The Best Medical Billing Companies of 2020

Outsource the details of getting paid for medical care

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First Look

Medical billing companies act as a third party to take care of the billing aspects of a medical practice. A practice may hire a medical billing company to not only bill for care, but also to act as a go-between for the provider and insurance or government agencies involved.

As medical billing has moved to a largely online system with many codes for charges, the demand for medical records and health information technicians has increased. According to the U.S. Bureau of Labor Statistics, the job outlook to 2029 is expected to grow at a rate of 8% (much faster than average). These specialty trained personnel can be vital to a medical practice’s success for correctly billing and tracking complex medical information, as well as maintaining patient confidentiality.

Hiring a medical billing company often means evaluating the company itself, its computer platform, and the costs associated with its services. In reviewing the best medical billing companies, we took these factors into account, as well as the services provided, the company’s clean claim rates, and the number of clients the company serves. We reviewed more than 30 companies before narrowing down our choices of the best medical billing companies.

Our Top Picks

Best Overall: AdvancedMD

AdvancedMD

AdvancedMD

Pros
  • Has a 95% first-pass acceptance rate

  • Requires only a one-year contract

  • Provides customized reports for billing practice performance

Cons
  • Does not offer coding services

  • Must request a personalized quote

AdvancedMD is a company that offers practice management solutions, including medical billing services. The company was founded in 1999, but it was purchased in 2011 by Automatic Data Processing, Inc. Based in South Jordan, Utah, the company has a national footprint that includes more than 33,000 practitioners. It processes an estimated 6.5 million insurance claims on a monthly basis.

On the billing side, services include appeals, claims, denials, and exclusions. According to the company's website, its software and business model achieves a 95% first-pass acceptance rate. As part of its services, the company will provide reports on practice performance and analyze each revenue cycle, highlighting opportunities for improvements.

In addition to managed billing services, AdvancedMD also offers a number of practice-oriented solutions. This includes practice management, patient engagement, patient portal services, appointment reminders, ePrescribing, and telemedicine technology services. However, AdvancedMD does not offer coding services, which means medical practices must handle this aspect in-house.

AdvancedMD provides a custom quote for costs. The service does charge a percentage of its monthly collections, for which it takes into account factors such as practice size, medical specialty, and how complex the billing is likely to be. The company offers “bundled” discounts, meaning the more software and services, the larger the discounts are expected to be.

If a practice does not wish to customize a bundle, the company offers standard bundles too. Although we didn’t obtain a clear pricing model, we did like that AdvancedMD requires a contract for a year—this was different than most companies that required a two-year commitment.

Best Budget: CareCloud

CareCloud

CareCloud

Pros
  • Low percentage collections rate of between 3% and 7%

  • Can outsource different billing aspects

  • Cloud-based system doesn’t require extensive software installs

Cons
  • Do not offer in-person training

  • Typically requires a three-year contract

Founded in 2009, CareCloud is a practice management system whose services include medical billing. The company was acquired by MTBC in January 2020. While its headquarters are in Miami, Florida, the company also operates in Boston, Massachusetts.

The “cloud” portion of CareCloud signifies that the service is a cloud-based system—this means that you do not have to install its software specifically to all office-linked computers. The company offers webinars and live, online training. However, CareCloud does not currently offer in-person training, which could be a detriment if your office staff would prefer this.

The company's medical billing services include claims processing, claims scrubbing, compliance tracking, insurance verification, and remittance advice. It also offers coding and charge entry if you would like to take this off your staff’s hands. The company's billing dashboard includes tabs like Practice Performance, where you can view your total billing versus payments, reimbursements per procedure, and patient visits. The company reports its total (not first-pass) resolution rate is 97% for billing, and its first-pass resolution rate is 94%. It also reports that its platform reduces clients’ days in accounts receivable by 33%.

In addition to its medical billing services, CareCloud also offers several complimentary services. This includes practice management, patient portals, a HIPAA-compliant telehealth platform, and a secured app for practitioners to access patient records via an iOS device.

