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Updated Jun 27, 2024

The Best Medical Billing Services of 2024

Your healthcare practice will benefit from a medical billing service with a first-pass acceptance rate that will get you paid sooner.

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Written By: Leah ZitterSenior Analyst & Expert on Business Strategy
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A business.com editor verified this analysis to ensure it meets our standards for accuracy, expertise and integrity.
Best RCM Software
RXNT
RXNT logo
  • Starts at $193 monthly per provider
  • Medical billing software only
  • 30-60-day implementation process
USALinks to RXNT
Visit Site
  • Starts at $193 monthly per provider
  • Medical billing software only
  • 30-60-day implementation process
Best for Claim Scrubbing
CareCloud
  • Costs 3% to 7% of collections
  • Three-year contract minimum
  • Implementation period varies
  • Costs 3% to 7% of collections
  • Three-year contract minimum
  • Implementation period varies
Best for Workflows
DrChrono
Dr. Chrono logo
  • Costs 4% to 8% of collections
  • One-year contract minimum
  • 30-60-day implementation process
  • Costs 4% to 8% of collections
  • One-year contract minimum
  • 30-60-day implementation process
Best for Tracking Claims
Tebra (Formerly Kareo) – MBS
Tebra logo
  • Costs 4% to 9% of collections
  • Intuitive software
  • Extensive training materials
  • Costs 4% to 9% of collections
  • Intuitive software
  • Extensive training materials
Best for Ease of Use
AdvancedMD – MBS
  • Costs 3% to 8% of collections
  • One-year contract minimum
  • 8-11-week implementation period
  • Costs 3% to 8% of collections
  • One-year contract minimum
  • 8-11-week implementation period

Table of Contents

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How We Decided

In our extensive research of medical billing services, we examined each vendor’s tools for fast, error-free revenue cycle management. We looked for providers with certified billers and coders who...

MoreMore

In our extensive research of medical billing services, we examined each vendor’s tools for fast, error-free revenue cycle management. We looked for providers with certified billers and coders who could sufficiently code and scrub claims, respond to payment denials in a timely manner and coordinate with a medical practice’s in-house staff for a seamless, efficient workflow. We compared first-pass acceptance rates and medical software integrations, on top of studying monthly costs and implementation fees.

15

evaluated

11

researched

6

chosen

In our extensive research of medical billing services, we examined each vendor’s tools for fast, error-free revenue cycle management. We looked for providers with certified billers and coders who could sufficiently code and scrub claims, respond to payment denials in a timely manner and coordinate with a medical practice’s in-house staff for a seamless, efficient workflow. We compared first-pass acceptance rates and medical software integrations, on top of studying monthly costs and implementation fees.

15

evaluated

11

researched

6

chosen

Medical billing and coding is a time intensive process that requires specialized team members, representing a significant expense for medical practices. Medical billing services exist to outsource medical billing and coding so practices can focus on serving their patients instead of chasing down payments. Their expertise also helps them streamline the process with payers, reducing days in accounts receivable and boosting first pass claims rate — that all boils down to practices collecting payments sooner.

To help you find the best medical billing service for your medical practice, we conducted hundreds of hours of research and tracked the space as it has evolved over the years. We’ve chosen the following medical billing services as our best picks, each of which provides a unique value proposition to medical practices in need of revenue cycle management (RCM) support.

athenahealth dashboard

Medical billing services handle the process of generating claims, working to get them paid and revising rejected claims so medical practice staff can focus on serving patients instead. The best medical billing services offer full transparency through a practice management software, such as athenahealth’s platform displayed above. (Source: athenahealth)

Compare Our Best Picks

BDC Ribbon
Our Top Picks for 2024
CareCloud
DrChrono
Tebra (Formerly Kareo) – MBS
AdvancedMD – MBS
athenaCollector
Rating (Out of 10)0.08.78.68.68.58.7
Best For

RCM Software

Claims Scrubbing

Workflows

Tracking Claims

Ease of Use

New Practices

Pricing

Starts at $193 per month, per provider (RCM software only)

