The Best Medical Billing Services of 2021

*Some billing companies rely on a composite first-pass claims rate, which may slightly inflate the percentage of claims truly accepted and paid on the first pass.

**Does not offer medical billing services; instead provides software used by medical billers in practices and at RCM companies.

Medical practices can expect to pay 3% to 9% of their monthly collections for revenue cycle management. Your exact rate will depend on several factors, including your claim volume, average claim value, billing cycle complexity and practice size.

Depending on your rate, outsourcing your medical billing may prove more expensive than hiring an in-house team. However, outsourced medical billing often includes detailed financial reporting and specialty expertise that an in-house team might not offer.

To make the proper choice between in-house and outsourced, you should ask your revenue cycle management candidates for full details of the services you get with your plan. You should also clarify whether clearinghouse fees, if applicable, are part of your monthly fees or added on later. Lastly, you should check whether copays count as part of your collections. The answer will affect how much you pay monthly.

These are some of the most important features of a medical billing service:

1. Charge entry and coding

Though this is not universal, most medical billing service providers will handle charge entry and coding, kicking off the billing process at its very first step. This step even precedes claim scrubbing and submission – without it, the process hasn't truly begun. If your medical billing company of choice doesn't offer this service, an in-house staff member will need to handle it.

2. Claims scrubbing

Thoroughly scrubbed claims are far less likely to result in denials or rejections, especially when your medical billing service of choice includes a rules engine. Companies with these engines automatically check their claims for errors that payers commonly use to deny or reject claims. Once these errors are flagged, you or your medical billing company can revise them and refile your claims with these mistakes excluded. The result will be a higher FPAR and faster payment.

3. Denied-claims management

No medical billing service can entirely avoid denied claims, but most medical billing companies will manage the revision and resubmission processes when this does happen. Some companies will go the extra mile and prioritize denied claims to get them paid as soon as possible. In either case, your back-office staff won't be left poring over rejected or denied claims, trying to find and fix errors before resubmission.

4. Medical software access

While not necessarily reflective of the quality of the billing service itself, most revenue cycle management companies include access to their practice management software (PMS) and electronic medical records (EMR) in their offerings. This can be a cost-effective way to gain access to some of the top medical software on the market. Most medical billing providers will also require you to use their PMS, though you can typically use whichever EMR you please. If not, you may have to pay extra to migrate your data from your old EMR to your new one.

5. Flexible services

Some medical billing companies can manage as much or as little of the revenue cycle as you need. If you're only looking for someone to pick up the slack after you file your claims, you can arrange an appropriate deal. If you're instead looking to entirely outsource your revenue cycle management, that too is possible. However, some medical billing companies don't offer certain services, such as charge entry and coding, whatsoever. In this case, you may need in-house billers and coders as well.

6. Integrated clearinghouse

As part of your medical billing service, you want either a fully integrated clearinghouse or a partnership with one that results in no extra fees for your practice. Most of the companies we reviewed have one of these two arrangements, and a small number even bypass clearinghouses entirely and submit medical claims directly to payers. Make sure to ask about clearinghouses and fees anytime you speak with a potential billing services provider.

7. Follow-up on unpaid claims

Virtually every medical billing company we reviewed will follow up all unpaid claims on your behalf. This service applies to payments from both your patients and their payers. An effective medical billing service will follow up on unpaid claims promptly and repeatedly until the account is settled. When handling patient statements and follow-ups, the best medical billers consider customer service and how their collection efforts could reflect on your practice.

As with any service, a firm knowledge of the advantages your practice will receive is key to your RCM choice. That's because an in-house medical billing staff is often less expensive, but the benefits of outsourcing may be well worth the extra spend.

• Greater efficiency: Especially if you're a small practice, outsourced medical billing can be key to ensure your team isn't overworked. Small practices' front-office teams are often jacks of many trades for whom the revenue cycle is tedious, lengthy, and complex. Outsourcing the process (partially or entirely) alleviates this challenge.
  
  
• Higher accuracy: Careless claim errors are a huge revenue drain. When you outsource your billing to experts, especially those with rules-based engines, you mitigate this risk. These experts and their technology are a powerful combination for identifying potential claim errors and solving them before they become huge issues.
  
  
• More collections: Outsourced medical billing teams focus entirely on billing. The result is more collections more quickly. Even the best in-house teams, given their many responsibilities, can rarely achieve the revenue peaks possible with outsourcing.
  
  
• In-depth data and analytics: Many medical billing services will analyze your accounts receivable and use the trends they observe to suggest modifications to your processes. You should also be able to create reports at will in the included PMS.
  Through these reports, you can get a clear view into your finances and see how to adjust your operations for more revenue.
  
