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Updated May 22, 2024

The Best Medical Billing Services of 2024

Want to get paid faster for the healthcare you provide? High-quality billing services like CareCloud and AdvancedMD can help.

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Max Freedman, Business Operations Insider and Senior Analyst
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This guide was reviewed by a Business News Daily editor to ensure it provides comprehensive and accurate information to aid your buying decision.
Best RCM Software
RXNT Medical Billing
RXNT logo
  • Starts at $193/month/provider
  • Month-to-month subscription
  • One- to two-month implementation
USALinks to RXNT Medical Billing
Visit Site
  • Starts at $193/month/provider
  • Month-to-month subscription
  • One- to two-month implementation
Best for Flexibility
CareCloud Medical Billing
CareCloud company logo
  • 3% to 7% of monthly collections
  • Minimum three-year contract
  • Implementation varies by tier
  • 3% to 7% of monthly collections
  • Minimum three-year contract
  • Implementation varies by tier
Best for New Practices
DrChrono Medical Billing
Dr. Chrono logo
  • 4% to 8% of monthly collections
  • Minimum one-year contract
  • One- to two-month implementation
  • 4% to 8% of monthly collections
  • Minimum one-year contract
  • One- to two-month implementation
Best for Reporting
athenahealth Medical Billing
athenahealth company logo
  • 4% to 7% of monthly collections
  • Minimum two-year contract
  • Up to 11-week implementation period
  • 4% to 7% of monthly collections
  • Minimum two-year contract
  • Up to 11-week implementation period
Best for Large Practices
AdvancedMD Medical Billing
AdvancedMD company logo
  • 3% to 8% of monthly collections
  • Minimum one-year contract
  • Up to 11-week implementation period
  • 3% to 8% of monthly collections
  • Minimum one-year contract
  • Up to 11-week implementation period

Table of Contents

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Business News Daily’s team of experts regularly research and test business software and services to identify the best solutions for improving essential business operations. These analysts compare competing products, investigate vendor claims and seek testimonials from real users. Each evaluation adheres to our guiding principles of fairness and accuracy.

To determine the best medical billing services, we independently investigated different solutions on the market. We looked at how each one handled charge entry and coding, claim scrubbing and rejected claim management. We studied each vendor’s first-pass acceptance rate and considered how well the billing system integrated with leading medical software. We also examined costs, clearinghouse fees, setup charges and contract terms. Learn more about our methodology.

Medical practices contend with a convoluted billing process involving payers, clearinghouses, rejections and denials. This system can often mean practices have to wait weeks or months to see payment for services rendered to patients. It’s also a highly bureaucratic process, requiring dedicated medical billers and coders creating and tracking claims until payment is received. All these factors could add up to immense costs and serious cash flow challenges.

That’s why there are revenue cycle management (RCM) services, also known as medical billing services. These outsourced services will handle some or all of the aspects of a practice’s medical billing needs. We did the work for you to identify some of the best RCM services on the market. From charge entry to medical coding, claims submission and denial management, each of the billing services below offer an efficient and reliable way to outsource your medical billing.

How We Decided

Our team spends weeks evaluating dozens of business solutions to identify the best options. To stay current, our research is regularly updated.

14

considered

10

reviewed

10

selected

Our team spends weeks evaluating dozens of business solutions to identify the best options. To stay current, our research is regularly updated.

14

considered

10

reviewed

10

selected

Compare Our Best Picks

BND Ribbon
Our Top Picks for 2024
RXNT Medical Billing
CareCloud Medical Billing
DrChrono Medical Billing
athenahealth Medical Billing
AdvancedMD Medical Billing
Tebra (Formerly Kareo) Medical Billing
Rating8.8/108.7/108.7/109.3/109.2/108.6/10
Best For

RCM Software

Flexibility

New Practices

Reporting

Large Practices

Ease of Use

Pricing

Starts at $193 per month, per provider (RCM software only)

3% to 7% of monthly collections

4% to 8% of monthly collections

4% to 7% of monthly collections

3% to 8% of monthly collections

4% to 9% of monthly collections

RCM Services

N/A**

End-to-end

End-to-end

No medical coding; no denial management

No medical coding

Third-party RCM services

First Pass Acceptance Rate*

N/A

~97%

96%

93%

96% (contractually guaranteed)