3% to 7% of monthly collections

4% to 8% of monthly collections

4% to 9% of monthly collections

3% to 8% of monthly collections

4% to 7% of monthly collections

Contract Requirement

N/A

Three-year minimum

One-year minimum

30-day cancellation notice

One-year minimum

Two-year minimum

Implementation and Training

30- to 60-days

Varies

30- to 60-days

30 days

8 to 11 weeks

11 weeks

Mobile App

iOS/Android

iOS/Android

iOS

iOS

iOS/Android

iOS/Android

Review Link
Scroll Table

Our Reviews

RXNT logo
  • Base Price: Starts at $193 per month, per provider (practice management software subscription; no RCM service)
  • Contract Minimum: Monthly subscription
  • Implementation and Training: Implementation and training are included free with a subscription. Expect an implementation period of between 30 to 60 days.
Editor's Rating: 0/10
Visit Site

Why RXNT is Best for RCM Software

RXNT software layout

RXNT offers user-friendly medical billing software that makes it easy to generate and track claims, adjust rejected or denied claims, review electronic remittance advice (ERAs) and more. It is suitable for a practice’s in-house medical billing and coding or managing a medical billing service’s client portfolio. Source: RXNT

Pricing Plan Cost What’s Included
PM Bundle $193 per month, per provider Access to administrative software features like appointment setting, patient demographics and medical billing tools
Full Suite $298 per month, per provider Access to all the practice management features, as well as clinical tools found in RXNT’s electronic medical records software

Advantages

  • RXNT offers free implementation and training, as well as weekly coaching sessions to help medical practices make the most of the platform.
  • RXNT’s mobile application is supported on both iOS and Android devices.
  • RXNT is competitively priced compared to other medical software platforms we’ve reviewed.

Disadvantages

  • RXNT does not offer revenue cycle management services, so you can only rely on its medical billing software to perform in-house billing and coding.
  • The scalability of RXNT’s medical software is limited and may not be suitable for mid-sized and large practices or healthcare systems.
  • Customer service is often hit or miss, which can be a problem when in need of a quick solution.

Customer Reviews

RXNT received an 8.0/10 from users who reviewed the platform on TrustRadius. Users liked RXNT’s medical software and data migration process. However, some users complained about slow customer service.

  • Base Price: 3% to 7% monthly collections
  • Contract Minimum: Three years
  • Implementation and Training: Some training is included with subscription price. The implementation period varies depending on practice size, specialty and scope of needs.
Editor's Rating: 8.7/10

Why CareCloud is Best for Claim Scrubbing

We chose CareCloud as the best medical billing service for claims scrubbing because it relies upon a powerful billing rules engine, CollectiveIQ, that is frequently updated as payers provide new feedback about denied or rejected claims. Additionally, CareCloud provides some of the most detailed reports we found in our review, keeping its clients in the loop about why claims may have been rejected or denied by payers. CareCloud’s staff effectively works to absorb electronic remittance advice and resubmit claims when they’re rejected, though its first pass claims rate is among the highest we found in our review.

CareCloud layout

CareClouds’ EMR software and practice management software seamlessly integrate, making charge entry and claim generation easy. When outsourcing your medical billing to CareCloud’s RCM service, you’ll be able to track their billers’ and coders’ activities directly in the practice management software. (Source: CareCloud)

Advantages

  • CareCloud provides practices with helpful reports on common denial reasons and updates their billing rules engine regularly to align with payer feedback.
  • CareCloud does an excellent job of helping practices identify billing problems and proactively resolve them.
  • CareCloud medical billing service is fully outsourced, from claims creation and coding to denial resolution and reporting.

Disadvantages

  • CareCloud typically requires a three-year contract minimum for most RCM clients, which is the longest minimum we encountered during our review.
  • Implementation periods vary depending on the implementation tier you choose, and it may represent an additional fee.
  • Some users have complained about slow loading times, which could be disruptive to daily operations.

Customer Reviews

CareCloud received a 9.1/10 from users who reviewed the platform on TrustRadius. Users liked CareCloud’s training support and found customer service to be prompt and helpful. However, some users complained about slow loading times and bugs that occasionally crashed the software.

