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CareCloud

Best Low-Cost Medical Billing Service

A Business News Daily Review

Product and service reviews are conducted independently by our editorial team, but we sometimes make money when you click on links. Learn more.

After conducting research and analysis of medical billing services, we recommend CareCloud as the best low-cost medical billing service.

We chose CareCloud from a pool of dozens of medical billing services. To learn more about our full methodology and for a more comprehensive list of medical billing companies, see Business News Daily's best picks.

CareCloud's medical billing service has three different tiers, each of which offers a different scope of service for practices with different billing needs. Whether you need the services of full revenue cycle management or you want to keep costs down by only outsourcing a portion of your billing process, CareCloud has a plan to match.

CareCloud charges a percentage of a practice's net collections, and the percentage varies by the selected service tier and the practice's size, specialty, claims volume, and billing complexity. CareCloud's medical billing service, known as Concierge, works with practices of any size and specialty. It also offers a good organization-wide first-pass claims rate of 94%.

Editor's note: Looking for a medical billing service for your practice? If you're looking for information to help you choose the one that's right for you, use the questionnaire below to receive more information from our vendor partners.

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The service's exact billing process depends on which service level you choose. Clients at the lowest tier only outsource a portion of their billing operations, while those at the highest hand off all their billing to CareCloud. These are the plans available through CareCloud Concierge:

  • Concierge: The most limited level of managed billing that CareCloud offers, Concierge requires practices to generate their own claims by capturing charges and coding them appropriately. With Concierge, CareCloud will take over the claims submission and denial management process, getting claims to the appropriate payers in a timely manner and then monitoring for any rejections. If a claim is rejected, CareCloud's billing team will work to revise and resubmit the claim as needed.
  • Concierge Plus: The second tier is similar to the first, except CareCloud adds a claims scrubbing step to the process. Using its rules engine, CollectiveIQ, CareCloud checks each claim against a database of more than 120 million common errors. If a potential mistake is flagged, its billing team will more closely review that claim prior to submission.
  • Concierge Pro: Concierge Pro is CareCloud's full revenue cycle management tier of service. CareCloud will access clinical documentation from the practice to generate claims by performing charge entry and coding services. Once created, those claims are put through the CollectiveIQ claims scrubbing system and adjusted if needed. Once scrubbed, the claims are submitted through the appropriate clearinghouse or directly to the proper payer. CareCloud billers will follow up on unpaid claims and work any denials all the way to the point of payment.

CareCloud boasts a good organization-wide first-pass claims rate of 94%, meaning only 6% of the claims it submits are denied and require additional work. The CollectiveIQ database, which is used to scrub claims prior to submission, is regularly updated with new rules anytime a CareCloud client encounters a problem that was not previously indexed. That means your practice has the benefit of learning from denials that occur across CareCloud's entire network of clients.

CareCloud also performs billing functions related to the patient directly. The company follows up on any outstanding patient statements by sending reminders and working to collect the funds quickly. Once the money is collected from either patient or insurance payer, the funds are deposited directly into the practice's accounts, minus CareCloud's service fee.

At all levels, CareCloud helps ensure practices are enrolled in Electronic Data Interchange (EDI) with payers, which allow practices or third parties acting on their behalf to submit claims and receive payments electronically. CareCloud's billing team includes certified coders with certifications from organizations such as the AAPC and AHIMA. CareCloud works with several clearinghouses, including Change Healthcare, TriZetto, Availity and Optum. The company also works directly with Medicare-associated payers.

CareCloud charges its client practices monthly, based on a percentage of their net collections, like all the other medical billing services in our review. The precise percentage depends on the service level the practice selects, as well as on practice size, specialty, claims volume, claims value and the complexity of their billing operations. The typical CareCloud client can expect a cost between 3% and 7% of its net collections, which represents a low cost to an average cost among the other companies in our review.