95%

Implementation and Training

1 to 2 months

Varies

1 to 2 months

11 weeks

8 to 11 weeks

One month

Contract Requirement

N/A

Three-year minimum

One-year minimum

Two-year minimum

One-year minimum

30-day cancellation notice

Mobile App

iOS/Android

iOS/Android

iOS

iOS/Android

iOS/Android

iOS

Review Link
Scroll Table

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

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

Our Reviews

RXNT logo
  • Starting Price: Access to the practice management software and medical billing tools starts at $193/month/provider.
  • Contractual Requirement: None
  • Training and Setup: Setup and training are included with a subscription at no extra cost. Implementation typically takes between one and two months for most medical practices.  
Editor's Rating: 8.8/10
Visit Site

Why We Chose RXNT

RXNT is our choice as the best medical billing software because it offers an effective platform that supports in-house medical billing and coding teams, as well as RCM services managing their clients’ billing. It’s important to note that RXNT does not offer medical billing services like the other vendors on this list. Instead, it provides thorough medical billing tools in a cost-effective platform, making the revenue cycle management process smooth and efficient. To use RXNT’s medical billing tools, you’ll need to subscribe to the practice management software plan or higher. We recommend RXNT to healthcare organizations looking to keep their revenue cycle management in-house, but with the meticulous detail of an outsourced service.

RXNT patient payment screen

RXNT excels at helping medical billing teams to collect payments from both payers and patients. Above is an example of its patient payment screen, where staff can facilitate patient co-payments and view a breakdown of what the insurance company covered. (Source: RXNT)

Subscription Plan Price Features and Tools
Practice Management $193 per month, per provider Administrative features such as scheduling appointments, patient profiles, insurance verification and medical billing tools
Practice Management + Electronic Medical Records $298 per month, per provider Complete software suite including EHR and PM software features

RXNT Pros

  • The medical billing software supports in-house medical billers and RCM services.
  • The company charges a subscription rate instead of a percentage of collections, making it easier to budget.
  • The mobile application is supported on both iOS and Android devices.

RXNT Cons

  • The company does not offer medical billing services. Instead, it offers software that supports in-house medical billing and coding teams or enables RCM services to manage their clients’ billing.
  • You’ll need to hire your own medical billers and coders, which could substantially increase your labor costs.
  • Scalability is limited and the platform may not be suitable for the needs of large medical practices.

What RXNT Customers Have To Say

RXNT customers often praised the company for the effectiveness of its e-prescribing features and the ease with which it facilitated data migration from other platforms. However, some complained that customer service was often slow to reply when they needed assistance. RXNT earned an 8.0/10 on TrustRadius.

CareCloud company logo
  • Starting Price: 3% to 7% of monthly collections
  • Contractual Requirements: Three years
  • Training and Setup: A basic level of training is included in the subscription price. Setup varies depending on the specifics of each practice and the implementation tier chosen.
Editor's Rating: 8.7/10

Why We Chose CareCloud

CareCloud is our pick for best medical billing service for flexibility. We found it helpful how the company will outsource all or part of a medical practice’s revenue cycle, letting you pick and choose which aspects to keep in-house if you’d like. Additionally, CareCloud doesn’t require its RCM clients to use its practice management software, something that most other medical billing services require. We also liked CareCloud’s CollectiveIQ rules engine, which is regularly updated to flag the latest errors that lead to rejections and denials by payers.

CareCloud layout

CareCloud provides a user-friendly platform and effective medical billing tools. In the example above, a user navigates an encounter, which billers can easily leverage for charge entry and claims submission. (Source: CareCloud)

CareCloud Pros

  • The company is able to manage all of your revenue cycle or just part of it if you prefer to keep some aspects in-house.
  • Unlike almost every other medical billing service we reviewed, CareCloud doesn’t require you to use its PMS.
  • Claims submission includes the CollectiveIQ rules engine, which scrubs all claims and which CareCloud updates regularly as payers provide feedback on rejected claims.

CareCloud Cons

  • The implementation and setup process is an additional fee and can be expensive, depending on the service tier you need.
  • The company typically requires a three-year contract, which was the longest contractual requirement we found during our review.
  • Occasional bugs and slow loading times can sometimes be disruptive, according to customer reviews.

What CareCloud Customers Have To Say

Customers frequently cited CareCloud’s effective training and personalized attention to each practice’s needs as a major benefit of working with the company. Many also said customer service was helpful and quick to respond to requests for assistance. However, others complained about limitations when it came to the mobile browser or application, as well as slow loading times. CareCloud earned a 9.1/10 on TrustRadius.

Read our full CareCloud review.