Check out our complete CareCloud review for more information.

Dr. Chrono logo
  • Base Price: 4% to 8% of monthly collections
  • Contract Minimum: One year
  • Implementation and Training: Implementation and training are included free at all subscription levels. Expect 30 to 60 days for the implementation period.
Editor's Rating: 8.6/10

Why DrChrono is Best for Workflow

We chose DrChrono as the best medical billing service for workflow because its practice management software is extremely user-friendly. For medical practices that want transparency into their revenue cycle management, but don’t need all the bells and whistles of more cumbersome medical software, DrChrono makes things simple and efficient. Drag and drop functionality for most of its tools makes the platform one of the most intuitive we encountered in our review. DrChrono also includes automated workflows for practice management functions, helping both the front office and medical billing team streamline their processes.

DrChrono layout

Posting patient payments is straightforward and intuitive with DrChrono, like most features the platform provides. Staff should require little to no training to become proficient with DrChrono thanks to its simple learning curve, meaning less disruptions and a seamless software launch. (Source: DrChrono)

Advantages

  • DrChrono provides an exceptional user experience for medical practices in need of straightforward medical software tools.
  • DrChrono maintains a team of medical billing and coding experts, taking the burden entirely off of medical practices.
  • DrChrono’s practice management software offers full visibility into revenue cycle management services, so you can always keep tabs on your practice’s financial health.

Disadvantages

  • DrChrono had some of the longest customer support wait times we encountered in our review and often required work orders to be submitted for minor fixes.
  • DrChrono’s mobile application is only supported on iOS devices.
  • Medical practices with more advanced software needs may find DrChrono’s slate of features to be limited.

Customer Reviews

DrChrono received a 9.0/10 from users who reviewed the platform on TrustRadius. The biggest standout praise from users was the platform’s ease of use and quick setup. However, others complained about lack of customization and flexibility.

Check out our complete DrChrono review for more information.

Tebra logo
  • Base Price: 4% to 9% of monthly collections
  • Contract Minimum: 30-day cancellation notice
  • Implementation and Training: Implementation and training are included in the subscription. Tebra offers a fast implementation period of about 30 days.
Editor's Rating: 8.6/10

Why Tebra is Best for Tracking Claims

We chose Tebra as the best medical billing service for tracking claims because it offers a highly navigable system for monitoring payments, from charge entry to denial management. We like how medical practices can easily keep tabs on everything when outsourcing their medical billing to Tebra, an important aspect of quality assurance when it comes to a medical practice’s financial well-being. We also were impressed with Tebra’s real-time reports, which are updated 24/7 and provide an instant window of visibility into all your practice’s fiscal data.

Tebra layout

Tebra’s medical billing tools include a patient self-pay option which can help you collect outstanding co-payments with ease. Patients receive a receipt that includes a breakdown of services, so they can always understand what they were charged for and why. (Source: Tebra)

Advantages

  • Tebra is easy to navigate, from monitoring the company’s medical billing and coding activities to pulling up your practice’s financial data.
  • Tebra offers a fast implementation process and requires no long-term contractual commitment.
  • Tebra’s patient self-service tools are easy to use, provide detailed information and help drive patient satisfaction.

Disadvantages

  • Tebra’s customer service is hit or miss.
  • Tebra’s medical billing service is among the more expensive RCM services we reviewed.
  • Tebra is intended for independent and new practices, and may be unsuitable for mid-sized and large practices.

Customer Reviews

Tebra received a 6.9/10 from users who reviewed the platform on TrustRadius. Tebra users cited the medical software’s ease of use as a major selling point. Others complained about disruptive bugs and crashes, however.

Check out our complete Tebra review for more information.

  • Base Price: 3% to 8% of monthly collections
  • Contract Minimum: One year
  • Implementation and Training: Implementation and guided training are included. Free two-day on-site implementation is available for practices with more than $200,000 in monthly collections.
Editor's Rating: 8.5/10

Why AdvancedMD is Best for Ease of Use

AdvancedMD is our choice for the best medical billing service for ease of use because its practice management software combines a powerful slate of features with superb usability. We were impressed with how easily medical practices can track the activity of AdvancedMD’s billers and coders with customizable and scalable software that can meet the needs of any growing healthcare organization. We also liked that the company provides custom bundles tailored to your unique needs, with discounts of up to 30 percent, making it cost-effective and worthwhile to devise your own plan.

