The Best Medical Billing Service Providers of 2020
Updated: August 13, 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
Our Best Picks
Best Medical Billing Service for Large Practices
Best Medical Billing Service for Small Practices
Editor's note: Looking for a medical billing service? Fill out the below questionnaire, and our vendor partners will reach out to you with more information.
The service includes an implementation and onboarding team, as well as a U.S.-based support team, that is available from 8 a.m. to 8 p.m. EST on business days.
Pricing for Chartlogic ranges from 3% to 6% of monthly collections, and the company boasts a first-pass claims rate above the industry standard of 95%. ChartLogic requires a two-year contractual commitment, which is not uncommon within the industry, but is longer than the terms other services have.
ChartLogic maintains a full staff of certified medical billers and coders. While other medical billers maintain some certified staff members, ChartLogic was one of the few services that made certification a prerequisite for hire. Certified coders and billers must remain up to date with current industry practices and insurance company policies. Additionally, ChartLogic pairs coders and billers with practice specialties in their area of expertise as well as in their particular geographic region whenever possible.
Where CareCloud offered three tiers of service in the past, the medical biller can now be broken down even further. For example, if you only want to outsource follow-ups and denial management, you can. Alternatively, CareCloud can manage the entirety of your billing process, in addition to offering a comprehensive, user-friendly healthcare IT platform comprising an EMR system, practice management software, and patient engagement tool.
CareCloud employs a rules engine called CollectiveIQ, which maintains a list of more than 120 million rules across multiple specialties. Claims are analyzed against the rules engine to see if they are likely to be accepted by payers on the first pass. CareCloud reports an organization-wide first-pass claims rate of 97%.
CareCloud also maintains proprietary EMR and practice management software. Clients of the billing service are not required to use the EMR but must use the practice management software. CareCloud billers work directly in the practice management system, allowing clients to view biller activity in real time.
CareCloud's custom pricing plans allow practices to select an option suitable for their budget and the scope of service they need. Depending on which plan a practice requires, CareCloud typically charges 3% to 7% of collections. CareCloud requires a three-year contract, which was one of the longer-term contracts we found in our review. Additionally, CareCloud charges upfront implementation fees that can be somewhat pricey – a company representative quoted us at about $1,000 per provider.
Medical Billing Services
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.
How to Choose a Medical Billing Service
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?
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?
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?
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.
In-House Medical Billing vs. Outsourced Revenue Cycle Management
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.
Frequently Asked Questions About Medical Billing Services
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.
What to Expect in 2020
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.
Previous Best Picks
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
List of Medical Billing Services
Here is a full list of medical billing services we reviewed. This alphabetical list includes our best picks (which are denoted with an asterisk).
*AdvancedMD – AdvancedMD is our best pick for medical billing services for large practices. With a 95 first-pass claims rate and access to AdvancedMD's full healthcare IT platform, it is a strong choice for a practice looking to outsource its revenue cycle management. advancedmd.com
Athenahealth – Athenahealth's billing service, athenaCollector, boasts a first-pass claims rate of 94 percent and employs a rules engine that learns from all other providers in athenahealth's network. The company aims to get practices paid 6 percent more and 32 percent more quickly. athenahealth.com
Auctus Group – Auctus Group is focused on medical billing for plastic surgeons and dermatologists. It is unique in that there is no mandatory minimum contract and practices can cancel services at any time. auctusgroupconsulting.com
BillingParadise – BillingParadise offers a revenue cycle management service that works with several different leading electronic health record systems. The company maintains seven specialized teams to focus on each aspect of the billing process. billingparadise.com
*CareCloud – CareCloud's revenue cycle management services include a fully integrated electronic health record and practice management platform as well as a 97 percent composite claims resolution rate. The company typically works with longer-term contracts but can accommodate annual clients. carecloud.com
*ChartLogic – ChartLogic's medical billing service includes a highly detailed patient insurance eligibility check and coding assistance from certified coders on staff. Chart Logic will also help your providers through the insurance credentialing process if they are not yet credentialed. chartlogic.com
