The Best Medical Billing Services

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.

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)

Medical billing is the process by which claims are generated, coded and submitted to payers like insurance companies. Medical billers then monitor these claims and handle rejections, denials and adjustments. Medical billing also involves the creation of patient statements for collecting any out of pocket expenses a patient may owe.

Unlike many other businesses, medical practices don’t get paid at the time services are rendered. Instead, they need to work with insurance companies to collect payments. This can take 30 days or more depending on the efficiency of the billing department and how quickly payers react to claims. A sluggish medical billing department can lead to significant problems for a medical practice’s cash flow.

The medical billing process begins before the encounter, when front office staff captures patient details and verifies their insurance. During the encounter, providers complete a patient’s chart, which includes services rendered during the visit. Then, medical coders and billers take over, creating claims and submitting them to payers. They will follow up on any denied or rejected claims, as well as handle patient billing for out-of-pocket expenses and copayments.

Here’s a general overview of the typical medical billing process from start to finish.

1. Patient registration: Collect patient information and insurance details
2. Insurance verification: Check coverage and eligibility
3. Service documentation: Record medical services provided
4. Charge entry: Convert services into billable codes (CPT, ICD-11)
5. Claim generation: Create and submit claims to insurance companies
6. Payment posting: Record payments received from insurers and patients
7. Follow-up: Address denied or partially paid claims
8. Patient billing: Bill patients for remaining balances after insurance
9. Reporting: Analyze financial performance and identify areas for improvement

When you choose the right medical billing service, you’ll notice a range of benefits almost immediately. These include faster payments, improved organization and reduced errors.

• 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.

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 HIPAA security and privacy laws. When you partner with a top medical billing service, you can rest easy knowing sensitive patient and financial data is secure.

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.

Choosing the right billing service means interrogating every aspect of their process before signing a contract. A medical billing service will be handling your money and highly sensitive patient data, so you should have the utmost trust and confidence in a service before you hire them.

“From my experience and understanding, the must-have features are robust claims processing, coding accuracy, and compliance with regulations like HIPAA,” said John Russo, vice president of Healthcare Solutions at OSP. “Effective denial management and patient-friendly billing systems are essential to ensure financial stability and improve patient satisfaction.”

Consider average reimbursement time

When choosing a medical billing service, compare them to your existing billing department with specific metrics like reimbursement time. The sooner you get paid, the stronger your cash flow, which is a major factor in a small business’s survival. A medical billing service should significantly improve upon your current average reimbursement time.

“I worked on a project where we streamlined the submission of insurance claims, significantly reducing the time it took for reimbursements to come through,” Russo said.

Consider coding accuracy and first pass claims rate

Medical coding is critically important when it comes to getting claims paid quickly and on the first pass. Scrutinize a medical biller’s track record when it comes to medical coding and first pass claims rate before hiring them. If their medical coding is up to par, their first pass acceptance rate should exceed the industry standard 95 percent.

“Another essential function is coding accuracy. Proper coding ensures correct billing services,” Russo said. “In one of my recent projects, we implemented a system that automatically checked for coding errors, which cut down on claim denials by 25 percent.”

Review denial management processes

The ability to revise claims and turn denials into collections is the hallmark of an effective billing department. To be able to do so quickly and efficiently is even more important. Review a service’s denial management process to determine how quickly you can expect them to fix errors and get claims paid.

“Denial management is also crucial. Handling rejected claims efficiently can save much revenue,” Russo said. “In a recent project, we created a module that flagged and provided detailed reasons for denied claims, making it easier to address issues quickly.”

Don’t forget about patient billing

It can be easy to focus on dealing with the payers and asking billing services how they’ll manage following up on denied claims, but patient billing is just as important. Collecting copayments at the point of care is a big part of it, but oftentimes you’ll need to send patient statements for out-of-pocket expenses after the fact. Patients may sometimes be slow to pay when receiving a statement well after their appointment, so a robust and prompt patient billing process is critical.

“Patient billing and collections are equally important. Clear, accurate bills and efficient follow-up on unpaid bills help maintain a healthy revenue cycle,” Russo said. “I’ve seen firsthand how a patient-friendly billing system can improve collections and patient satisfaction.”