AdvancedMD layout

AdvancedMD excels at displaying important information at a glance, especially on its flexible, customizable dashboards. The example above shows a dashboard that’s been configured to display financial data and important medical billing and coding news. (Source: AdvancedMD)

Advantages

  • AdvancedMD maintains a robust code library that’s up to date with the latest medical coding standards.
  • AdvancedMD offers built-in connections with major clearinghouses to further streamline the billing process.
  • AdvancedMD’s medical software offers extensive features and is highly scalable for growing medical practices.

Disadvantages

  • AdvancedMD may not be suitable for physical therapy and behavioral health specialties.
  • AdvancedMD is one of the more expensive platforms we reviewed.
  • AdvancedMD’s implementation period is among the longest we encountered in our review.

Customer Reviews

AdvancedMD received a 7.3/10 from users who reviewed the platform on TrustRadius. Users most often liked AdvancedMD’s thorough implementation and wide range of features. However, some complained about lackluster customer support.

Check out our complete AdvancedMD review for more information.

  • Base Price: 4% to 7% of monthly collections
  • Contract Minimum: One year
  • Implementation and Training: Implementation support and full training are included in the subscription price of the software. Expect a lengthy implementation period of about 11 weeks.
Editor's Rating: 8.7/10

Why athenahealth is Best for New Practices

We chose athenahealth as the best medical billing service for new practices because the company provides next-level consultation and coaching that can get a medical practice started on the right foot. In addition to expert medical billers and coders, we were impressed how athenahealth provides extensive data through the athenaNet, a database that collects information from more than 100,000 healthcare organizations that operate on athenahealth’s platform. This information can help set clear targets and key performance indicators (KPIs) for new practices to help them grow with purpose in their earliest days.

athenahealth workflow dashboard

athenahealth includes a medical billing workflow dashboard that makes it easy to follow claims in real-time, even across multiple locations. It also features an “open items” list that directs users’ attention to pressing tasks that need to be addressed, keeping processes moving smoothly. (Source: athenahealth)

Advantages

  • athenahealth offers expert coders to support your team when managing denied claims, so you won’t have to go it alone.
  • athenahealth automatically sends bills for outstanding claims and patient statements, staying on top of accounts receivable.
  • athenahealth tracks data from its network of more than 100,000 healthcare providers to establish baseline metrics to help track the growth of your practice.

Disadvantages

  • athenahealth does not provide full medical billing outsourcing, and you’ll need to keep a biller and coder on staff to handle coding and denial management.
  • athenahealth has the longest implementation period of any medical billing service we reviewed.
  • athenahealth’s medical software is not intuitive and extensive training is highly recommended.

Customer Reviews

athenahealth received an 8.0/10 from users who reviewed the platform on TrustRadius. Users frequently cited athenahealth’s reporting as one of the best around, and many applauded its practice management software for its front-office features. However, some users complained about the level of difficulty when creating custom reports and said the dashboard was not flexible enough.

Check out our complete athenahealth review for more information.

Additional Options Worth Exploring

Not convinced that one of our best picks is the right medical billing service for you? Check out these altentaive options that are worth considering if you’re looking to outsource your revenue cycle management to a reliable partner.

