How to Choose a Medical Transcription Service: The Best Medical Transcription Companies of 2020

Healthcare organizations generate a lot of notes every day, from clinical documentation of patient encounters and patient records to administrative documents. Voice recognition software has become a go-to way for many healthcare providers to dictate their clinical documentation, but it has its limitations. Accuracy remains spotty, requiring providers or their assistants to spend a great deal of time proofreading work that has already been completed. While speech recognition software is improving all the time with new technological advances, sometimes medical documents require a human touch.

For those times, there are medical transcription services, which allow healthcare organizations to outsource their medical transcribing. By simply uploading audio files that you deliver to them by one of several methods, a medical transcriptionist can turn your voice into written health records. These transcription services' accuracy rate is generally much higher than speech recognition software's, and proofreading is part of their quality assurance processes. Some medical transcription services go above and beyond by entering data into the appropriate systems for you.

Choosing a medical transcription service can be difficult at first, as you must separate the wheat from the chaff. Transcription outsourcing requires you to send sensitive information to a third party; not only must you be sure it will deliver a quality product so you get your money's worth every time, you must also trust it to manage your patients' records with care.

This guide will help you conduct your research of the medical transcription industry and vet companies before signing up for their services. Business News Daily has also arrived at several best picks and written extensive reviews of their services to help you in your buying journey.

Medical transcription services have long been a tool of medical practices and hospitals. Trained transcriptionists – whether they're employed in-house or by a third-party service – save physicians time by writing out and editing dictations for personal notes, charts or communications with other medical professionals. Third-party transcription services often have several layers of quality control, meaning more pairs of eyes scour the transcribed document for mistakes before it's returned to the dictating physician. Most services charge a fee – usually 6 to 14 cents – per line of transcription, but for a practice that generates a lot of reports, it can be worth the cost to shift that workload to an outside source.

In recent years, the medical transcription industry has undergone a massive shift that has made another option widely available. The arrival of relatively cheap and fairly accurate voice recognition software has driven down the demand for human transcriptionists. With voice recognition software, physicians can complete their reports and finalize them in real time, without waiting for a transcriptionist to return it.

While voice recognition software reduces turnaround time, the dictating physician now must act as the proofreader as well. Although voice recognition software has come a long way, it still makes plenty of mistakes and requires human oversight. Many physicians find the extra workload unnecessary and irritating, and more errors are likely to get through without the added layers of protection a transcription service offers. Others see voice recognition software as the best, cheapest way to quickly and efficiently generate notes and reports.

Dr. Joseph E. Glaser, a nuclear medicine physician at Radiologic Associates PC, told Business News Daily that whether you use a trained transcriptionist or voice recognition software is really a matter of your own workflow and personal preference.

"You have to look at the needs of your practice," he said. "If you dictate very infrequently and somebody in your office [or employed at a service] can take dictation, it might not pay for you to invest in medical transcription software. If it's frequent, you might want an in-house software package, but then it depends on the kind of work the doctor is going to do all day. It comes down to workflow."

A key benefit of both transcription services and voice recognition software, according to Dr. Kathleen A. Bishop, a professor of health sciences at Purdue University Global, is that they allow doctors to have more personal encounters with patients, rather than be distracted by filling out charts during the appointment.

"Medical transcription services allow the physician to record the patient information at their leisure, which can be sent to a service that can transcribe it while the physician takes his or her time with the patient," Bishop said. "[The physician] has the ability to look the patient in the eye and hold their hand, if need be, instead of looking at a computer screen documenting the visit."

If you decide a trained human transcriptionist is the best option for you but don't want to allocate internal resources to the task, a third-party transcription service could provide a great deal of assistance to your medical practice. You have to know a few things about the company you're partnering with first, though. Business News Daily spoke with some experts in the industry to find out what questions you should ask.

Costs 

Previously, the industry standard was 6 to 14 cents per line (a line being 65 characters). Now, there is a shift toward what are known as "visible black characters," or VBCs. A VBC is any character of typed text, like a letter or punctuation mark, so spaces don't count. According to Eric Slimp, purchased services director at TractManager, the VBC model is intended to make pricing more specific and exclude spaces from the costs. There are usually about 52 VBCs per 65-character line, he said, so if one line costs 10 cents, for example, each individual VBC would cost 0.19 cents. However, Slimp added, the per-line model does still exist, so be sure you understand the pricing model spelled out in the contract before you sign.

Turnaround Time

Most transcription services have a standard turnaround of about 24 hours. However, some documents can be completed even quicker, and many services can prioritize certain documents for an additional fee. For standard documentation, if a company's turnaround time is much longer than 24 hours, you might want to shop around a bit more.

Domestic and Offshore Services

Another big consideration is how much transcription a third-party service performs domestically and how much it offshores. Offshoring results in a cheaper rate but often sacrifices a bit of accuracy. Make certain that the contract specifies the percentage split (for example, 65% domestic, 35% offshore). Also consider your needs. If the majority of your transcribed documents are for your use only, maybe a heavily offshored service is fine for you. But if the documents must be perfectly accurate, like for clinical records or communications with other providers and health systems, then you'll want the transcription to be done domestically.

