insurance claims and bill submission that could force you to forfeit revenue because of poor recordkeeping. Here are the eight best medical billing services we have found.
• Works with all types of practices
• Very high first pass success rate
• Works with denied claims
• Checks claims for coding errors
• Get a Free Quote
For medical practices that want the highest possible success with insurance claims on the first pass, AdvancedMD is a strong performer. It guarantees it will deliver one of the highest percentages of success on initial claims submission in the industry at 95%, and it claims to exceed that number under real world conditions.
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.
- 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
- Does not do the initial coding, so you’ll need an in-house certified coder
- Has some extra fees
• Extremely easy to use
• Works with your team
• 90-day minimum contract
• Great low prices
• Get a Free Quote
When you want your staff to handle the majority of the billing process with a bit of guidance from a service, AthenaCollector is a good choice. This is primarily an automated medical billing service that attempts to catch errors that your staff may make during the billing process.
It is easy to use, and training requirements don’t take a long time, so you can be up and running quickly.
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.
- Extremely easy to use
- Designed to help your in-house service
- Shorter than average minimum contract length
- Price point is a bit below average
- Not made for those who want a complete third-party billing service
- First pass success rate in claims is a bit lower than others
• Strong matching EMR system
• 1 year minimum contract
• Multiple plans
• Competitive pricing
• Get a Free Quote
One of CareCloud’s biggest advantages versus other RCMs is its ability to tailor its pricing tiers to match the way your practice works. Rather than a one-size-fits-all billing, 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.
- Multiple pricing tiers with competitive overall pricing
- Has a strong matching EMR system
- Offers a minimum contract length of one year
- Excellent coding results
- Startup fees are high for new clients
- Requires a minimum monthly guarantee
• Great for large practices
• Multiple advanced features
• Patient account collection services
• Handles all aspects of billing
• Get a Free Quote
For those medical practices that have complex billing needs, the Cerner billing service is able to handle these requirements. However, with the advanced features comes some challenges in training, so don’t expect to be up and running quickly with this biller.
Cerner will handle the entirety of the billing process from start to finish, including resubmissions of denied claims and account collections from patients. Cerner is best for larger practices.
- 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
- Higher than average pricing
- Training process is long and involved
- Customer service has hit and miss results
• Geared toward small practices
• High first pass success rate
• No minimum contract
• Low startup costs
• Get a Free Quote
Small practices that want to start using a medical billing service without shelling out a significant upfront investment will appreciate CureMD.
This service has a first pass success rate for claims at up to 98%, which is one of the highest in the industry. It 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.
- Low initial price for basic service
- Geared toward small practices
- No minimum contract requirement
- Very high first pass success rate on claims
- Has multiple add-on fees, depending on the level of service you need
- Will not support some uncommon specialty areas
• Full service plans
• No minimum monthly guarantee
• Start to finish claim submission
• High percentage of success
• Get a Free Quote
For smaller than average sized medical practices, a full service system that encompasses EMR, practice management, and billing services may be the best option, which is what DrChrono offers. (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.
- 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
- Must be a DrChrono EMR software client
- May not work as well for larger practices
• Best for smaller practices
• Highly flexible plans
• Personalized & customized service
• Great customer service
• Get a Free Quote
When you want a highly personalized and customized service from a medical biller, Human Medical is an excellent choice. 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.
- Highly flexible service
- Handles all aspects of the claim generation process, including coding
- Great for smaller practices
- Very good customer service
- Has no EMR or practice management software option
- Percentage fees are a bit higher than average
• Flexible service plans
• Works with resubmissions
• Training options
• Competitive pricing
• Get a Free Quote
If you are a customer of the Kareo EMR and practice management software, 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.
- Competitive pricing
- Handles all aspects of medical billing, if desired
- Works with resubmissions
- Nice level of training options
- 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 just the right medical billing service to meet your needs requires completing a bit of homework on your part. Think about which RCM services are most important for your practice (and in which areas you need the most help), and find a service that has the strengths in those areas.
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%.
Unfortunately, you cannot consider price alone when comparing the best medical billing services. 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.
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, as 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.
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.
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.
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.
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.
Summary: Putting a Medical Billing Service to Work for You
Some medical practices choose to handle medical billing and insurance claims with in-house personnel. If you have the budget to hire insurance coders who know how to handle the medical billing process, this choice may work nicely for you.
However, 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. If you try to perform medical billing in-house and you fall behind, it can be almost impossible to catch up again, which will cost you cash flow.
Certainly, medical billing services have an expense associated with them. You may end up paying more for RCM services than what you’d pay someone in-house to handle the work. But the extra expense may be worth the peace of mind a billing service gives you, as well as the steady flow of successful insurance claims.