  • ChartLogic: ChartLogic is a medical billing service dedicated to making the onboarding and training process as simple as possible. The entire onboarding process takes no longer than six weeks and is meticulously customized for your practice. Training is quick and straightforward, and the interface is user-friendly. Users can start using the software right away. Support staff is available for ongoing support and challenges. ChartLogic is perfect for the tech-panicky individual. ChartLogic has all the EHR tools necessary to make your practice, including your billing, run as smoothly and efficiently as possible. Office managers use its practice management tools to handle appointment scheduling, reporting and claims, while billing specialists use its functions to determine eligibility and manage collections.
  • CureMD: CureMD offers one of the most intuitive, flexible dashboards for setting and tracking your practice’s key performance indicators (KPIs). Regardless of your practice’s specialty or size, you can adjust its KPIs and targets, and then track their progress as CureMD performs charge entry, coding, claim submission and denial management. CureMD is a low-cost medical billing service starting at a price of 4% of your monthly collections, which is more cost-effective than many of the medical billing services we reviewed, whose rates can range from 5% to 10% of monthly collections. CureMD also supports more than 30 specialties, making it a good fit for a wide range of medical practices. Certain specialties have unique needs, such as specific ICD-10 codes or payer rules.
  • MedicsPremier: MedicsPremier, a software platform and medical billing service from the Advanced Data Systems Corporation (ADSC), is an effective choice for growing practices looking for a competitively priced solution. For one thing, MedicsPremier begins your service with a test run on 50 to 100 patients, ensuring all vital elements of your billing operations (such as insurance eligibility verification and patient statements) are running smoothly. This is key for scaling operations, helping you guarantee your systems won’t break when your claims volume increases. MedicsPremier’s pricing is on par with other billing services we reviewed. Ranging from 3% to 6% of your monthly collections, based on the specialty and claims volume of your practice, MedicsPremier beats the industry-standard pricing we discovered in our research.

What Are Medical Billing Services?

Medical billing services allow practices to outsource their medical coding and billing processes. Also known as revenue cycle management (RCM) services, medical billing companies remove the burden of coding claims, submitting them to payers, following up on unpaid claims and managing denied claims.

Outsourcing your RCM puts a dedicated team in charge of generating your claims, scrubbing them for errors, and chasing denials or underpayments, which reduces or eliminates the workload associated with in-house billing. Best of all, most services operate directly within your clinic’s existing practice management software, allowing your staff to monitor the progress of your submitted claims.

While medical billing services offer significant benefits, it’s important to choose the right one for your practice. The wrong partner could tie up your practice’s money and possibly allow patients’ payments to fall through the cracks. To ensure smooth cash flow, medical billing departments need to capture charges and create claims for them quickly, properly code those claims, and submit them through the right channels to the proper payers. Even as new charges come in, the billers must keep tabs on previously submitted claims in case they are rejected or denied by payers. If they are, the billers must revise and resubmit those claims – without falling behind on the new claims. Medical billers are also responsible for sending statements to patients for copayments or out-of-pocket expenses and following up on unpaid patient accounts.

The challenges of medical RCM require billing departments to be nimble and adaptable. They must stay abreast of updates, such as changing regulations and shifts in payers’ policies. No matter which way you slice it, in-house medical billing demands a lot of time, energy and money. That’s why many medical practices outsource the process to third-party medical billing companies, sometimes called RCM services.

Costs of Medical Billing Services

Pricing models are primarily the same from company to company in the medical billing industry. Most companies in our review charge a percentage of your net monthly collections, meaning the more revenue they generate for you, the more they get paid. Those percentages typically fall between 3% and 9%, although there are outliers on both ends.

Some companies charge additional fees, such as setup, implementation or clearinghouse fees. These fees can vary greatly by company, so it’s important to ask sales representatives about their companies’ policies.

Occasionally, medical billing services will institute a monthly minimum in case the practice’s revenue for the month isn’t high enough to be profitable for the billing company. Other services charge a monthly per-provider base price, taking a small percentage of collections on top of that, but this model is rare.

TipBottom line

Look for a medical billing service that doesn’t charge implementation fees or add-on costs for its healthcare IT features. For some practices, hiring a medical billing service is a great way to gain access to a healthcare IT suite, which is virtually a requirement for a modern healthcare practice.