This service can be somewhat expensive upfront because it charges one-time fees to get providers started on the system. Included in these fees is CareCloud's assistance getting all providers enrolled in Electronic Data Interchange (EDI) with the appropriate payers, which is required for practices (or third parties acting on their behalf) to submit claims and receive payments electronically. The startup fees are $5,000 per provider for the first three providers, and then $2,750 per provider after that. While these costs are high compared to other medical billing services in our review, they are generally offset by the lower percentage cost practices will pay over time.

CareCloud requires a minimum contract commitment of one year, though many of its clients are contracted for as long as three years. The company cites its implementation and training period requirements as a primary reason for signing a longer contract, though it is not required. It also includes a minimum payment amount each month that is calculated based on the expected monthly collections of a practice. Minimum monthly payments were not uncommon in our review, though not every company included monthly minimums in their contracts.

CareCloud offers both a proprietary electronic health records (EHR) system and practice management software. Revenue cycle management clients must use CareCloud's practice management platform because all billing is performed through that system. Use of the company's EHR software is optional, although it is included in the price of the billing service.

All billing activity performed by CareCloud can be viewed within the practice management system, so any activity that occurs will be available in the practice management system in real time. Moreover, practices can use the practice management software's reporting tools to gain deeper insights into their financials. CareCloud's "command center" provides a high-level overview of a practice's key performance indicators, such as revenue, collections by payer and outstanding claims. The system also includes more than 150 report templates that can be scheduled to run on a daily, weekly or monthly basis using data updated in real time.

For practices that want even more control over their data, CareCloud's analytics tool includes a massive spreadsheet that contains all the data stored across both the EMR and practice management platform. That spreadsheet can be sorted and filtered in any way useful to the practice, as well as being used to generate customized reports. All data is exportable to Microsoft Excel.

CareCloud offers practices a dedicated account manager upon signup, who acts as a liaison between the practice and the company. The account manager is responsible for answering questions about the system, helping to train in-house staff and keeping the practice fully apprised of all billing operations. The company also has a U.S.-based support staff available every weekday from 8 a.m. to 9 p.m. EST. In addition, there is a ticket system for requesting help with technical issues and a ticket tracking system that allows you to monitor progress on any outstanding requests for technical help.

CareCloud helps practices with EDI enrollment and ensures all providers are properly credentialed with the appropriate payers. Not all medical billing companies offer credentialing assistance, and its inclusion here accounts in part for the high implementation and startup fees that CareCloud charges. The company also offers training to in-house staff the proper use of their systems. Once signed up, a practice will also have a unique login to access the CareCloud community, which connects the practice with other CareCloud clients to discuss tips and tricks, ask questions, provide support, and review answers to frequently asked questions.

The main limitation we discovered with CareCloud is its significant setup fees, which are steep compared to other medical billing services we reviewed. Even among companies that do charge setup fees, CareCloud is the most expensive. While these fees are one-time costs incurred during onboarding, they can become a significant upfront expense, especially for a practice on a tight budget.

CareCloud's lowest tiers are great options if you're trying to keep costs down, but before signing up, be aware that the setup fees are a requirement you'll have to meet. Of course, any implementation fees must also be weighed against the expense of keeping billing in-house, which is a recurring salary cost, oftentimes for multiple staff members. Despite the high setup fees, CareCloud remains our best pick for flexible medical billing service for its versatile offerings and ability to adapt to a wide range of billing operations and workflows.

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

Editor's note: Looking for a medical billing service for your practice? If you're looking for information to help you choose the one that's right for you, use the questionnaire below to receive more information from our vendor partners.

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Adam C. Uzialko

Adam C. Uzialko, a New Jersey native, graduated from Rutgers University in 2014 with a degree in political science and journalism and media studies. He reviews healthcare information technology, call centers, document management software and employee monitoring software. In addition to his full-time position at Business News Daily and Business.com, Adam freelances for several outlets. An indispensable ally of the feline race, Adam is owned by four lovely cats.