Dr. Chrono logo
  • Starting Price: 4% to 8% of monthly collections
  • Contractual Requirements: One year
  • Training and Setup: Training and setup support are included free at all subscription levels. Implementation generally takes one to two months.
Editor's Rating: 8.7/10

Why We Chose DrChrono

DrChrono is our best pick for new practices because it includes user-friendly medical software, as well as training and implementation support that can be invaluable for setting new practices up for success. DrChrono requires a one-year contract, which is typical of medical billing services we reviewed; we recommend new practices partner with a medical billing service for at least a year, anyway, to ensure their revenue stream is stable and predictable before making changes. DrChrono also features customizable workflows, which we found useful, so you can set your processes up however you like from day one and create SOPs around them.

DrChrono reporting

DrChrono provides useful data analysis, such as the reports shown above. Keeping tabs on charges, collections and adjustments can help you stay apprised of how well the medical billing team is performing on your behalf. (Source: DrChrono)

DrChrono Pros

  • The medical software, including the medical billing tools and reports, is easy to use and flexible enough to tailor to your own workflow.
  • Medical billing and coding experts on DrChrono’s team offer useful insights and support for new practices.
  • The reporting in DrChrono’s practice management software is detailed and can help new practices monitor their financial performance closely.

DrChrono Cons

  • Customer support was often slow during our testing and submitting work orders for minor tasks could be disruptive.
  • Mid-sized and large practices may find that DrChrono is not especially scalable and lacks more advanced features.
  • The mobile application is only available for iOS devices.

What DrChrono Customers Have To Say

Clients of DrChrono often cite its usability as a top feature, including its clinical tools such as its templates. However, some users expressed a desire for more flexibility and customization throughout the software suits. DrChrono earned a 9.0/10 on TrustRadius.

Read our full DrChrono review.

athenahealth company logo
  • Starting Price: 4% to 7% of monthly collections
  • Contractual Requirements: One year
  • Training and Setup: Training and setup support are included in the subscription price of the software. athenahealth has one of the longest implementation periods in our review, typically lasting about 11 weeks.
Editor's Rating: 9.3/10

Why We Chose athenaHealth

athenahealth is our pick as the best medical billing service for reporting thanks to its in-depth database athenaNet. The company gathers data from more than 100,000 providers to establish performance benchmarks for practices of similar sizes and specialties. This isn’t something all of the providers we reviewed offered. Access to this data can be extremely useful for gauging how its RCM service is performing on your behalf. Moreover, it learns from rejected and denied claims across its entire network to frequently update its claims scrubber and billing rules engine, helping to keep first pass claims acceptance rates high. athenahealth’s standout tool is its consulting and reporting suite. Its billing team will reach out to you first if it notices a drop in performance or metrics below the standard for practices similar to yours. You’ll also receive custom reports and learn how to manage your practice for higher profits. This extent of consultation is rare among RCM services and, for some practices, may make up for athenahealth’s flaws.

athenahealth layout

athenahealth’s practice management software includes useful medical billing tools for in-house teams, as well as a high degree of visibility for practices outsourcing their medical billing. Above, a user engages in charge entry to develop a claim prior to submission. (Source: athenahealth)

athenaHealth Pros

  • Bills are sent automatically to payers and patients on a recurring basis until they are paid, helping reduce outstanding balances.
  • The athenaNet network of more than 100,000 providers contributes to frequent rules engine and claims scrubber updates.
  • athenahealth offers coding experts to support in-house medical coders and billers.

athenaHealth Cons

  • athenahealth does not offer medical coding services or denial management, meaning you’ll need to keep medical billers and coders.
  • The medical software athenahealth offers is powerful, but not at all intuitive and extensive training is recommended.
  • Implementation takes 11 weeks, which is the longest period we found in our review.

What athenaHealth Customers Have To Say

Customers of athenahealth often applauded the platform’s reporting suite as extensive, detailed and helpful. Others cited its practice management software as effective for supporting appointment scheduling and other front-office tasks. Some users expressed concern about how challenging it was to create custom reports, though, as well as the lack of customization options for the dashboard. athenahealth earned an 8.0/10 on TrustRadius.

Read our full athenahealth review.

