The Best Medical Billing Services of 2024

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.

“A medical biller will create, scrub and submit daily charges, as well as work Clearinghouse rejections, post payments and work denials  and send any applicable balances to patient responsibility,” said Stormy Sturz, CPC, CPMA, vice president of operations for Complete Practice Solutions. “A medical biller will also often aid the front office in ensuring the proper entry of patient insurance information.”

*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.

Medical billing services can handle part or all of your medical billing, including charge entry and coding, claims scrubbing, submitting claims through a clearinghouse, and following up with payers on unpaid, denied or rejected claims. Medical billing is a complex and time-consuming process; outsourcing your billing to a revenue cycle management service can save you time and money while allowing your team to focus on other tasks needed to run your medical practice.

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

“In addition to a percentage of collections, a revenue cycle management company will likely charge for additional services such as credentialing, contract negotiations, coding services, authorization services, and custom reporting,” Sturz said.

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.

“A medical practice may decide to have in-house billers if they are a smaller practice with knowledgeable and trained staff to handle all areas of the revenue cycle,” Sturz said. “When determining the cost difference between an in-house or outsourced billing scenario, you would want to keep in mind the extra costs having an in-house biller comes with.”

According to Sturz, in addition to an in-house biller’s salary, employers typically offer PTO, healthcare benefits and workers comp insurance. “When you outsource your billing, you don’t have to worry about those extra costs, as well as the HR maintenance of those employees,” Sturz added.

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.

Medical billing services may handle the entire billing process or just part of it. The key features to look for in a medical billing service, especially if you want to completely outsource your billing, include the following.

• 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: Medical billing services should scrub claims for errors that payers commonly reference in denials or rejections. The result will be a higher FPAR and faster payment. “Claim scrubbers are a useful tool to identify common coding errors such as bundling, ICD mismatch/NCD linkage errors, and invalid code entries amongst many others,” Sturz said. “Rules Engines are particularly useful for building your own custom errors based on your own knowledge of a particular situation to ensure that claims are going out as clean as possible per payer guidelines.”
• 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. “You should expect full transparency from a medical billing service within your medical software platform,” Sturz said. “Stray away from companies that plan to bill services out of a separate software.”

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 on 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.

Choosing the right medical billing service offers some significant benefits for your medical practice. When you work with an RCM partner that does a good job, you can expect the following.

• Greater efficiency: Outsourced medical billing can be key to ensuring your team isn’t overworked, especially if you’re a small practice. 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, resulting in more collections more quickly. Given their many responsibilities, even the best in-house teams can rarely achieve the revenue peaks possible with outsourcing.
• In-depth data and analytics: Many medical billing services 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. These reports can give you a clear view of your finances and show you 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.

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.

“You’ll want to ensure that your medical billing service has implemented & maintains timely billing processes, from claim creation to submission, and in every other area of the claim cycle,” Sturz said. “Your medical billing service should provide you with monthly reporting that includes a financial summary (charges, payments, contractual adjustments) as well as both patient and insurance aging reports.

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.

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.

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.

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.

At Business News Daily, our team of small business billing experts have been researching and testing medical billing services for years, comparing some of the leading solutions across more than 20 key metrics. We considered 14 medical billing platforms and closely reviewed and tested 10 of them before selecting our six best picks above.

Below are the factors we considered when determining our best picks. Each is weighted according to how much the criteria typically influences business owners’ buying decisions.

• Pricing (30%): We considered not just the base cost of the software but also the number of pricing plans, contract minimums, additional fees and add-on costs to determine which provide the most value per dollar.
  
• Features (25%): We particularly evaluated the medical billing process from start to finish, including charge entry and coding, claims scrubbing, clearinghouse integrations, rejection and denial management, and ERA posting. We also looked for medical billing services that provided clear reporting through integrations with medical billing software.
  
• Usability (20%): We considered the medical software each billing service worked within and how user-friendly these platforms were. We placed particular emphasis on medical billing services that offered flexibility in medical software, allowing practices to keep using the platform they are already familiar with.
• Customer Support (15%): We examined the ease with which customers can contact the team in need of help. We reviewed customer feedback to determine how well the customer service team meets the needs of existing customers.
• Expert Insight (10%): Our product reviews are conducted by industry experts who are deeply familiar with medical billing services. Given their institutional knowledge of different platforms and firsthand experiences using these programs, we take their judgment into account when determining our best picks.

In addition to scoring each medical billing service we reviewed based on this criteria, we also determined the best use case scenarios for each. No two businesses are exactly alike, so we put ourselves in the shoes of different types of small business owners and identify the best medical billing service for a variety of needs.

To learn more about how we review and test billing products and services for small businesses, read about our editorial process here.