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AdvancedMD - Medical Billing Services Review

Adam Uzialko
Adam Uzialko

Large healthcare organizations need a medical billing partner that can handle high volumes of claims with ease and provide full visibility into the process in real time. They also need access to a software platform that is scalable enough to meet their needs. AdvancedMD offers a top medical billing service that includes access to a powerful healthcare IT suite, including its electronic medical record (EMR) system and medical practice management software. The scalable platform provides powerful tools and full transparency into outsourced billing. For these reasons, AdvancedMD is our choice for the best medical billing service for large practices.

AdvancedMD - Medical Billing Services

AdvancedMD - Medical Billing Services

The Verdict

AdvancedMD offers a full suite of powerful software and thorough medical billing services at a competitive cost. With an organization-wide first-pass claims rate of 98.4%, AdvancedMD is our best pick for medical billing service for large practices.

AdvancedMD Editor's Score: 8.7/10

Pricing/value 8/10
EMR/PMS 8/10
RCM process 8/10
First-pass claims rate 9.6/10
Customer support 8.5/10

 

Editor's note: Looking for the right medical practice management solution for your business? Fill out the below questionnaire to have our vendor partners contact you about your needs.

 

Why AdvancedMD Is Best for Large Practices

AdvancedMD is our choice for the best medical billing service for large practices because it offers a wide range of revenue cycle management (RCM) services for many different specialties and its healthcare IT platform provides the functionality that large, multilocation organizations require.

AdvancedMD's billing services are exceptional, with a company-wide first-pass claims rate guaranteed to exceed 95%. It is a competitively priced service that has the flexibility and expertise to serve practices of various sizes across a wide range of specialties.

AdvancedMD excels at claims scrubbing and first-pass acceptance by payers, primarily because it leverages the same claims scrubber used by its preferred clearinghouse partner, Optum. This means any issues that would be flagged by Optum's system are captured by AdvancedMD before submission, increasing the likelihood that claims make it through to payers and are accepted the first time they're submitted. Most other medical billing services maintain a rules engine, but not all are so closely linked to the clearinghouse that will process the claims. This improves the odds that claims are not rejected by the clearinghouse.

AdvancedMD enables denial management directly within the medical practice management software; RCM clients can monitor outsourced billing activity in real time.

In the event of a denial, AdvancedMD guarantees a rapid turnaround of three days to resubmission. Similarly, any claims that languish unpaid are followed up on within 40 days (often much sooner). These processes help turn claims over regularly, reducing the time it takes from the day your practice renders services to the day you receive payment.

In addition, AdvancedMD's RCM service includes access to its exceptional EMR system and practice management software for no additional cost. To learn more, you can read our review of AdvancedMD's electronic medical records system and our full review of AdvancedMD's medical practice management software.

AdvancedMD Pros

  • It maintains the expertise and flexibility to serve dozens of specialties.
  • It includes an exceptional EMR system and medical practice management software in the cost of RCM services.
  • It leverages the same rules engine as Optum, the primary clearinghouse through which AdvancedMD submits claims.

AdvancedMD Cons

  • It does not offer medical coding services, which means clients must maintain a certified medical coder on staff.
  • Some key EMR/PMS features are add-ons, requiring an additional monthly fee to access.

AdvancedMD Medical Billing Service Pricing

Like most medical billing services, AdvancedMD charges a percentage of your monthly collections. Its typical pricing ranges from 3% to 8% depending on several factors, including practice size, specialty and billing process complexity. While this range is indicative of the company's typical clients, there are outliers that are charged as little as 2% of monthly collections or as much as 9%.

The typical contract term for AdvancedMD's RCM service is one year, which is on a par with the other medical billing services we reviewed. Many medical billing services require contracts of at least two years, so AdvancedMD excels in this regard.

Included at no additional cost with AdvancedMD's medical billing service is access to the full healthcare IT platform, including the EMR system and practice management software. RCM clients must use AdvancedMD's healthcare IT products, which is a standard requirement across the medical billing services we reviewed. However, some important features are considered add-ons, meaning they represent additional costs beyond the percentage of monthly collections.