AdvancedMD company logo
  • Starting Price: 3% to 8% of monthly collections
  • Contractual Requirements: One year
  • Training and Setup: Setup support and guided training are included in the subscription price. On-site implementation support is free for two days for practices with more than $200,000 in monthly collections. Setup period typically takes between eight and 11 weeks.
Editor's Rating: 9.2/10

Why We Chose AdvancedMD

Large healthcare systems that want to outsource much of their medical billing department can leverage AdvancedMD’s RCM services and its powerful medical software. While AdvancedMD does not offer medical coding – you’ll need to keep that aspect of the billing process in-house – it does guarantee in writing a 96% first pass claims acceptance rate (FPAR) at minimum, which is especially high among the companies we reviewed. AdvancedMD’s high FPAR stems from the fact that all its billing team members must have at least one year of experience, and many are certified medical coders. These experts are more than qualified to scrub your claims in ways that minimize errors. In the rare event that your claims are denied, AdvancedMD will handle all the work involved in pursuing them, keeping the burden off your staff so you can focus on delivering care. We also like how AdvancedMD will follow up with payers or patients who haven’t yet paid their bills. Another positive to us was how AdvancedMD offered discounts on custom plans, so you can develop precisely the level of service your practice needs.

AdvancedMD reporting

Much like the rest of AdvancedMD’s medical software, medical billing reports are extensive and detailed. The reporting tools give you full visibility into how AdvancedMD’s medical billing staff is performing. (Source: AdvancedMD) 

AdvancedMD Pros

  • AdvancedMD provides a contractual guarantee that it will attain at least a 96% FPAR on all claims.
  • The company provides customized bundles tailored to a practice’s specific needs, and these plans are subject to steep discounts.
  • The medical software suite that comes with AdvancedMD’s RCM services is comprehensive and powerful, yet also easy to use.

AdvancedMD Cons

  • AdvancedMD doesn’t provide medical coding services, so you’ll need to keep a medical coder on staff.
  • Costs are among the most expensive of the medical billing services and software we reviewed.
  • The company does not serve physical therapy and behavioral health specialties.

What AdvancedMD Customers Have To Say

Customers frequently praised AdvancedMD’s thorough implementation process and comprehensive slate of features. Others, though, said customer support was often slow and dissatisfying. AdvancedMD earned a 7.3/10 on TrustRadius.

Read our full AdvancedMD review.

Tebra logo
  • Starting Price: 4% to 9% of monthly collections
  • Contractual Requirements: One month notice for cancellation
  • Training and Setup: Setup and training are included in the subscription price. Tebra’s implementation period is generally complete within one month, the fastest in our review.
Editor's Rating: 8.6/10

Why We Chose Tebra

Tebra is our choice as the best medical billing service for tracking claims. The platform’s medical billing tools are highly user-friendly, making it easy to track the process from charge entry through to denial management. Tebra doesn’t provide medical billing services directly, however; instead, it acts as a broker that connects practices with third-party providers. That makes the transparency Tebra’s practice management software provides all the more important, giving clients a window into how the medical billing teams are performing on their behalf.

We like how with Tebra, you’ll get the standard features for medical billing services, including charge entry and coding, claim scrubbing, denied-claim management and follow-up on unpaid claims. You’ll also get full access to Tebra’s EMR system at no additional cost. Also included are Tebra’s clearinghouse fees, for which some other billing services charge extra.

Tebra coding library

Tebra’s encounter form includes useful features like an ICD-10 coding library, a breakdown of charges, and automated workflows for approvals. You can also attach documents and files that are relevant to the encounter for later review. (Source: Tebra)

Tebra Pros

  • Practice management software is easy to navigate and offers detailed reports to monitor medical billing activity.
  • Implementation is the fastest in our review, taking just one month from start to go-live.
  • Patient self-service tools are easy to use and help patients take care of co-payments and outstanding statements with ease.

Tebra Cons

  • Tebra does not provide direct medical billing services but instead connects customers with third-party RCM providers.
  • The percentage of monthly collections Tebra charges for RCM services is among the highest in our review.
  • Tebra is best for independent and new practices, but mid-sized and large practices may find the service limited.

What Tebra Customers Have To Say

Tebra customers often describe the software’s usability and detailed billing reports as the platform’s top benefits. However, some noted that they experienced crashes and bugs on occasion, disrupting operations. Tebra earned a 6.9/10 on TrustRadius.

Read our full Tebra review.

Alternatives to Consider

Not sure if our best picks are the right fit for your medical practice? Consider these alternatives we reviewed, which also offer reliable, effective revenue cycle management services.