Layers of Oversight

A good transcription service will offer two to four layers of quality assurance – meaning three or four individual people, including the transcriptionist, will take a look at your transcribed record before it is returned for your signature. This practice virtually guarantees that errors will be caught and rectified before the transcribed document is returned to your practice. However, some transcription services only have one layer of human oversight. You'll want to know exactly how many pairs of eyes look over your documents before they are returned. More oversight means fewer mistakes. You should also make sure your documents are being created by a certified medical transcriptionist.

Specialty Experience and Certified Transcriptionists

The documents you need transcribed might be very different from those of other specialties, so it's always important to ensure the company you contract with has experience serving your specialty. You should check references for the company and ask to see examples of its past work for your field. Remember, if the company provides you with a list of references, they are probably only the favorable ones. Ask for a complete list of the company's clientele in your area and field to get the real scoop. You'll also want to make sure the company employs certified medical transcriptionists who are well trained and experienced.

Once you choose a medical transcription service, you can begin dictating. There are several ways to do this, and the method might vary based on the service you select. Sometimes, physicians will dial in to the company's database by phone and dictate into the system, where a transcriptionist will access the recording to create the written record. Other times, physicians can use an audio recorder and digitally upload the files to the transcription service. If you prefer, you can always send recorded tapes by snail mail, but this will likely have a slower turnaround.

With the increasing effectiveness of voice recognition, physicians often use the software and employ transcription services more as proofreaders and editors. It's also common for a service to offer a mobile application for Apple or Android devices, through which you can create audio dictations that are uploaded directly to the company's database. Overall, medical transcription services tend to be pretty flexible in how they accept dictation.

The experts and professionals consulted for these tips include Dr. Joseph E. Glaser, nuclear medicine physician at Radiologic Associates PC; Eric Slimp, purchased services director at TractManager; and Dr. Kathleen A. Bishop, professor of health science at Purdue University Global.

1. Consider your workflow.

No solution is right for every practice. Your workflow, the preferences of your staff, your specialty and your practice's needs all influence which service or product will be most effective. For some practices, outsourcing transcription services might be an immense benefit; for others, it could be a waste of valuable resources when in-house voice recognition software would have sufficed. It's all about how you work, the volume of your documentation, and what your practice best adapts to. Look at transcription from all angles before deciding which direction to go.

"If you're looking to retrofit an existing practice, or a transcriptionist is retiring, you could consider getting a service that's used infrequently," Glaser said. "If you're going from room to room seeing patients all day … [then you might] prefer to have a transcriptionist look at the dictation later."

2. Spell out absolutely everything in the contractual terms.

When negotiating with any third-party service, it's important to know exactly what you can expect from it and at what cost. This means taking the time to sit down and negotiate the contract that you need line by line. It can be an arduous task to make sure before signing that the contract includes every last detail, even the seemingly understood ones, but it's well worth it for your practice. You can also use the terms of the contract to hold the company accountable for its performance.

"Build quality metrics into the contract," Slimp said. "The way we see it typically is that it will be a tiered scale, where it will have certain percentages … You want to shoot for 98% accuracy in general, that being for major errors. There will be just typos and things like that. Minor errors are OK, but you want to strive for 98% of charts without major errors."

Slimp said you can enforce the target metrics by negotiating some incentives for when the company delivers exceptional service and penalties for when it demonstrates poor service. Make those quality-control metrics measurable and grounded in statistics that you can easily demonstrate with the transcribed reports you have on record.

3. Make sure you only pay for what you need.

Many vendors pride themselves on flashy features and a lot of optional components. While some of these might be useful for you and your staff, it's worth considering whether you really need all the latest features and frills. If all you need is effective, accurate transcription, then you should only pay for the basic package. Scrutinize the pricing models: Find out if it's a one-time fee or a monthly subscription, and also ask about the frequency and cost of software updates. As always, inquire about the level of support you can expect from the vendor if something goes wrong.

"Some companies can be very expensive and want to give you all the bells and whistles when you only need the basic package," Bishop said. "Find out how much it will cost – is it a one-time price, or do you pay for the software/hardware and then a monthly or yearly fee? Are there upgrades of the software, and if so, are they free, and how often do they upgrade? And if there is a bug or glitch in it, how quickly do they get it fixed?"

4. Make sure the software interfaces with your existing systems.

Any software that you might use, either on your own or in conjunction with a medical transcription service, has to be compatible with your electronic health records (EHR) system and practice management system. In today's increasingly digitized healthcare industry, the ability to generate and share records across platforms – both in your office and other providers' offices – is invaluable. Any software necessary for the transcription process needs to be able to properly communicate with all the electronic aspects of your practice.

"Everything has got to work together," Glaser said. "It's a question you must pose to the vendor when you're buying these things. I've seen some practice management systems with transcription built in … but you have to make sure it can interface with your records system as well."

5. Always check references.

As with any other major purchasing decision, it is important to perform thorough research before buying. Ask for a complete list of the company's references within your specialty, not just a predetermined list of positive reviewers. Find out from other physicians in your field how they use transcription services, what it costs them, and what the quality of their service is. You can also find ample reviews online and look up information on the company with the Better Business Bureau. If there is a dearth of information on a given vendor, that should be a signal that something isn't quite right. There's usually at least some useful information out there on any reputable vendor.

