The Best Medical Billing Service Providers of 2019

Revenue cycle management (RCM) is an important, albeit cumbersome, part of running a medical practice. Billing is not straightforward for healthcare providers like it is in other industries. It requires the coding and submission of claims to clearinghouses and payers, and payments for the same services can differ depending on the payer. Plus, you have to monitor denied claims so they can be altered and resubmitted. Managing the whole process as more claims are going out can be a nightmare, which is why hiring a medical billing service is often an attractive option.  

The trouble is there are so many medical billing services out there. How do you know which one will live up to your standards? To make your search easier, Business News Daily reviewed some of the best medical billing services for medical practices in 2019.

ICD-11 standards have been proposed and are under consideration by World Health Organization member states.

In May 2019, the World Health Organization (WHO) proposed new standards for the 11th edition of the International Classification of Diseases (ICD-11). ICD-11 would expand the library of diagnostic codes from the 14,400 of the existing ICD-10 to 55,500. Many medical practices and healthcare IT products in the U.S. only transitioned to ICD-10 within the past few years. However, ICD-10 became the global standard back in 1998, so the WHO's move to release ICD-11 isn't unexpected. Still, for those worried about yet another burdensome transition on the horizon, there is likely plenty of time before member states ratify and implement the new ICD-11 standards. If adopted, ICD-11 won't go into effect until January 2022, meaning ICD-10 will remain the industry standard for at least a few more years.

Still, it would be wise to keep an eye on how ICD-11 proceeds through the bureaucratic process so you have time to prepare for any changes implemented down the line. The shift from ICD-9 to the more expansive ICD-10 was challenging for many healthcare IT vendors, so it should be no surprise if work related to the shift from ICD-10 to ICD-11 begins immediately after the standards are adopted. Knowing how your medical billing service or practice management vendor plans to address the changes is crucial to ensuring your practice doesn't fall behind.  

The medical billing service market will continue its growth.

The global medical billing service market has grown unabated as ever-changing regulations and technology continue to remake the healthcare industry worldwide. According to Market Research Engine, the global medical billing service industry will eclipse $16 billion in total value by 2024. The growth is largely spurred by rapidly changing healthcare regulations and a need for providers to decrease labor in-house while increasing their revenue streams. However, growth will also be constrained, the report reads, by the reluctance of providers to grant third parties access to their patients' medical records. That constraining factor could likely be addressed by services that are willing to provide documentation regarding their staff's certifications and demonstrate evidence their operation adheres to data privacy laws, such as HIPAA.

If you opt to have your own staff cover medical billing, you'll be responsible for coding, submitting and following up on claims. That means 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'll need staff to manage that as well. 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 gives you 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 yet, if the proper time and attention are not given to the billing process, you might end up losing out on a substantial amount of money.

Medical billing services can alleviate that burden and wholly manage your revenue cycle for a percentage of your collections or a subscription fee, but it might end up being more expensive than in-house staff. A good medical billing service will increase your collection rate, reduce rejections and denials, and even provide an analysis of your accounts receivable – while freeing up your staff 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.

Regardless of which option you choose – in-house billing or outsourced RCM – you're going to need practice management software. If you choose to outsource your billing, discuss with your billing partner which software they are familiar with. You'll also need to ensure that software is interoperable with your electronic health record (EHR) system.

At best, outsourcing your revenue cycle management can result in more money for your practice without allocating your own staff to complete the arduous tasks of coding and billing. But how can you possibly know which billing service to trust with something as important as your revenue cycle management?

When selecting a medical billing service, there are a few things to keep in mind. Of course, you'll want to know the costs of the service, but 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 help guide your practice. You can locate a professional consultant here. But if you decide to go it alone, there are some questions that should be on your mind when selecting a medical billing partner. Here are a few aspects to consider before buying:

Costs

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. Companies most commonly 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:

1. What specific services are included in the monthly percentage I am paying?
2. Are clearinghouse fees included in the percentage, or are they charged to my practice in addition to the percentage?
3. Does the percentage include any co-pays my staff collects at the time services are rendered?

Services

Most billing companies will scrutinize your claims for errors before processing them, and many follow up with the insurance company to ensure the claims are accepted. However, some companies will also provide a periodic analysis of your accounts receivable, along with recommendations on how to improve your practice's financial performance. Others even include access to an electronic health records system and/or practice management software. When you're selecting the company to outsource your RCM to, it will be important to consider which services your practice and patients need. You'll also want to consider the following:

1. Does the medical billing service have certified coders on staff, or will my practice be responsible for coding?
2. If the billing service does perform coding, is it up to date with the transition to the more robust ICD-10 coding system?
3. How detailed are the financial reports from the medical billing service? Can my practice expect analysis and suggestions to improve performance?
4. Does the medical billing service have experience with billing for my specialty?

Support

You'll want a communicative billing partner that keeps you engaged at every turn. Most companies offer software that allows practices to regularly review their revenue cycle, claims and rejections. You'll want to ensure that your medical billing partner will 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:

1. Can I access information about my practice's revenue cycle at any time?
2. What can I expect from the medical billing service when a mistake is made?
3. Will the billing service provide my practice with copies of any "explanation of benefits" or "electronic remittance advice" documents it receives from payers?

Patient Engagement

A medical billing service should also keep your patients in the loop and deal with delinquent accounts. Many billing services will send patients their statements directly and transfer unpaid accounts to collection agencies if necessary. Some medical billing services field phone calls and address patient questions as well. Some companies even offer a patient portal, where patients can directly access and pay off their accounts. You'll want to be sure your medical billing partner is willing to stay engaged with your patients and keep them abreast of what they owe. You'll also want to find out the following:

1. How long will the billing service wait to transfer unpaid balances to a collection agency?
2. Is a patient portal included in my monthly percentage, or is it an additional cost?

We researched dozens of prominent vendors in the medical billing space to determine which were worthy of our best picks. Our initial research included reviewing client testimony, other reviews, company websites and Better Business Bureau ranking. We also examined brands' other offerings in the healthcare space; for example, we considered whether they offer electronic medical record software. We used the information we gathered to narrow down our initial vendors list to 10 finalists to be considered for reviews and best picks. Once the list was narrowed down, 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 electronic medical records 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 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 DrChrono as the best medical billing service for small practices, AdvancedMD as the best medical billing service for large practices and CareCloud as the best low-cost medical billing service.

In our 2018 review of medical billing services, we selected Human Medical Billing as our best pick for flexible medical billing services. In 2019, we updated the criteria we used to review companies and eliminated this best-pick use case and company from our selection. However, if you'd like to read our previous review for Human Medical Billing services, you can see the full review here.

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

Kareo – Kareo's revenue cycle management services include a rules engine for claims scrubbing prior to submission, as well as a claims-tracking tool that allows you to monitor the status of your claims in real time. The company also offers a billing analytics tool, which breaks down the financial health of your practice and offers an additional level of transparency into billing operations. kareo.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

MTBC Practice Pro – MTBC Practice Pro includes a complete medical billing service with access to an integrated electronic health record and practice management platform. The process includes built-in claims automation and complete claim follow-up. mtbc.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

Nuesoft Technologies – Nuesoft Technologies' NueMD medical billing service was recently acquired by AdvancedMD. The service is highly customizable and can work with a variety of different specialties to get claims adjudicated in about 30 days. nuemd.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: b2bconsiderrequest@business.com.

Ready to choose a medical billing service? Here's a breakdown of our complete coverage:

• Best Medical Billing Service for Large Practices
• Best Medical Billing Service for Small Practices
• Best Low-Cost Medical Billing Service