ClaimCare – ClaimCare's revenue cycle management team aims to boost collections by 10 to 20 percent and offers 24/7 insight into billing operations through a reports dashboard. It includes a claim-scrubbing process that reduces errors prior to submission. claimcare.net
Clinical Info Solutions – Clinical Info Solutions medical billing service includes patient insurance eligibility checks and a free cloud-based practice management software. The company can also use your existing practice management software to provide billing services if you prefer. clinicalinfosolutions.com
CRT Medical Systems – CRT Medical Systems offers a comprehensive revenue cycle management service that includes financial analysis and recommendations as well as collections from delinquent patient accounts. coronishealth.com
CureMD – CureMD is a medical billing service that serves more than 32 specialties. It is aimed at collecting 6 percent more, 35 percent faster and includes an automated rules engine that scrubs claims for common errors. curemd.com
DrChrono – DrChrono is our best pick for medical billing services for small practices. It offers a comprehensive service and complete healthcare IT suite at a relatively inexpensive price. DrChrono offers a hybrid service model for new practices that are ramping up but want to retain some of their billing operations in-house. drchrono.com
eClinicalWorks – eClinicalWorks medical billing service includes a proprietary rules engine for claims scrubbing, which covers coding, clearinghouses and insurance payer policies. It boasts a low 2.9 percent cost of net collections; however, that is in addition to a fixed monthly rate. eclinicalworks.com
GroupOne – GroupOne's revenue cycle management service is built to work with any practice size across multiple leading electronic health record and practice management platforms. The company boasts a quick turnaround time and a rules engine that scrubs claims prior to submission. grouponehealthsource.com
Human Medical Billing – Human Medical Billing is our best pick for a flexible medical billing service because although it requires an annual contract, it allows for cancellation with just 30 days' notice. Human Medical Billing is a small company with three dedicated account managers, and it offers highly personalized customer service. humanmedical.net
InSync Healthcare Solutions – InSync Healthcare Solutions offers dedicated account managers to help oversee your outsourced billing operations. Its claims submission process includes withdrawing problematic claims from a batch and revising them, allowing the others to proceed unhindered. insynchcs.com
Iris Medical – Iris Medical's billing service employs a committee-style system that has experienced staff focus on one aspect of the billing process. The company turns around claims within 24 hours of receiving them from the practice. iris-health.com
iSalus Billing Service – iSalus Medical Billing Service includes an end-to-end billing service as well as training and meaningful-use certification for 4 to 12 percent of monthly collections, depending on your practice's size, specialty, and volume. isalushealthcare.com
Medical Billing Professionals – Medical Billing Professionals offers several plans for revenue cycle management services with a pay per claim model, rather than a percentage of net collections. The company also includes plans specific to chiropractors, physical therapists, and mental health providers. mbpros.com
Nationwide Medical Billing – Nationwide Medical Billing offers full-service revenue cycle management that includes overnight data entry, claims scrubbing, electronic submissions, claims follow-up, denial management and full reporting. Practices have on-demand access to all data associated with their billing operations, as well as digitization of paper documents and access to electronic remittance advice and explanations of benefits documents. https://www.nwmedbill.com
Office Ally Practice Mate - Created by A&B Billing Associates, Office Ally Practice Mate is HIPAA compliant and the website has 128-bit encryption. You can access your data, which is stored on Office Ally network serves, at any time and from any place. myabbillingassociates.com
Precision Practice Management – Precision Practice Management's medical billing service serves about two dozen specialties and offers custom financial reports to help clients monitor their financial health. precisionpractice.com
ProMD Practice Management – ProMD's medical billing service aims to increase collections by up to 20 percent. The company also helps providers obtain their insurance credentialing if they are not yet credentialed upon signing up with ProMD. promd.us
Talisman Solutions – Talisman Solutions provides an end-to-end medical billing service, medical coding assistance and medical transcription services. The company claims it maintains a 95 percent first-pass claims rate, making it highly competitive by industry standards. talismansolutions.com
If you’d like your company to be added to this list and possibly considered as a best pick for our next round of reviews, please email your request to email@example.com.
Ready to choose a medical billing service? Here's a breakdown of our complete coverage:
Full List of Medical Billing Services
Editor's note: Looking for a medical billing service? Fill out the below questionnaire, and our vendor partners will reach out to you with more information.