  • ChartLogic: ChartLogic is among the most hands-on medical billing services we reviewed. All ChartLogic RCM clients are paired with a dedicated account manager during setup. This contact will check in with you before and after implementation to solve any problems. Alongside this extensive support comes a team of certified medical coders and billers. Each biller or coder on ChartLogic’s staff is highly experienced in a certain medical specialty and will be assigned to you accordingly. Among billers and coders well versed in a given specialty, you’ll be paired with contacts who know your local payers’ unique rules. ChartLogic provides all of this at a low cost. You’ll pay 3% to 6% of your monthly collections to use ChartLogic, which is competitively priced even on the high end.
  • CureMD: CureMD is among the most versatile medical billing services we reviewed. It can manage the revenue cycle of 32 medical specialties with its vast knowledge of ICD-10 codes and payer rules. It also charges as little as 5% of your monthly collections. Most of the companies we reviewed charge 6% to 8% of monthly collections (and some charge as high as 9%), making CureMD’s pricing highly competitive. Although medical coding and billing are its bread and butter, you can also hire CureMD for denial management, credentialing, schedule review and insurance eligibility verification.
  • MedicsRCM: MedicsRCM from Advanced Data Systems is a low-cost medical billing service with features that offer outstanding value. It charges 3% to 6% of your monthly collections – a very competitive range compared to other medical billing services we reviewed. For any claims that get denied or rejected, MedicsRCM will manage the entire revision and resubmission process within three days. MedicsRCM will also verify your patients’ insurance so you can know whether payers will actually cover your services. We like that MedicsRCM takes the time to understand your payer mix, specialty and state billing requirements. With this information, MedicsRCM can submit your claims at their highest possible value, potentially earning you more revenue. MedicsRCM also offers out-of-network scheduling alerts, 24/7 data access and a patient responsibility estimator.

Medical Billing Costs

Medical practices can expect to pay 3% to 9% of their monthly collections for RCM. 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 RCM candidates for full details of the services you get with your plan. You should also clarify whether clearinghouse fees, if applicable, are part of the monthly cost 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.

Key Medical Billing Features

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.

AdvancedMD templates

This example of charge slip templates comes from AdvancedMD, our best pick for large practices. (Source: AdvancedMD)

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.

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.

Medical software access

While not necessarily reflective of the quality of the billing service itself, most RCM companies include access to their PMS and EMR system 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 system you please. If not, you may have to pay extra to migrate your data from your old EMR system to your new one.

CareCloud patient chart

Medical software includes clinical tools like patient medical charts and demographics. This example comes from CareCloud, our best pick for flexibility. (Source: CareCloud)

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. But if you’re looking to entirely outsource your RCM, you can do that as well. However, some medical billing companies don’t offer certain services, such as charge entry and coding. In this case, you may need in-house billers and coders.

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.

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.

Advantages of Medical Billing Services

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 ensuring 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: Claim errors from carelessness 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 RCM 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.
Did You Know?Did you know

Using your billing service’s EMR system 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.

Choosing a Medical Billing Service

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 RCM 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.

RCM companies will generally take a monthly percentage of your collections instead of charging a flat fee. 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 services than your other candidates before making a decision.

As you compare prices, you should also check whether the RCM company includes EMR system 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 EMR system). In some cases, migrating your data from your old platform 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.

FYIDid you know

Medical billing setup and implementation can take anywhere from several weeks to three months.

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 at all times or just during weekday business hours. 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.

TipTip

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.

MEDICAL BILLING SERVICE FAQS

Medical billers convert your practice’s rendered services into standardized codes and add them to medical claims. They then submit these claims to insurance carriers or other payers so that your practice is properly reimbursed for its services. They typically do so within just a few days after services are provided, and they always lessen your front-office staff’s workload.

Medical billing services remove the burden of managing billing from 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. [Related article: How to Fill Out and File an HCFA Form]

A good FPAR is one that exceeds 95%. Some of the best medical billing services we reviewed have FPARs of 96% to 99%.

Medical billing services typically cost 3% to 9% 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.

The steps of the medical billing process, which medical billing companies handle for your practice, are as follows.

  1. Determining financial responsibility.
  2. Creating superbills.
  3. Generating claims.
  4. Submitting claims.
  5. Tracking claim status.
  6. Creating patient statements.
  7. Following up on patient statements.

What to Expect in 2024

The medical billing industry is projected to see significant growth in the coming years. Spherical Insights predicts a compound annual growth rate (CAGR) of 13.23 percent for the global medical billing outsourcing market through 2032. Spherical Insights data also shows that the market will reach a total value of $41.9 billion by 2032. This puts numbers to the notion that medical practices of all sizes are increasingly outsourcing their revenue cycle management. Doing so eliminates tedious, repetitive tasks for a medical practice and frees up more time for other needs.