The Benefits of Medical Billing Services

Medical billing services help medical practices in various ways. These are the major benefits of medical billing services:

  • Streamlined back-office processes: Outsourcing to a medical billing service reduces the staff and resources your practice must expend on back-office processes like billing and coding. Because these services minimize the administrative burden on your staff, they have been known to reduce burnout in the healthcare field.
  • Payment tied to success: A medical billing service’s payment is connected to the success of your practice, since it generally costs a percentage of your monthly collections to outsource to an RCM service. The more money a medical billing service successfully collects on behalf of your practice, the more it gets paid, so it is invested in helping you succeed.
  • Faster reimbursements: Medical billing services are experts in coding and billing, so they can typically navigate the process much more easily than a single practice can. This is especially true if the RCM service has an existing relationship with clearinghouses and payers. This means less waiting around for payment on the services you’ve already rendered.
  • Lower denial and rejection rates: With its knowledge of payers’ expectations and advanced claim-scrubbing software, a good medical billing service should immediately reduce the rate of your claims’ denial or rejection by payers. Look for a first-pass claims rate above 95% to be sure you’re partnering with an effective RCM service.
  • Patient statements and follow-up: Medical billing services don’t just deal with insurance companies; they also manage your patients’ statements. Whenever a patient owes money out of pocket and hasn’t paid in your office, your medical billing service will send them a statement explaining their bill. If the bill goes unpaid, the billing service will follow up with the patient. In extreme cases, a medical billing service may even refer unpaid accounts to a collections agency.

athenahealth platform

The best medical billing services and software platforms offer patient engagement tools, such as secure patient portals that enable self-pay. This example comes from athenahealth. (Source: athenahealth)

  • Detailed financial reporting: Many medical billing services capture all the data related to your claims and couch it in easy-to-filter reports. The level of reporting and the usefulness of the visualizations vary by company, but this full accounting of your practice’s finances can be extremely helpful.
  • HIPAA compliance: By law, medical billing services must comply with

Outsourced RCM vs. In-House Billing

Whether you should contract with a medical billing service or keep your billing in-house depends on how large your practice is, how much revenue you take in and how you utilize your staff. To do billing in-house, you will need a certified medical coder on staff. You will also need to keep up with ever-changing medical laws and codes. So many things can go wrong with medical claims, such as simple coding errors, that will make insurance companies reject them. If you manage your billing in-house, it will be up to you and your staff to deal with rejected claims. Billing services take care of all of that for you, including staying on top of laws, codes and policies.

CareCloud status

When outsourcing medical billing to the best RCM services, you’ll still receive detailed information about the status of claims in real-time. In the example above, a user reviews CareCloud’s claims management screen, which shows the status of each claim and updates as billers and coders take action. (Source: CareCloud)

Cost can ultimately determine the smartest choice for your practice. In-house billing requires payroll for a medical coder and usually an annual license for medical billing software. Someone with this certification will cost more to employ than an average clinical staff member, and taking care of claims will likely be their full-time responsibility. Billing services typically charge a percentage of net collections, often 4% to 9%. This should give you a general idea of what makes financial sense for your practice as you consider a medical coder’s salary versus the speculative cost of a service’s percentage. However, there are other costs to your practice to consider for each route.

Outsourced billing can be a good solution for small practices that need their staff to focus on other aspects of running the office. Having one person on payroll as a medical coder may not make sense in terms of the number of patients the practice serves. For larger practices and hospitals, a billing service may not be worthwhile if they have the budget for medical coders, a large volume of claims and the resources to handle them internally.

TipBottom line

If your in-house medical coding and billing is inefficient or can’t keep up with your claims volume, hiring a medical billing service to support even just a portion of your billing needs could be the answer. You don’t necessarily have to outsource 100% of your billing operations.

How Does Medical Billing and Coding Help Increase Cash Flow?

A dedicated medical billing and coding department can improve your practice’s cash flow by reducing the time a claim spends in accounts receivable, a metric referred to as “days in A/R.”

First-Pass Claims Rate

Many RCM services focus on reducing days in A/R by coding clean claims and scrubbing them for errors with the same or similar rules that clearinghouses use. This improves the chances that a claim will move through the clearinghouse to the payer and be reimbursed on the first pass. The rate at which claims are approved and paid after the first submission is known as a medical billing service’s first-pass claims rate or clean claims rate. This is a critical element of choosing a service: The higher a company’s first-pass claims rate is, the better.