Consider transparency in medical billing software

When you outsource your billing to a RCM service, you should still be able to monitor everything the team is doing in real-time. Before signing a contract, be sure you can see what coders and billers are doing on your behalf in your practice management software. You may have to switch to a new platform for certain medical billing services, as well, but others could integrate with your existing medical software suite.

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.

Not convinced that one of our best picks is the right medical billing service for you? Check out these alternative 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.

To determine the best medical billing service on the market, our team of billing experts evaluated an initial list of 15 service providers. Our experts and analysts studied each provider’s plans and services to evaluate their medical billing operations on more than 20 factors. After this initial round of research, we narrowed down our list of candidates and identified the services we wanted to review even more closely.

After whittling our list down to 11, we scheduled Q&A sessions with medical billing service specialists so we could get a better sense of how each company operated. After analyzing each against the criteria below, our expert reviewers ultimately chose six medical billing services as our top recommendations.

These factors were broken down into categories and were weighted differently in our overall conclusion. The weights were determined based on how much business owners prioritize these criteria when shopping for business software and services and making purchasing decisions.

• Pricing (30%): Our experts and analysts compared and contrasted each vendor’s plans, judging which packages offered the best bang for your buck. We took into account monthly subscription costs, contract requirements and additional fees.
• Features (25%): We looked for standard medical service functions like coding and charge entry, claims scrubbing, clearinghouse integrations and rejection and denial management. We also considered the medical billing software each provider worked within, and looked for services that offer flexibility to use the platforms you prefer.
• Ease of Use (20%): We tested the medical software that each medical billing service works within to determine how easy it was to use. This included navigation of the interface, use of key features and accessibility of key reporting metrics.
• Implementation and Training (15%): We considered the level of implementation and training support available, especially if a medical billing service requires practices to switch its medical software. Data migrations and set up of these systems can be complex and time consuming, so we prioritized medical billing services that would also help implement software and train staff on how to use it.
• Customer Service (10%): We evaluated the range of customer service options, including whether phone assistance was provided with all package tiers. We placed extra emphasis on medical billing services that provide a dedicated account manager as a point of contact.

Based on these criteria, we not only determined which medical billing services our readers could trust but also the ways in which each solution could best serve different business needs. Some platforms were better at certain tasks than others or more suited to a particular type of company. These takeaways informed the “Best for” use cases you see on this page.

To learn more about our methodology, see our full editorial process.

Many medical practice software solutions and third-party services go hand in hand. For example, EMR systems and practice management software are closely related. A medical billing service might work within your practice management software, while a medical transcription service can help you create notes in your patients’ charts, which are stored in your EMR system.

If you’re looking for a full suite of healthcare IT solutions or additional medical practice services to improve the way your practice runs, take a look at our other medical practice review categories.

• EMR systems: An EMR system contains all the necessary clinical tools for a provider’s encounters with its patients. In an EMR system, providers can review their schedules, access patient charts, e-prescribe medication, and electronically order lab tests and access the results. Some EMR systems include tools to easily review patient histories and map trends in their health over time. An EMR system’s ability to integrate seamlessly with practice management software determines how well the administrative and clinical departments work together. It can be an indispensable tool to healthcare providers, but choosing the right one is key. To learn more, see our reviews of the top EMR systems on the market.
• Medical transcription services: Medical transcription services support the creation of internal documentation, patient charts and communications via dictation. They generally offer multiple ways to securely upload dictation, and then return a transcript within 24 hours. Some also offer direct EMR entry, plugging in transcribed notes to the appropriate place in an EMR system, which saves healthcare providers and staff time and effort.
• Telemedicine software: Telemedicine is a relatively new technology that allows healthcare providers to see patients remotely. Using video conference platforms tailored to the needs and privacy regulations of healthcare organizations, HIPAA-compliant telemedicine software reduces unnecessary office visits. This is not only efficient for a medical practice, but also convenient for patients. It is also helpful in building and maintaining client relationships.

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.