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The Best Medical Billing Services of 2024

Updated Feb 22, 2024
Best for Flexibility
  • Partial or full RCM
  • No PMS requirement
  • Payer contract negotiation
  • Partial or full RCM
  • No PMS requirement
  • Payer contract negotiation
Best for New Practices
DrChrono Medical Billing
Dr. Chrono logo
  • Flexible services
  • Customizable reports
  • Integrated EMR system and PMS
  • Flexible services
  • Customizable reports
  • Integrated EMR system and PMS
Best for Reporting
athenahealth Medical Billing
athenahealth company logo
  • Thorough reporting suite
  • Similar-practice analysis
  • Hands-on consultation
  • Thorough reporting suite
  • Similar-practice analysis
  • Hands-on consultation
Best for Large Practices
AdvancedMD Medical Billing
AdvancedMD company logo
  • 96% first-pass acceptance rate
  • Highly experienced staff
  • Hundreds of customizable reports
  • 96% first-pass acceptance rate
  • Highly experienced staff
  • Hundreds of customizable reports
Best for Tracking Claims
Tebra (Formerly Kareo) Medical Billing
Tebra logo
  • Great user experience
  • Flexible services
  • Over 95% first-pass acceptance rate
  • Great user experience
  • Flexible services
  • Over 95% first-pass acceptance rate

Table of Contents

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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 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. To help you find the best medical billing service for your organization, we reviewed the following services.

Compare Our Best Picks

BND Ribbon
Our Top Picks for 2024
CareCloud Medical Billing
DrChrono Medical Billing
athenahealth Medical Billing
AdvancedMD Medical Billing
Tebra (Formerly Kareo) Medical Billing
CureMD
MedicsPremier
ChartLogic
MedicsRCM
Rating8.7/108.7/109.3/109.2/108.6/108.6/108.2/108.5/108.2/10
Best use case

Flexibility

New practices

Reporting

Large practices

Ease of use

Tracking KPIs

Growing practices

Free implementation

Growing practices

Pricing (% of monthly collections)

3% to 7%

Requires quote

7% to 8%

3% to 8%

Varies among third-party billers

Starts at 5%

3% to 6%

3% to 6%

3% to 6%

End-to-end RCM?

Yes

Yes

No medical coding or denied/rejected claims management in some cases

No medical coding

Works with third-party billers

Yes

Yes

Yes

Yes

Contract requirement

3 years

1 year

2 years

1 year

30-day cancellation notice

1 year

Varies

2 years

Varies

Practice management software required?

Yes (from any vendor)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

First-pass claims acceptance rate*

~97%

96%

93%

96% (contractually guaranteed)

>95%

96%

~99%

>95%

~99%

Review Link
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*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

CareCloud Medical Billing: Best Flexible Medical Billing Service

  • CareCloud is a medical billing service provider that can manage part or all of your revenue cycle.
  • Unlike almost every other medical billing service we reviewed, CareCloud doesn’t require you to use its PMS.
  • CareCloud’s setup process is expensive, and the company typically requires a three-year contract.
Editor's Rating: 8.7/10
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CareCloud is a medical billing service that can manage part or all of your revenue cycle. You can also opt in to CareCloud’s medical software and consulting services when you hire the company for RCM. Even better, CareCloud is unlike most medical billing services in that, as of its 2020 acquisition by MTBC, it doesn’t require its RCM clients to use its PMS. This PMS-agnostic structure is exceedingly rare among medical billing services.

Like every medical billing service we reviewed, CareCloud takes a percentage of your monthly collections as its commission. The percentage you can expect to pay is between 3% and 7%. Rates on the high end are common among medical billing providers, but rates on the low end are somewhat rare. Your exact rate will depend on standard factors such as your average claim volume and value, billing complexity, specialty, and practice size.

CareCloud is a flexible and often low-cost medical billing solution, minus its setup. CareCloud often charges high setup fees, typically no less than $1,000, which could exceed the budgets of smaller practices. For high-revenue practices in need of flexible solutions, however, CareCloud is an excellent choice.

CareCloud also includes a platform designed for physical therapy (PT) practices. The platform is an enhanced version of CareCloud’s talkEHR system that integrates with CareCloud Remote. According to CareCloud, Remote streamlines revenue cycle management and improves the bottom line for PT practices.

Additionally, talkEHR has earned recognition from Google as Chrome Enterprise Recommended, verifying that talkEHR meets all of the company’s rigorous security and testing standards.

CareCloud RCM customers who also use the brand’s EMR software should soon expect enhanced generative AI features within the platform. These tools, which CareCloud developed in partnership with Google Cloud, can surface key medical and insurance data as practitioners assess treatment options. Smarter, more efficient decision-making is the expected result.

