The Best Medical Billing Service Providers of 2020

• Medical billing services are third-party companies that handle a medical practice's revenue cycle management.
• The cost of medical billing services range from 3% to 10% of monthly practice collections.
• ChartLogic is the best medical billing service for small practices; AdvancedMD is the best medical billing service for large practices; and CareCloud is the most flexible medical billing service we reviewed.
• This article is for medical practice administrators considering outsourcing their revenue cycle management to a medical billing service.

Medical practices contend with a convoluted billing process unlike other businesses, which can often mean payment for services rendered often comes weeks or months after the fact. Medical billing services expedite the time it takes practices to receive payment from insurance providers and the government, plus it helps practices save on payroll costs. To determine the best medical billing services of 2020, we thoroughly examined nearly 30 vendors, comparing key factors like pricing, fees, contracts, claims processes, and broader healthcare IT products. Read more below about the options we think are best for various types of medical practices

Medical billing services are third-party organizations that take over some or all of the billing process for medical practices, reducing or eliminating the need to maintain in-house medical coders and medical billers.

These services generally cover the entirety of the billing process from start to finish, though some only pick up after the practice has generated and coded claims. Here's a closer look at what you can expect from most medical billing services.

What Kinds of Medical Billing Services Are Available?

A medical billing service that is capable of handling the entirety of your practice's billing would offer the following services:

• Provider credentialing with appropriate clearinghouses and payers
• Patient insurance eligibility verification at the time of visit
• Claims generation and claims coding services
• Claims scrubbing for errors and revision before submission
• Claims submission through clearinghouses to appropriate payers (insurance companies, Medicare, Medicaid, etc.)
• Unpaid claims monitoring and follow-up
• Revision and resubmission of rejected or denied claims
• Delivery of patient statements for outstanding balances
• Follow up with patients on unpaid balances
• Referral of unpaid patient balances to collections agencies

Some medical billing services offer all these services, while others only offer some. Before you begin contacting these services, have a clear understanding of whether you need to outsource all of some of your billing. Partial outsourcing is generally more cost-effective, but you'll need to keep some medical coders or medical billers on staff. Before partnering with any medical billing service, request an agreement that details their responsibilities and your practice's obligations to ensure you are getting what you paid for.

What Is the Difference Between a Medical Billing Company and Medical Billing Software?

Medical billing software, which is often a component of practice management software, helps practices manage their financials in house. It usually consists of a patient insurance eligibility verification system, integrations directly with clearinghouses and payers, and reporting tools to monitor your financial performance. However, practices must manage the actual billing – from credentialing to denial management – themselves.

Medical billing services take over the management of a practice's revenue cycle (which is why medical billing services are also called revenue cycle management companies). Many times, these services work directly in a medical practice's billing software. Many services also offer their own proprietary practice management software and EMR (electronic medical record) systems; in some cases, billing clients are required to use these software programs when they sign up with the medical billing service.

Key takeaway: Medical billing services vary in their offerings, but many can cover the entirety of your medical practice's billing operations from start to finish.

When selecting a medical billing service, there are a few things to keep in mind.

Of course, you want to know how much it costs; you'll also want to know exactly what you can expect from a billing partner. That can be difficult. Without knowing the right questions to ask, a practice can wind up working with a medical billing service that doesn't live up to its promises.

It might be worth hiring a professional consultant with extensive experience to advise your practice. You can locate a professional consultant here. If you go it alone, some questions should be on your mind when selecting a medical billing partner. The section below outlines the aspects to consider before buying.

What Percentage of Monthly Revenue Do Medical Billing Companies Charge?

These are highly variable based on the size and specific focus of your practice. You'll need to contact a sales representative for hard numbers, but some billing services' websites offer a general estimate of what they charge. Most companies charge a percentage of your monthly revenue as payment, often between 3% and 9% of net collections.

It's important to consider the costs (in time and money) of keeping your billing in house versus the cost of outsourcing, keeping in mind the potential increase in revenue if you outsource. Here are three key questions to ask a medical billing service when discussing costs:

• What specific services are included in the monthly percentage I will be paying?
• Are clearinghouse fees included in the percentage, or are they charged to my practice in addition to the percentage?
• Does the percentage include any copays my staff collects at the time services are rendered?
  
  

Billing Services

Most billing companies scrutinize claims for errors before processing them, and many follow up with the insurance company to ensure the claims are accepted. However, some companies also provide a periodic analysis of your accounts receivable, along with recommendations on how to improve your practice's financial performance. Others include access to an electronic health records system and/or practice management software.

When you're selecting the company to outsource your RCM to, consider which services your practice and patients need. Consider the following as well:

• Does the service have certified coders on staff, or will my practice be responsible for coding?
• If the billing service does perform coding, is it up to date with the transition to the more robust ICD-10 coding system?
• How detailed are the financial reports from the service? Can my practice expect analysis and suggestions to improve performance?
• Does the medical billing service have experience with billing for my specialty?
  