"When outsourcing, make sure you have looked at all the services that the company or transcriptionist is prepared to offer and if they actually do what they say they can," Bishop said. "Get a couple of references, look them up online, and check out the Better Business Bureau … to see how reputable they are."

6. Use your practice's small size as leverage.

If you are a small or even midsize practice, just about any transcription service will be equipped to handle the volume of reports you generate. Unlike large hospital systems, which produce so much dictation that only a large company could handle the workload, smaller practices have the option of using smaller transcription services. You can use this as leverage when considering a transcription service or negotiating a contract. You could go virtually anywhere, so make the company truly win your business.

"[A small practice] will want to use to their advantage that their volume is low enough that almost any service provider could offer them what they need," Slimp said. "Small practices have the option of going anywhere because almost anyone can handle their volume. It's important to know the playing field is really open and to use that competitive advantage as leverage."

7. Focus on getting as short a term as possible.

Finally, do your best to negotiate a short contract, or find a company that offers monthly subscriptions. That way, if the service you partner with ends up being something other than what you expected, you can always go elsewhere at the end of the contracted period. Some companies will try to lock you into a longer contract, but it's best to talk them down to one year or less. Remember, they don't have your business until you sign the contract, and simply refusing to sign on to a multiyear agreement might persuade them to reduce the timeframe. Of course, if you're satisfied with the service, you can always extend the contract in the future. 

"There are companies – and we still see this – that will want to lock you into a three-, four-, five- or even six-year contract," Slimp said. "But you'll really want to focus on getting as short a term as possible."

When choosing a medical transcription service, you should keep several factors in mind. These questions are some of the first things people wonder about medical transcription services, plus some of the most important things you should ask any specific company you're considering.

What are the benefits of a medical transcription service?

Medical transcription services offer an easy and quick way to transcribe audio dictation accurately without using internal resources. Many providers don't want to spend time typing during a clinical encounter, nor do they want to write up audio recordings after the fact. Office staff might need many documents for billing and insurance purposes. Medical transcription companies can reduce the burden of these tasks for just a few cents per line of text, freeing up your practice's staff to take care of more pressing duties.

How can a medical transcription service streamline operations?

One area where medical transcription services can improve your practice's operations is insurance and medical billing. Medical billing can be a complex and time-consuming process, but medical transcription services can optimize your charts for the most efficient billing process. With properly transcribed charts, billing teams can easily code claims and submit them properly with a lower risk of rejection or denial by the payer. Not only does a well-organized chart speed up the submission process, but the lower risk of denial means less denial management for your billing team.

Moreover, medical transcription services can help providers who don't like using EMR systems by directly transcribing audio dictation into the appropriate fields in the EMR. This can save providers hours of transcribing audio from clinical encounters, or save them the distraction of typing while seeing a patient.

What is the quality assurance process for a medical transcription service?

To maintain and improve accuracy rates, a medical transcription service should have a set quality assurance process in place. Ask any service you are considering how it guarantees the accuracy and quality of your transcripts.

Many medical transcription services ensure that transcripts go through at least two people – the transcriptionist and a proofreader. Many go beyond this standard, requiring three or even four sets of eyes to approve transcripts prior to release.

But it's not just the number of people reviewing the documents that matters. You should also inquire about certification requirements, ongoing training and specialty experience. It's important to verify that transcriptionists and senior staff maintain accredited medical transcription certifications and are regularly trained on matters such as HIPAA compliance and AHIMA standards.

What are the available turnaround times for transcribed documents?

Medical transcription services often offer some flexibility in how quickly your documents are turned around, while some only offer next-day delivery. The turnaround you need depends on the nature of your business; some healthcare organizations only need 24- or 48-hour turnarounds, while others sometimes need transcriptions performed in as little as one hour.

Of course, faster turnaround means elevated costs, so you need to build your expectations into your budget. However, it's important when researching companies to confirm whether a medical transcription service offers the turnaround times you require. If you need transcripts returned in less than 24 hours, be sure to inquire about additional costs for that. If you can wait 48 hours for them, see if there is a discount for that.

How can a medical transcription service ensure HIPAA compliance?

It is critical for any medical transcription service to fully comply with the HIPAA privacy laws. Because you are sending the company audio that likely includes sensitive patient information, it needs to not only have the proper technical security infrastructure in place, but also train its staff on the proper handling of protected health information.

Also ask a medical transcription service what encryption it uses on any portals or email inboxes that it uses to transmit sensitive information, either the audio or transcripts. Ask if any information is stored, how it is stored, how it is protected and when it is deleted. Your patients' data is your responsibility, so entrusting an unscrupulous or neglectful third party with it is a breach of confidence. Do your due diligence and make sure that the service you choose takes the proper security measures to prevent a data breach.

Security goes beyond the technical, of course. How is the transcription service's staff trained to handle sensitive data? Are its physical facilities secure? These questions might seem nitpicky, but securing your patients' data is of the utmost importance, in terms of both legal compliance and your own reputation.