However, not all services track clean claims rates in the same way. Some companies only tally a “clean claim” if it was accepted and paid. Others factor in unpaid claims that were not denied, inflating their first-pass claims rate. Ask a company for clarification on how it tracks its clean claims rate before basing your decision on that rate.

Faster Payments With Denial Management and Follow-up

Medical billing services can also expedite the revision of rejected or denied claims. When a payer rejects a claim, it is usually due to a clerical error. Once edited, the claim can be resubmitted for payment. Good medical billing services keep close tabs on rejections and denials, acting swiftly to revise any errors and ensure timely payment.

Sometimes claims sit with a payer for a while without any response. In these cases, medical billing services follow up (sometimes rather aggressively) to get the payer to respond. This often results in faster approval and reimbursement. In other cases, it results in a denial or rejection; however, that also gives the billing service the opportunity to revise and resubmit the claim.

Each of these elements of an RCM service contribute to downward pressure on the days in A/R, which means you get paid sooner for the services your practice has rendered, keeping your cash flow regular and healthy.

Medical Billing Services FAQs

The answers to these frequently asked questions can shed additional light on the medical billing services space.

The medical billing process is complex and involves several third parties. However, it breaks down to these general components:

  1. The medical biller generates and codes claims based on clinical data.
  2. The claims are scrubbed (manually or using an automated system) and edited if any errors are found.
  3. Claims are transmitted through clearinghouses to the appropriate payers (insurance companies, Medicare and Medicaid).
  4. When payment is received, the billing service posts it to the practice’s account, minus the service’s percentage fee.
  5. If a claim languishes unpaid, the medical billing service follows up with payers.
  6. If a claim is denied, the medical billing service revises and resubmits the claim, tracking it until it is paid.
  7. All financial data is stored for reporting, sometimes directly within the client’s practice management system.

The process also includes tracking patient balances owed and following up on unpaid accounts. In some cases, the medical billing service will refer the balance to collections.

 

Medical billing services should be secure and HIPAA compliant. They should also employ certified medical coders and billers, preferably with years of experience in the industry. Some medical billing services also offer access to their EMR systems and practice management software as part of the percentage costs. If you need those platforms, bundling them with a medical billing service could be the way to go.

Before signing up with a medical billing service, ask for a sample contract or operating agreement in writing that spells out the percentage of collections you will be charged and the responsibilities of both the billing service and your own practice. You should also seek out practices similar to your own and request recommendations of medical billing services they’ve successfully used.

Outsourced RCM is right for some medical practices but not for others. If you find that your claims are going unpaid or you are receiving a high rate of rejections, you should consider partnering with an experienced medical billing service. Additionally, if the cost of a medical billing service is lower than that of maintaining full-time coders and billers on your staff, outsourcing is likely the right choice.

For patients whose payer is Medicare or Medicaid, the 72-hour rule governs the period before hospital admissions. Any outpatient diagnostic or other medical services that occur within 72 hours prior to hospital admission must be billed alongside hospital costs. Any RCM companies you hire for your practice should be familiar with this rule.

What to Expect in 2024

Through 2032, the worldwide medical billing outsourcing market is expected to grow at a compound annual growth rate (CAGR) of 12.3 percent, according to DataHorizzon Research. This reflects an increasing tendency for solo practitioners and small medical practices to outsource their medical billing as a way to reduce their overhead and eliminate labor-intensive, in-house billing operations. In fact, DataHorizzon Research also found that the medical billing service industry is projected to reach a market value of $40.1 billion by 2032. In short: In 2024, a growing number of medical practices are expected to outsource their medical billing to third-party services.

As technology improves, so do medical billing services’ offerings. Automation has been a key driver of growth in recent years, streamlining not only in-house medical billing operations, but also the way practices work with third-party RCM providers. It offers new opportunities for medical billers to quickly and easily scrub claims and submit them through clearinghouses to payers.

For example, practices and medical billing services often automate the creation of superbills. They may also automate the processes through which they verify that a superbill’s coding is accurate and billable. Claims transmission and patient statement generation may also be automated.