CareCloud currently serves more than 17,500 medical professionals in the United States across upward of 5,000 medical offices. It manages more than $4 billion in annual accounts. A key aspect of its management is flexibility—you can choose aspects of your practice (or particular providers) who use this platform or segments of billing you’d rather not deal with (such as denial management) instead of having to use their entire suite of services.

In terms of pricing, CareCloud uses a provider per-month pricing model. It has customizable features with a base price that starts at about $349 per month per provider. Its complete management practice is about $629 on average per month per provider. It also offers a concierge service with full-service revenue cycle management for about 3% to 7% of practice collections per month, dependent upon the size of your practice. We liked that there were a variety of pricing options.

On the drawback side, CareCloud typically requires a slightly longer contract than most companies—about three years. This is likely reflected in their lower costs per provider. It also requires a setup fee that varies per provider, but is on average about $1,000.

Best for Reimbursements: athenahealth

athenahealth

athenahealth

Pros
  • Offers reimbursements for unposted claims and denials

  • 93% first-pass resolution rate

  • No contract requirements

Cons
  • Must have at least one in-house billing staff member

  • Does not disclose average rates for services

Athenahealth is a healthcare technology company that offers medical records, revenue cycle, and patient engagement services to its clients. The company was founded in 1997 and has its headquarters in Watertown, Massachusetts. However, it has national locations in Maine, Georgia, Texas, Vermont, Washington, and New Jersey, as well as some international operation sites.

The company has a first-pass resolution rate of 93% for claims and collects more than $29 billion in collections annually and performs more than 400 million eligibility checks annually on behalf of its clients. It utilizes an intuitive “rules engine” that studies billing errors across its client network. Once it flags a new “rule,” the computer program can alert medical billing staff in the future to problems. Ideally, this enhances first-pass claims rates. A dashboard interface includes a reporting system that shows how athenahealth’s billing team is progressing through a practice’s claims.

In addition to its medical billing services, athenahealth offers a number of cloud-based practice management systems. These include athenaOne (comprehensive practice management), athenaClinicals (electronic medical records), and athenaCommunicator (patient engagement portal and self-scheduling).

Athenahealth has several innovative policies that led us to recognize the company for its reimbursements. It offers them if the company's staff does not follow up on denials or unposted claims within an agreed-upon timeframe. For example, if the company fails to manage a denied claim within 10 business days and the insurance company rejects the claim, athenahealth refunds its client the value of the claim. This level of accountability breeds trust and ensures the billing department is working for your practice.

One difference between athenahealth and many of the companies we reviewed is that it does require you to keep at least one in-house medical biller/coding professional. Your in-house staff member creates the codes and charge postings. After this time, athenahealth’s billing department takes over. This could prove a challenge if you were not looking to retain any in-house billing staff, which is often true for smaller medical practices.

Best for Small Practices: Kareo

Kareo

 Kareo

Pros
  • Cloud-based software

  • No costs for onboarding, training, or support

  • Platform geared toward smaller practices

Cons
  • No customizable billing dashboard

  • No clean claims rate advertised

Kareo is a company that offers several managed billing and practice management services. Founded in 2004, the California-based company has upward of 65,000 providers in 50 states utilizing Kareo’s technology. Its software is cloud-based, so there is no in-person installation process required. Its products are designed for use with minimal training required, although the company does make dedicated “Success Coaches” available for assistance.

Kareo’s medical billing services include claims processing, scrubbing, coding, insurance verification, and practice management. One drawback on the billing side is that it does not offer a customizable billing dashboard if your practice desires customizations. The company does offer billing analytics, so practices can monitor their performance. However, the company does not advertise its average clean claims rate.

Kareo specifies on its website that its products are intended for independent practices and not large-scale hospital systems. Its pricing structure relays this, as there are fewer up-front costs for their products: There are no costs for onboarding, training, or support services if your practice agrees to a one-year contract, which can be easier for a smaller practice. By catering to smaller practices, Kareo says it doesn’t include some programming intended for larger practices, which ideally makes the platform more user-friendly.