DrChrono Medical Billing: Best Medical Billing Software for New Practices

DrChrono Medical Billing
Dr. Chrono logo
  • DrChrono is great for new practices in need of medical billing, as it handles the entire revenue cycle.
  • DrChrono has a high FPAR of 96%.
  • DrChrono requires you to use its practice management software as well as its EMR system.
Editor's Rating: 8.7/10

In our review, we found DrChrono’s RCM services ideal if you are opening a new medical practice and need a lightweight yet effective system to get started. The company can handle your entire billing cycle, from charge entry and coding to final payment, while achieving an above-average FPAR of 96%.

DrChrono not only thoroughly scrubs your claims before filing them, but it also monitors your claims throughout the approval process. These processes largely explain how DrChrono achieves its high FPAR. In the rare event that any claims are denied, DrChrono will oversee the entire process of rectifying them and getting them approved and paid.

DrChrono’s RCM services include access to its EMR system and PMS. Like most medical billing services, DrChrono requires you to use its PMS. However, unlike most services, DrChrono also mandates that you use its EMR system, and you’ll have to pay for the data migration if you need to switch EMR platforms to make this happen.

EverCommerce, a medical software-as-a-service company, recently acquired DrChrono. This acquisition has resulted in EverCommerce adding DrChrono to its EverHealth integrated medical software.

That said, EverCommerce already has its own medical billing service, AlertMD. It remains unclear whether EverCommerce will merge AlertMD and DrChrono into one new product or AlertMD will absorb all DrChrono medical billing features and staff. For now, DrChrono remains a distinct entity with no changes to its medical billing operations.

athenahealth Medical Billing: Best Medical Billing Service for Reporting

athenahealth Medical Billing
athenahealth company logo
  • Athenahealth’s consulting and reporting services go above and beyond those of most RCM services.
  • The athenahealth rules engine scrubs your claims based on common denials from a uniquely large network of nearly 7,000 other practices.
  • Athenahealth often won’t enter and code your charges or manage all your denied claims, so you’ll need an in-house medical biller.
Editor's Rating: 9.3/10

In our review, we found that athenahealth is an excellent RCM pick for practices interested in a hands-on consultative approach.

Athenahealth’s medical billing team will use its rules engine to scrub your claims for common errors. The information behind this engine comes from common payer denials among athenahealth’s vast network of nearly 7,000 practices and 150,000 providers. You can customize athenahealth’s services to reflect your payers’ common reasons for denial as well.

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.

AdvancedMD Medical Billing: Best Medical Billing Service for Large Practices

AdvancedMD Medical Billing
AdvancedMD company logo
  • AdvancedMD has an especially high first-pass acceptance rate of 98.4%.
  • AdvancedMD is well versed in working with large practices.
  • AdvancedMD won’t code or enter your charges.
Editor's Rating: 9.2/10

We’ve chosen AdvancedMD as the best medical billing service for large practices. Its RCM team boasts a first-pass acceptance rate (FPAR) of 97.68%, 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. That said, you’ll have to do the work to get your claims into AdvancedMD’s system, as its billing services don’t include charge entry or coding.

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.

AdvancedMD also lets you send unsolicited claims attachments to carriers and track payer contractual reimbursements. The latter feature introduces the automatic inclusion of electronic remittance advice (ERA) with write-off calculations to increase the likelihood of proper payment. Through these features, your on-staff coder can more effectively and efficiently handle their part of the medical billing process.

Large practices in need of medical billing services can work with AdvancedMD. Its clients’ average number of monthly patient encounters is 317,000, though some clients see as many as 350,000 patients per month.

When it comes to customer service, AdvancedMD is implementing new tools to help ensure they are meeting their customers’ needs. Since making changes to its phone system, clients have said that the switch is resulting in more streamlined, convenient customer service. This prioritization of excellent customer service is a huge plus for AdvancedMD medical billing clients.

Tebra Medical Billing: Best Medical Billing Service for Tracking Claims

Tebra Medical Billing
Tebra logo
  • Tebra is great for small practices that want to outsource only some of their billing needs.
  • Tebra offers an especially user-friendly PMS where you can track its billing team’s progress on your claims.
  • Tebra doesn’t typically respond to its Better Business Bureau complaints.
Editor's Rating: 8.6/10

Tebra is another excellent choice for small practices, especially those that need to outsource only part of their RCM. These practices will benefit from Tebra’s ability to oversee small, modest or large swaths of the process while remaining accountable to you. Because Tebra requires you to use its PMS, you’ll see real-time updates of its billing team’s progress with your claims.

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’s automated billing service sends patients text, email and printed statements to have up-to-date records of their bills. This helps ensure that patients can receive bills in the form that is most convenient for them. The convenience and accuracy this service provides have resulted in more than 1,600 billing companies across the U.S. using Tebra.

Tebra is especially well known for its user-friendliness. Its EMR and PMS dashboards resemble social media feeds, and most features are accessible with just one or two clicks. We were slightly concerned to see that Tebra does not respond to customer complaints on the Better Business Bureau’s site. That said, conflating this lack of responsiveness with a bad product is ill-advised – overall, Tebra is quite strong.