  
• Practice management consultation: Especially for smaller practices, the consulting services that accompany revenue cycle management can precede growth. The operational advice you receive can result in more revenue, which you can invest in hiring more staff or expanding your services. And if you follow your consultant's recommendations, you'll be on a fast path to even more revenue soon enough.

FYI Using your billing service's EMR and PMS is a great way to find medical software for less than it costs to hire in-house medical staff and obtain separate EMR and PMS solutions.

As you compare potential medical billing services, take the following steps to determine the best candidate:

1. Get a full picture of the company's features.

Claim scrubbing and follow-up are par for the course. You'll also commonly find that revenue cycle management companies include reporting, consultation, and EMR and PMS access with your services. Check for these features as you speak with company representatives.

You should also determine whether the features that accompany your medical billing leave the company or your own team responsible for entering and coding charges. It's worth asking if your billing service candidates are following the most recent ICD-10 coding system updates. You should also get a sense of the billing company's experience with other practices in your specialty. Lastly, ask about the depth and extent of reporting and analytics solutions.

2. Compare prices.

Revenue cycle management companies will generally take a monthly percentage of your collections instead of charging flat fees. The percentage will vary based on the factors described above, and different billing services may quote you different percentages. Think about whether a company that charges you more would provide better or lower-quality services than your other candidates before making a decision.

As you compare prices, you should also check whether the RCM company includes EMR and PMS access with its billing services. These inclusions may justify the company charging higher prices. That said, most medical billing services require you to use their PMS (and a few have the same rule about their EMRs). In some cases, migrating your data from your old platforms to your new one may incur additional charges.

3. Determine how long setup and implementation will take.

Since you'll be installing software (unless you are opting to work through your existing software provider for your billing), you'll need to account for the implementation process in the timeline. Fully setting up the software side of your billing services often takes several weeks to three months. Sometimes, the setup process results in additional fees, though we found that many companies include implementation and training for free.

FYI Medical billing setup and implementation can take several weeks or months, usually three months at maximum.<

Check whether your medical billing provider includes free training with your implementation. If it does, chances are you'll be paired with a dedicated account manager who will help you set it up. You may also get access to setup resources you can browse on your own time. 

4. Figure out your support options.

With medical billing services, support isn't just about phone calls and emails; it's about having a full, transparent window into your billers' work at all times. Look for providers whose PMS platforms include a portal where you can see your claims' real-time status and look over your third-party billers' work.

On the traditional support side, you should check whether you can reach your provider by phone, email, or live chat just during weekday business hours or at all times. The company's representatives should be happy to assist you and easy to reach. 

Your billing service should also provide you with your payers' electronic remittance advice and explanations of benefits. These documents are important for obtaining a transparent view into your payers' operations.

Tip: When dealing with something as sensitive as your practice's finances, you should thoroughly vet any potential service partner to guarantee trust and transparency.

5. Consider patient engagement tools.

Medical billing is primarily a payer-facing need, but not entirely. Since most medical billing services require you to use their PMS, they may also manage the patient portal that most PMS platforms include. This means that your billing service can directly send patients their statements and follow up on unpaid charges. Should statements go unpaid long enough, your billing service could even oversee the process of sending patients to collections.

It's important to find out whether the patient portal will cost your company extra or is included with your billing services. You should also find out how exactly your company of choice pursues unpaid bills and how long it waits to send these bills to collections.

How can a medical billing service improve a medical practice?

Medical billing services take the burden of managing billing off of medical practices' staff, offering charge entry, coding, claim scrubbing, denial management and more. They can also follow up on unpaid claims, contacting payers and patients who are late on their payments. In addition, they will stay on top of all electronic remittance advice (ERA) from payers to ensure claims are usually accepted on the first pass.

Most medical billing services provide access to their medical software as well. Medical software automates and streamlines many key functions in the front office, clinical environment, and back office. The front-office tasks include registering patients, scheduling appointments, verifying insurance, and checking patients in and out. Clinical providers use medical software to fill out patient charts, order tests, prescribe medications, and share patient histories with other providers. Finally, the back-office tasks include charge entry, medical coding and medical billing. Medical software works in tandem with RCM services to support all of these needs. [Read Related: How to Fill Out and File an HCFA Form]

What is a good first-pass claims acceptance rate?

A good first-pass acceptance rate (or FPAR) exceeds 95%. Some of the best medical billing services we reviewed have FPARs of 96% to 99%.

How much do medical billing services cost?

Medical billing services typically cost 3% to 8% of a medical practice's monthly collections. This percentage is usually determined by a combination of factors, mainly the practice's size and specialty, the volume and value of its claims, and the complexity of the coding and billing required.