  

Support

You want a communicative billing partner who keeps you informed at every turn. Most companies offer software where practices can regularly review their revenue cycle, claims and rejections. A medical billing partner should be responsive and helpful, particularly if something goes wrong. Open lines of communication can mean the difference between a breakdown in the billing department and a boost to your bottom line. It's important to ask the following questions before signing on the dotted line:

• Can I access information about my practice's revenue cycle at any time?
• What can I expect from the service when a mistake is made?
• Will the billing service provide my practice with copies of any "explanation of benefits" or "electronic remittance advice" documents it receives from payers?
  
  

Patient Engagement

A medical billing service should also keep your patients in the loop and deal with delinquent accounts. Many services send patients statements directly and transfer unpaid accounts to collection agencies if necessary. Some medical billing services field phone calls and address patient questions. Some companies even offer a patient portal, where patients can access and make payments to their accounts. In addition to a medical billing partner who stays engaged with your patients and keeps them abreast of what they owe, you want to find out the following:

• Does the medical billing service deliver patient statements for co-payments, co-insurance and out-of-pocket expenses?
• Does the medical billing service follow up on unpaid patient balances, and how long do they wait to do so?
• How long will the billing service wait before transferring unpaid balances to a collection agency?
• Is a patient portal included in my monthly percentage, or is it an additional cost?

Key takeaway: Medical billing costs vary depending on practice size, specialty and complexity of billing. Obtain a written document explaining what services the cost of a billing service includes.

If you opt to have your staff handle the billing, you're responsible for coding, submitting, and following up on claims. You'll need a certified medical coder on staff as well as an established process that ensures claims are created, scrubbed, and submitted in a timely fashion. If a claim languishes or is rejected by the payer, you need staff to manage that too. It's also crucial to stay on top of the ever-changing regulatory framework and new policies.

Keeping billing in house is often cheaper and you have more control over the process, but for a small practice with staff members who already wear many hats, billing can be time-consuming and complex. Worse, if the proper time and attention are not given to claims, you could lose a substantial amount of money.

Medical billing services alleviate that burden and wholly manage your revenue cycle for a percentage of your collections or a subscription fee, but it might be more expensive than in-house staff. A good medical billing service increases your collection rate, reduces rejections and denials, and even provides an analysis of your accounts receivable while freeing up your staff's time to focus on other tasks. You'll typically be able to generate on-demand reports and view your day-to-day finances through the company's software as well.

Whether you choose in-house billing or outsourced RCM, you'll need practice management software. If you outsource your billing, discuss with your billing partner the software they are familiar with. You'll also need to ensure that software is compatible with your EMR system.

Why Should a Large Medical Practice Hire a Medical Billing Service?

Large practices might hire a medical billing service for many of the same reasons a small practice would: to reduce overhead associated with maintaining full-time staff who follow up on unpaid claims and who manage rejections or denials. Large practices have more resources at their disposal than small practices, meaning they can usually retain some staff in-house, like coders, while outsourcing a portion of their medical billing process.

Our best pick for a medical billing service for large practices is AdvancedMD, though it does not perform coding services. While that deficiency may not work for a small practice, large practices typically perform coding in house, and then outsource the remainder of their billing service to AdvancedMD, for example. Outsourcing still removes the burden of managing claims from a large practice, allowing them to focus on rendering services in the here and now rather than chasing claims down from a month or two prior.

Why Should a Small Medical Practice Hire a Medical Billing Service?

Small practices use a medical billing service to cut costs and improve efficiencies. Additionally, many medical billing services also offer ambulatory EMR systems and practice management software, which small practices need to run day-to-day administrative and clinical operations. For a small practice, especially new practices just opening their doors, accessing a complete healthcare IT suite, in addition to medical billing services – usually just for the percentage cost of the billing service – is a big win. Some of the best billing services, like CareCloud, our best pick for flexibility, use a consultative approach that can help small businesses ramp up operations and grow their business.

Additionally, the best medical billing services ensure HIPAA compliance, protecting sensitive patient data, as well as your practice's financial information. HIPAA stipulates strict protections of patient data in transit and at rest, so your medical billing service provider must guarantee the requisite levels of security required under the law.

Outsourcing revenue cycle management can result in more money for your practice without allocating your staff to complete the arduous tasks of coding and billing. But how do you know which billing service to trust?

Key takeaway: Outsourcing RCM to a medical billing service makes sense when your in-house billing is too costly or is underperforming.

These are some common questions about outsourcing your medical billing and coding to a revenue cycle management service.

How can medical billing and coding help you increase cash flow?

Medical billing and coding can increase your cash flow by reducing the number of days a claim spends in accounts receivable, aggressively following up on unpaid claims, and effectively managing rejections and denials as claims are kicked back by payers.