FYIFYI: Medical billing services generally determine pricing based on an organization's unique situation and the scope of services required. To provide a precise quote, the service provider will have to examine historical collections data.

AdvancedMD Medical Billing Process

Because AdvancedMD does not offer medical coding services, your practice must code all claims before sending them to AdvancedMD. When you send the coded claims to AdvancedMD, the company scrubs the claims for any errors and submits them to the proper payers.

The AdvancedMD claims inspector tool allows users to review biller activity in their medical practice management software using the same rules engine as Optum, the company's preferred clearinghouse partner.

AdvancedMD boasts a high first-pass claims rate and guarantees it in writing – something most other medical billing services don't do. This 96% first-pass claims rate means there are relatively few denials to deal with, and if a claim is denied, the service will work to revise and resubmit it until it is accepted and paid. AdvancedMD has a 72-hour resolution window from the time a claim is denied to when it is resolved and resubmitted.

If a payer or patient has not paid their outstanding balance, AdvancedMD billers will follow up to secure the payment within 40 days from the date the claim was filed or the patient statement was sent. This was generally standard among the medical billing services we reviewed.

When AdvancedMD receives electronic remittance advice (ERA), which describes why payers denied or underpaid claims, the service stores the ERA in the easy-to-access eRemittance Review tool. Clients can access this tool in real time to see where claims went wrong or why the amount was underpaid. AdvancedMD also uses this information to improve future collections by better conforming to payers' expectations.

Electronic remittance advice is stored in a single easy-to-view place, which keeps both clients and AdvancedMD informed about what payers expect and how to boost collections.

All billers on AdvancedMD's staff must have at least three years of experience in the industry. Although there are no certification requirements for AdvancedMD coders and billers, 10% to 20% of the company's billers are also certified coders, which helps with claims scrubbing.

AdvancedMD works with a wide range of clients, including small, independent practices and larger, multilocation practices with up to 100 providers. The average AdvancedMD client has about 3,000 patient encounters per month, while larger clients may have up to 30,000 encounters per month. AdvancedMD is one of the most scalable services we found in our review. The company's diverse experience makes it a flexible service that can work with smaller practices but also excel at revenue cycle management for large practices.

Implementation and Training

There are three implementation/training packages that clients can choose from when getting started with AdvancedMD. The company offers webinars and self-guided training materials for tech-savvy teams, but those who want hands-on training to get up to speed quickly should consider one of the higher-tiered implementation plans.

  • Tier 1 – Limited ($1,995): The Limited tier includes configuration and two hours of training. This option is intended for small practices with experienced staff members who plan to complete the majority of their training through AdvancedMD's webinars.

  • Tier 2 – Standard ($2,995): The Standard tier builds on the first by adding two additional hours of training. It also includes an integrated training tracker, a video training library, help materials, an onboarding webinar series, an implementation phone line, a partner interface collaboration, a post-utilization follow-up and a dedicated implementation consultant.

  • Tier 3 – Comprehensive ($3,995): The Comprehensive tier adds thorough configuration, plus 12 hours of product training. This tier is recommended for practices that are implementing a fully custom system and whose staff need to learn every aspect of the software.

AdvancedMD's implementation pricing for the Comprehensive tier is slightly higher than the pricing for other companies' higher-tier packages. Expect these upfront costs when signing up with AdvancedMD; large organizations are more likely to be able to absorb these costs.

TipTip: Unless your team is already familiar with the system, it is wise to opt for hands-on, live training sessions. While the cost of this package is higher, it could save you money in the long run by helping your staff be more productive and use the healthcare IT system effectively.

Customer Support

Our customer service experience with AdvancedMD, which included a discovery call and a demonstration of the healthcare IT platform, was exceptional. After we connected with a representative for the demonstration, we requested follow-up information on the healthcare IT platform and medical billing service, which we promptly received.