The company offers per-month pricing that starts at about $160 and increases based on the number of providers, services utilized, and medical specialty complexity. The only fee-based costs are about $1 per electronic claim for those in its “Low-Volume” subscription plan. All other subscription levels do not have per-claim charges, but there may be other charges based on additional services you choose to add to your plan.

Best for Large Practices: Cerner

Cerner

 Cerner

Pros
  • Large company with 24/7 customer service

  • Clinical and billing connectivity enhances clean claims rate

  • In operation for more than 40 years

Cons
  • Can require significant training for maximum effectiveness

  • Requires custom quote for pricing

Cerner is a large company that offers several advantages for large-scale businesses. In operation since 1979, the company’s products are used in more than 27,000 facilities around the world.

With a company this large, medical billing is just one aspect of Cerner’s services. Its billing services include charge capture, where it uses clinical documentation, such as procedures, insurance plans, and encounter types, to create charges. It manages claims and can automatically send statements and letters via its claims service.

In addition to medical billing, you can choose to implement Cerner's other services, which include practice management, such as scheduling, registration, patient tracking, and accounting. It also offers billing coding, case management, and health information management. It uses voice recognition and auto-text software, which can speed the dictation and charting demands for larger practices.

Cerner’s larger size enables the company to offer customer support 24/7. Several reviews noted training and understanding the system can take time. But Cerner offers in-person webinar, and live, online training to help speed this process. Its abilities to merge clinical software with billing processes make Cerner a good fit for larger companies for whom this could otherwise be a challenge.

Cerner doesn’t post an overall clean claims rate, likely due to its larger size. It does, however, share client success stories of how its products were able to improve clients’ clean claims rates. In one example, Cerner increased clean claims for the Goodall-Witcher Hospital Authority from about 67% per month to 89%.

Unfortunately, Cerner also doesn’t provide a lot of information about costs on its website, instead requesting that you reach out for a quote. However, its software is largely based on an average cost per provider, per month and depends on the complexity and scale of the provider network.

Best Technology: CureMD

CureMD

 CureMD

Pros
  • "Cleaning" algorithms used to support a 96% first-pass claims rate

  • Additional technology platforms with billing services subscription

  • No minimum contract requirement time

Cons
  • Intended for practices with less than 10 providers

  • No 24-hour support

Founded in 1997, CureMD’s headquarters is in New York state, but it does have locations outside New York, including in Europe, the Middle East, and South America. It offers revenue cycle management for 32 medical specialties.

Its medical billing software is a cloud-based system and does not require any additional computer installation, licensing, or servers for a practice to operate. According to the company, it has a first-pass claims rate of 96%. It guarantees new providers will see between a 5% and 10% increase in its collections in the first few months of using the system.

CureMD utilizes its own unique algorithm for “claims scrubbing.” This is when its software will search for, edit, and correct potential mistakes before submitting a claim to an insurance company. The company reports it utilized more than 2,500 insurance policy formats into its algorithm, which ideally identifies problems and helps get claims passed faster. If the algorithm flags a claim in the computer, CureMD’s medical billing team reviews the flag and works to get it cleared.

If you utilize CureMD's billing services, it also offers the following technology platforms at no additional cost: electronic medical record services, practice management, patient portal, an iPad app, and free upgrades as available. There are no costs for system setup, training, or software installation.

In terms of pricing, CureMD charges both clearinghouse fees and a percentage of claims collected, which starts at 3.5%, but may increase based on practice size, specialty, and the number of claims. This fee enables five users to have computer software for each paying provider. If a practice chooses to have more than five people utilize the service, it is charged about $100 for each additional user on a monthly basis.

For this reason, CureMD's services seem geared more toward smaller practices. Customer service is available from 8:30 a.m. to 8:30 p.m., Monday through Friday.

How We Chose the Best Medical Billing Companies

We used a number of criteria to select the best medical billing companies, including reviewing the companies themselves, including their time in operation and breadth of services offered. We assessed customer satisfaction rates, testimonials, and videos regarding the billing companies' services. In addition, we considered data, such as the company’s first-pass claims rates, resolution rates, and policies on denial management. We also took pricing (when available), ease of interface, and abilities to cater to different practice sizes into account. Ultimately, we reviewed more than 30 companies and selected the standouts.