Improvements in automation technology have been a significant driver of the outsourced medical billing market’s expansion. This automation can expedite in-house and outsourced billing procedures while minimizing errors. It is increasingly part and parcel of cloud-based medical billing software.

Artificial intelligence is a significant driver of automation technology – a recent example worth watching is Outbound AI’s generative AI. Through this tool, which leverages ChatGPT and other AI technologies, billing teams minimize the manual labor of EOB processing, denial management and prior authorizations.

At every step of the way, AI software will remain vital to medical billing in 2024. Its importance is only expected to grow as healthcare IT vendors introduce machine learning algorithms into their products. More automation – and more accurate billing – should result.

Medical billing software data security is expected to be a paramount concern in 2024. This is especially true in light of the medical billing service Arietis Health informing patients of a data breach in October 2023. Due to this breach, personal medical information and key identifiers such as Social Security Numbers may be for sale among bad actors. Additionally, a February 2024 suspected ransomware attack against Change Healthcare, a UnitedHealth Group unit, may further fuel security concerns. Medical billing services – and the practices that use them – will likely prioritize security improvements to avoid similar breaches.

Additionally, according to study data published in December 2023, only 38 percent of U.S. hospital systems met three key medical billing quality standards. These standards were hospital legal action to collect outstanding patient payments, timely delivery of itemized patient statements and patient access to qualified billing staffers. Given that 62 percent of hospitals did not meet at least one of these standards, expect a focus on these medical billing areas in 2024. Hospitals and smaller practices alike may need to prioritize these measures.

Present-day medical billing options also come with personalization tools so patients can receive statements and use customized payment collection tools. Patient payment plans are also becoming more common. Outsourced medical billing providers may thus be expected to prioritize a personalized patient billing experience in 2024.

There will likely be a focus on medical billing transparency as well in 2024. State legislation reflects this, such as a 2023 Texas law that requires clear written invoices before sending patients to collections. So too do consumer concerns such as those out of Colorado, where one patient reported a billing error affecting tens of thousands of people. This patient filed a complaint directly with the state government, leading to national reporting on the issue. This suggests a renewed interest in medical billing transparency throughout the country.

Attention on medical billing has also emerged in Minnesota. There, the state Attorney General’s Office is investigating the health systems Mayo Clinic and Allina Health. In particular, Minnesota Attorney General Keith Ellison has been hosting listening sessions to get public input on negative medical billing experiences. As government focus on medical billing expands, prioritizing a highly positive patient experience will become increasingly important in 2024.

Additionally, in 2024, medical practices can expect compliance changes based on the federal No Surprises Act that went into law in 2022. This law protects patients from incurring unexpected medical bills, but many physicians have argued that federal involvement in insurer-practice disputes violates the Act’s guidelines. In fact, between February 2022 and February 2023, two federal district court rulings invalidated certain parts of the Act.

The confusion doesn’t end there. In July 2023, federal executive agencies asked a district court to reverse a previous ruling invalidating part of the Act. Furthermore, by late November 2023, approximately 30 public businesses had labeled the Act as a risk. The Act continues to be contested. In April 2024, the American Medical Association’s Litigation Center filed an amicus brief with the 5th U.S. Circuit Court of Appeals.

The AMA has requested to uphold the federal court’s previous decision regarding the rule about how payers may calculate a physician’s rate of pay. The AMA reasons that this rule is in contrast to the law’s original intent.

These worries may have come to fruition as per the Biden administration’s February 2024 progress report. According to this report, the three federal agencies co-managing the Act are spending substantially more time enforcing it than predicted. Additionally, in more than 80 percent of Act-related disputes, insurers were ordered to pay more to out-of-network providers than they would to contracted providers.

Medical practice and billing service requirements may fluctuate as courts and influential businesses weigh in on the No Surprises Act to change its scope. This makes the No Surprises Act key to watch in 2024.

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Max Freedman, Business Operations Insider and Senior Analyst
Max Freedman has spent nearly a decade providing entrepreneurs and business operators with actionable advice they can use to launch and grow their businesses. Max has direct experience helping run a small business, performs hands-on reviews and has real-world experience with the categories he covers, such as accounting software and digital payroll solutions, as well as leading small business lenders and employee retirement providers. Max has written hundreds of articles for Business News Daily on a range of valuable topics, including small business funding, time and attendance, marketing and human resources.
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