Tebra has merged with the healthcare marketing agency PatientPop. The merger gives all customers of one service access to the other. Since Tebra’s medical billing service includes access to its EMR system, it now also includes access to PatientPop. This arrangement means that, when choosing Tebra for medical billing, you’ll also get robust patient acquisition tools.

CureMD: Best Medical Billing Service for Tracking KPIs

CureMD
CureMD medical billing blue logo
  • CureMD offers medical billing services to 32 specialties at competitive prices.
  • CureMD’s services include charge entry and billing, credentialing, and schedule review.
  • CureMD’s setup and implementation can be difficult and time-consuming, and since you must also use the company’s PMS, you can’t avoid these steps.
Editor's Rating: 8.6/10

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. CureMD says its FPAR is 96%, which is competitive with the industry standard.

Unlike many other RCM services we reviewed, CureMD handles the majority of your implementation needs and takes a substantial burden off your plate. It will also train your team on how to use its platform. Nevertheless, some CureMD customers say that the implementation process is challenging and lengthy. And it’s not like you can avoid implementing CureMD’s software – like most medical billing services, CureMD requires you to use its PMS.

CureMD recently launched a new COVID-19 rapid testing platform to help practices manage demands for testing. The software can remind patients about their upcoming appointments, send test results, and automatically scrub and submit electronic claims. It also gives each patient a “digital health card” through which they can view their testing and results history.

The good news is that, after the challenges of setup, CureMD’s medical software platform is easy to navigate. For user-friendly, low-cost, versatile medical billing, CureMD is an excellent choice.

MedicsPremier: Best Medical Billing Service for Growing Practices

MedicsPremier
MedicsPremier company logo
  • MedicsPremier’s medical billing services cost 3% to 6% of your collections, which is highly competitive even at the high end.
  • MedicsPremier says that its rules-based claim-scrubbing engine results
  • MedicsPremier has one of the least user-friendly software interfaces we reviewed, likely requiring extensive training during implementation.
Editor's Rating: 8.2/10

MedicsPremier is a low-cost medical billing service with features that offer value greater than what you’ll actually pay. MedicsPremier costs 3% to 6% of your monthly collections, a very competitive range compared to other medical billing services we reviewed.

In our review, we found that MedicsPremier will scrub your claims using a proprietary rules engine, through which it claims it can achieve an FPAR of over 99%. For any claims that slip through and get denied or rejected, MedicsPremier will manage the entire revision and resubmission process. MedicsPremier will also verify your patients’ insurance so you can know whether your payers will actually cover your services.

We like that MedicsPremier billing services include credentialing with both clearinghouses and insurance companies. The company will post any explanations of benefits and electronic remittance advice that you and your patients should see. MedicsPremier can also help uninsured patients find insurance (though the patient is ultimately responsible for signup). This service is unique to MedicsPremier.

Although MedicsPremier is a cost-effective medical billing choice, the software interface isn’t very user-friendly. Without thorough training, your team may find the software difficult to navigate effectively. However, between MedicsPremier’s low price and high FPAR, growing practices may still find it to be the right choice to build on their momentum.

ChartLogic: Best Medical Billing Service for Free Implementation

ChartLogic
ChartLogic company logo
  • ChartLogic’s medical billing services are among the most competitively priced we saw in our reviews.
  • ChartLogic pairs you with a dedicated account manager who’s well versed in your specialty and local payer rules.
  • Some clients complain of poor customer service and challenges during the data migration step of the implementation process.
Editor's Rating: 8.5/10

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.

If you use ChartLogic’s practice management system (PMS) alongside its medical billing services, you get access to FlexScanMD inventory management technology. This way, you can track your claims’ status from the same platform where you track any products your practice dispenses, sells or stocks. The result is a centralized hub for all your incoming revenue sources.

MedicsRCM: Best for Growing Practices

MedicsRCM
Advanced systems RCM logo
  • MedicsRCM’s medical billing services cost 3% to 6% of your collections, which is highly competitive even at the high end.
  • MedicsRCM says that it can lower your operating expenses by 20%.
  • MedicsRCM has one of the least user-friendly software interfaces we reviewed, likely requiring extensive training during implementation.
Editor's Rating: 8.2/10

MedicsRCM 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.

We found that MedicsRCM claims it can achieve an FPAR of over 99%. This value is among the highest we encountered in our reviews. 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 your 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. MedicsRCM says these features can increase your net collections by 7% and reduce your operating expenses by 20%.

Although MedicsRCM is a cost-effective medical billing choice, the software interface isn’t very user-friendly. Without thorough training, your team may find the software difficult to navigate effectively. However, between MedicsRCM’s low price and high FPAR, growing practices may still find it to be the right choice.

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

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

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.

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.

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

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 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. 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.

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.

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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