AdvancedMD stood out as our best overall pick for its 95% first-pass acceptance rate, one-year contract, and customized reports, while CareCloud was a top pick for its low collection rates and its cloud-based service, which requires fewer software installs. CureMD stood out for its technology, using its own unique algorithm for “claims scrubbing.” Plus, it offers additional technology platforms at no additional cost.

What Is a Medical Billing Company?

Medical billing is a service that doctor's offices and hospitals hire to process and submit bills to insurance companies and individuals. The billing company will then follow up with insurance companies and individuals to secure payments. If an insurance company rejects a claim, the billing company can follow up with the insurance company to try to obtain payments.

What Types of Services Do Medical Billing Companies Typically Provide?

Medical billing companies take the claims or work and services a healthcare organization provides and submits them in the form of a bill to insurance companies or to the individual directly. If payments are not received in a timely fashion, the billing company follows up to secure payment.

Examples of services a medical billing company may provide include:

  • Processing claims
  • Submitting health insurance claims
  • Entering the patient’s demographic and insurance information into computer systems
  • Verifying a patient’s insurance benefits
  • Reconciling billing and accounts payable
  • Acting as accounts receivable by collecting payments
  • Auditing medical billing charges to ensure their accuracy

Medical billing companies may offer different services depending upon their size and expertise.

Are Medical Billing Companies Regulated?

Medical billing companies may not provide direct patient care, but they do handle sensitive health information that requires protecting a patient’s privacy. As a result, medical billing companies are regulated and must comply with federal and state laws regarding confidentiality and best practices.

One of the most common laws a medical billing company must follow is the Health Insurance Portability and Accountability Act (HIPAA). This act requires medical billing companies to incorporate HIPAA confidentiality into their operating policy. Employees must also closely follow HIPAA laws or face charges and fines.

In addition to HIPAA regulations, medical billing companies must act in an ethical manner when conducting billing. Medical billing fraud, such as charging for services a patient didn’t receive or increasing the charge for a procedure (known as upcoding), is a federal offense and can result in criminal penalties. 

How Do Medical Billing Companies Get Paid?

Medical billing companies may set their pay structures in several ways. These include:

  • Monthly service fee: Some medical billing companies may charge an agreed-upon fee for their services with the medical practice.
  • Cost per claim: Some billing companies may charge a fee for every claim they process and collect. Smaller medical practices often find this approach more affordable because they are paying when they also get paid.
  • Percentage of claims collected: Similar to a royalty or commission, some medical billing companies make a percentage of the revenue they collect. This can motivate the billing company to collect as much as quickly as possible.

Medical billing companies may choose to structure their fees in a variety of ways. Each usually involves some form of the abovementioned methods. A medical practice may also pay a setup fee when they first contract with a company. This fee helps cover the infrastructure costs, such as for computer systems, data encryption, and medical billing personnel who work for the company.

How Do You Start a Medical Billing Company?

A person who wishes to tap into the growing needs for medical billing assistance may choose to start their own medical billing company. Like any business, this requires an initial time and monetary investment in infrastructure, such as computers, billing computer programming, and a fax machine. This also includes choosing a company type (sole proprietorship, partnership, S-corporation, etc.) and filing the necessary paperwork to establish this business.

Speaking to an accountant in the early stages of setting up your business can help you determine the best business type to establish and set your accounting practices early. These efforts can often save you time and money as you continue to build your business.

If you do not currently have your certification in medical billing, you will also need to pursue this from a college or trade program. These programs provide training for the major coding manuals so you can learn to speak the “language” of medical billing. You will also need to earn your certification from a medical billing and coding association. An example is by taking the American Medical Billing Association’s “Certified Medical Reimbursement Specialist” exam.

You will also need to set up your pricing structure and recruit clients. As you build your business, you may also need to hire additional personnel to help you provide timely and effective services.

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Article Sources
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  1. Bureau of Labor Statistics. “Medical Records and Health Information Technicians.”

  2. National Health Care Anti-Fraud Association. “The challenges of healthcare fraud.”