However, some customer reviews cite unresponsiveness as a periodic problem for AdvancedMD. While this experience is far from universal – and many others said they've received excellent customer service from AdvancedMD – small practices (especially new ones) may need a more dedicated approach to customer service to ensure that crucial billing considerations, such as credentialing, are properly in place in time to begin rendering services. Our review of athenahealth notes the company's consultative approach to medical billing.

AdvancedMD's customer support is included in the subscription price. There is a 24/7 help desk, so you can contact a support representative any time you experience a problem with the software – something that sets AdvancedMD's customer service apart from many other vendors we reviewed. All customer support is in-house and ongoing after your practice completes the implementation process and training.

Limitations

AdvancedMD's medical billing service does not offer medical coding, so organizations have to maintain an in-house coder. Many of AdvancedMD's billers are certified coders, however, and they use that knowledge to inform the claim scrubbing process and thus reduce rejections and denials.

Even if you outsource your medical billing to AdvancedMD, you will have to keep a medical coder on staff to prepare claims for submission. The appeal of outsourcing medical billing is often cutting the expenses associated with keeping a full-time, in-house billing department on payroll. AdvancedMD can only cut so much of those expenses, since you need to retain coders. If you are looking for a service that includes medical coding, consider DrChrono. You can learn more in our review of DrChrono.

Additionally, AdvancedMD's healthcare IT platform has several important tools that are not included in the base subscription price. To get these tools, you have to purchase them as monthly add-ons. These tools include the Advanced Patient Portal, extensive reporting through Advanced Insights, telemedicine and e-prescribing of controlled substances.

What Is a Medical Billing Service?

Medical billing services are third-party companies that maintain a staff of medical coders and billers. These companies manage various aspects of a healthcare organization's RCM, such as coding claims, submitting claims to payers and managing rejected or denied claims. Generally, a medical billing service works in a particular medical practice management software; in fact, many medical billing services offer proprietary solutions or even require clients to utilize them. Usually, medical billing services charge practices a percentage of their overall monthly collections, so the more money a practice makes, the more money the billing service collects.

Methodology

We spent hours researching and analyzing medical billing services, including AdvancedMD. Our research included software demonstrations, phone interviews and customer service calls. We also analyzed customer service reviews, including those listed on the Better Business Bureau website. When choosing our best pick for large practices, we examined criteria such as specialty experience, company size, certified coding and billing staff, claims scrubbing tools and the healthcare IT platform. We chose AdvancedMD as our best pick for large practices based on those factors.

AdvancedMD Frequently Asked Questions

Will AdvancedMD perform medical coding?

No, AdvancedMD does not offer medical coding services. This means practices cannot fully outsource their RCM process to AdvancedMD and must maintain a medical coder on staff or find a separate service to perform the coding. Some of the other medical billing services we reviewed, like DrChrono, include medical coding.

Does AdvancedMD employ certified medical billers and coders?

Yes, AdvancedMD has certified medical billers and coders on its staff. While the company does not perform coding, the certified coders can thoroughly scrub claims and identify coding errors (and fix them) before submitting claims to the clearinghouse. This kind of quality control contributes to AdvancedMD's 96% companywide first-pass claims rate.

Bottom Line

We recommend AdvancedMD's medical billing service for ...

  • Healthcare organizations with medical coders on staff
  • Healthcare organizations with multiple locations or complex billing

We don't recommend AdvancedMD's medical billing service for ...

  • Healthcare organizations that need medical coding services.
  • Small practices that need a holistic RCM outsourcing service.

Image Credit: Lisa S. / Shutterstock
AdvancedMD - Medical Billing Services

AdvancedMD - Medical Billing Services

The Verdict

AdvancedMD offers a full suite of powerful software and thorough medical billing services at a competitive cost. With an organization-wide first-pass claims rate of 98.4%, AdvancedMD is our best pick for medical billing service for large practices.

Adam Uzialko
Adam Uzialko
business.com Staff
Adam Uzialko is a writer and editor at business.com and Business News Daily. He has 7 years of professional experience with a focus on small businesses and startups. He has covered topics including digital marketing, SEO, business communications, and public policy. He has also written about emerging technologies and their intersection with business, including artificial intelligence, the Internet of Things, and blockchain.