Additionally, Outbound AI has recently introduced generative AI technology to lessen billing staff administrative tasks. Through this technology, which includes ChatGPT, staff can more easily manage denials, process EOBs, and verify eligibility and benefits.

New technological developments also raise questions about data security, which may be a prominent concern given the Arietis Health data breach announced in October 2023. This breach resulted in patient data such as medical information and Social Security numbers being sold on the dark web. Another breach — this one a suspected ransomware attack against UnitedHealth Group unit Change Healthcare in February 2024 — may increase the focus on cybersecurity. Expect your medical billing service to fortify its digital security in tandem – and encourage you to do the same.

Additionally, medical billing quality may rank next to security in importance. That’s because a December 2023 study found that 62 percent of U.S. hospitals failed to meet at least one of three key medical billing standards: timely itemized patient statements, hospital legal action on unpaid patient bills and patient access to qualified billing representatives. Expect medical billing services to prioritize all these measures for hospitals and smaller health systems alike in 2024.

Modern medical billing software and services also allow healthcare organizations to personalize the patient experience in how they deliver statements and capture payments. Many services have begun implementing payment plans and other useful features to improve the patient experience. Expect more RCM providers to follow suit and double down on the trend of personalizing billing on a patient-by-patient basis.

Medical billing teams may also be expected to prioritize transparency throughout 2024 in response to both consumer and legislative concerns. For example, in Texas, Gov. Greg Abbott recently signed a bill mandating that hospitals not send patients to collections without first providing clear, itemized invoices.

Additionally, one consumer filed a complaint to Colorado’s Division of Insurance regarding a medical billing error that could affect tens of thousands of people. National news outlets have reported on this story, suggesting that transparency in medical billing will be of paramount concern nationwide in 2024.

In Minnesota, the Attorney General’s office has been holding public listening sessions about medical billing. These sessions are occurring as part of an investigation into the medical billing procedures of the health systems Allina Health and Mayo Clinic. This investigation suggests that medical practices and their billing teams must prioritize a positive, transparent patient experience in 2024.

Similarly, the No Surprises Act – implemented in 2022 to safeguard patients from unexpected medical bills – came under scrutiny in 2023. Namely, when a federal district court invalidated part of the law, the American Medical Association voiced its support for this decision. However, in July 2023, federal executive agencies requested that the court reverse its ruling. The AMA has since filed an amicus brief with the 5th U.S. Circuit Court of Appeals, requesting the original decision be upheld.

By the end of November 2023, close to 30 public companies had deemed the No Surprises Act a risk. The law’s exact provisions may thus shift over the course of 2024, and medical billing requirements may change in tandem.

Given the contents of the Biden administration’s February 2024 progress report, changes to the No Surprises Act should be all but expected. According to this report, in over 80 percent of court-mandated, Act-related decisions, insurers paid more money to out-of-network providers than the equivalent costs for in-network providers. Additionally, the three federal agencies that jointly oversee the Act’s enforcement are spending more time doing so than planned. These findings may necessitate changes to the Act and its enforcement.

Medical billing services should also be ready to accommodate potential changes to Medicare. For example, the U.S. Centers for Medicare and Medicaid Services (CMS) expanded Medicare dental coverage in 2023, continuing into 2024. This expansion mandates that Medicare Parts A and B cover dental services key to patient treatment and disease outcomes. It also covers a broader set of circumstances, such as treatment to eliminate infections before organ transplants and some cardiac procedures. Billing services must adapt to such coverage shifts to be effective.

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Written By: Leah ZitterSenior Analyst & Expert on Business Strategy
Leah Zitter's long-held passion for psychology and science led her to not only a doctorate but a career covering emerging technology in healthcare and related sectors. Her expertise has been trusted by The Centers for Disease Control and Prevention, and her analysis of medical software has proven invaluable for medical practices. Zitter has also studied SaaS and analytics more generally on behalf of clients like Google, Microsoft, Amazon Web Services and more. She also contributed to the book "Strategize Up: The Simplified Blueprint To Scaling Your Business."
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