Some services only facilitate claims submission and manage rejections or denials, requiring your practice to generate the claims. Others handle the entire process – creating claims from your clinical notes, scrubbing them for errors, submitting them to clearinghouses, following up with payers, and managing denials. Look for a medical billing service that offers the complete service and ask how you will be able to monitor its progress. Many offer a real-time view directly in your practice management software.

What can you expect from a medical billing service when a mistake is made?

Just like any third-party partner, a medical billing service should be forthcoming when it makes mistakes and seek to fix them. Mistakes are a common part of the medical coding and billing process, and it is not uncommon for claims to be denied or rejected outright by payers. (After all, insurance companies get to keep their money when claims are denied).

A medical biller's job is to try to get it right the first time, of course, but expecting a 100% first-pass claims rate is unrealistic. Instead, when mistakes are made, you should expect transparency from the biller as well as diligent follow-through on rectifying the mistake and getting the associated claim(s) paid.

How long does it typically take before the billing service transfers unpaid balances to a collection agency?

Different services have their individual policies on transferring claims to a collection agency. However, they must document and demonstrate repeated attempts to follow up with payers on unpaid claims. A major challenge for medical practices is the number of days a claim spends in accounts receivable – with some claims taking several months to be reimbursed. Medical billing services should reduce the days in A/R through clean claims submission, persistent follow-ups with payers, and nimble management of rejections and denials.

How detailed are the financial reports from a medical billing service?

The detail in a financial report issued by a medical billing service varies by company. However, the best medical billing services offer a real-time view of how your medical coding and billing are performed through integrations with your practice management software. Look for an RCM service that allows you to sign in and view its billers and coders, just as you would a member of your staff using the system.

The best medical billing services offer dozens (sometimes even hundreds) of monthly reports and are typically happy to generate recurring custom reports to suit your practice's operational needs. Discuss your options with a sales representative before buying, because detailed financial reporting is a critical part of guiding your practice to success.

Business News Daily strives to find the best products and services for your small business. We invest hours in identifying and researching the best products and services so you feel confident about our recommendations.

We revisit our categories each year, evaluating new changes in the industry and new companies. Our process involves revisiting our previous best picks to determine if they are still the best in their category.

In addition to our current recommendations, here are the companies we previously selected as best picks:

Most Flexible Medical Billing Service: Human Medical Billing

Best for Small Practices: DrChrono

The rapid global spread of COVID-19 has impacted virtually every healthcare organization. While much of the focus has understandably been on the point of care, there are also implications for the back office.

Medical billers and medical coders, for example, have had to rapidly adjust to determine how to code and generate claims for coronavirus-related treatments. For most coronavirus patients, coders can use the B97.29 code in the ICD-10, which classifies diagnoses as "other coronavirus as the cause of diseases classified elsewhere."

The World Health Organization has also released guidance to use emergency ICD code U07.1 to refer to COVID-19 as an acute respiratory disease. The ICD-11 code for coronavirus is RA01.0.

We researched dozens of prominent medical billing vendors to determine which were worthy of our best pick award. Our initial research included reviewing client testimony, other reviews, company websites and Better Business Bureau rankings.

We also examined brands' other offerings in the healthcare space; for example, we considered whether they offer EMR software. We used the information we gathered to narrow down our initial list to 10 finalists. From there, we considered the following criteria to determine our best picks:

• Pricing: How does the service's pricing compare to others in our review, and was the company upfront about how its pricing model works and what is included?
  
  
• Additional fees: Are there additional fees on top of the base pricing? Did the company explain these fees to us in a forthcoming manner?
  
  
• Contract requirements: What is the minimum contract requirement? Is there an opportunity to cancel early for no fee if the service is not meeting expectations?
  
  
• Healthcare IT suite: Does the company offer proprietary EMR software or practice management software? If so, is it a requirement for RCM clients to be on that company's system, or can they integrate with third-party systems as well?
  
  
• Claims process: What does the claims process look like, and what services does the company include in its pricing? Are there certified coders on staff? Will the provider's staff follow up on outdated or denied claims?
  
  
• Specialties: What specialties does the service commonly work with, and will it tailor its process to the needs of the practice given its specialty?
  
  
• First-pass claims rate: How many claims are generally accepted by payers on the first pass, and how many require resubmission or follow-ups?
  
  
• Denial management: What does the service's denial management process look like? Does it handle all types of denials and rejections or only certain types?
  
  
• Biller/coder certifications: What type of training, education, or certifications are the billers and coders for the RCM service required to maintain?
  
  
• Reporting: What kind of financial reporting can a practice expect and how often? Are reports customizable? Are they available on demand?

In the end, we selected ChartLogic as the best medical billing service for small practices, AdvancedMD as the best medical billing service for large practices, and CareCloud as the best flexible medical billing service.