When most people think of medicine, they probably don't think of billing beyond their own copayments and deductibles – unless, of course, they are members of the healthcare industry. Staff at medical practices and hospitals know how critical (and convoluted) medical billing is. Revenue cycle management is central to the successful operation of any healthcare organization, yet it is a timely and costly endeavor. However, it cannot be ignored, as ineffectual management of medical billing leads to delays in payment, underpayment, and even erroneous denials or rejections.
\r\nThis guide covers the ins and outs of revenue cycle management as well as reviews of some of the top medical billing services. Business.com has also selected the best services that stand out from the crowd.
\r\n\n"}},{"__typename":"SectionBestPicks","id":"best-picks","isInToc":true,"type":"bestpicks","megaBestPicksTopCardLimit":3,"bestpicks":[{"bullets":["Exceptional healthcare IT suite","Extensive reporting tools","Intuitive software"],"description":"AdvancedMD is our best pick for medical billing services for large practices; it serves practices with up to 100 providers and works across virtually every specialty. AdvancedMD guarantees a minimum first-pass claims rate of 95% in writing, but the organization-wide first-pass claims rate is reportedly 98.4%. The company's average client reports about 3,000 patient encounters per day, though it also provides services to clients that see as many as 30,000 patients per day.\r\n \r\nAdvancedMD RCM clients must use AdvancedMD's practice management system as well, but they are free to use any third-party EMR they prefer. AdvancedMD's medical billing service is competitively priced compared to the other services in our review, with a typical client's bill ranging from 4% to 6% of net collections. As with other companies in our review, the exact price depends on the size of the client, the complexity of their billing practices and the volume of claims they submit. \r\n\r\nAdvancedMD typically requires at least a one-year contract agreement for all clients. For smaller clients or new practices, AdvancedMD sometimes includes a monthly minimum payment requirement of $1,500 to $2,000.","descriptionTest":"","fullTitle":"Best for Large Practices","isFeaturedBestPick":false,"isJumpLink":true,"tabTitle":"Best for Large Practices","review":{"displayName":"AdvancedMD - Medical Billing Services","canonical":"https://staging.business.com/reviews/advancedmd-medical-billing-services/","id":"2d5127d7ed4611a8a16ee21f88652db0","url":"https://www.advancedmd.com/","review":{"pros":["AdvancedMD offers a powerful, user-friendly healthcare IT suite, which is included in the cost of the RCM.","Its extensive reporting tools make tracking financial performance and biller activity as easy as logging in to your practice management software."],"cons":["AdvancedMD does not perform coding services, meaning your practice is responsible for properly coding claims in-house."],"fullReviewTest":"
AdvancedMD historically focused on small, independent practices, but more recently moved into the larger provider space. It offers a medical billing service that includes access to its powerful EMR system and practice management software; however, it does not offer coding services. This means your practice is responsible for coding claims internally, which requires an in-house medical coder. However, the billing services that AdvancedMD does offer are exceptional, generating a companywide first-pass claims rate guaranteed to exceed 95%. It is a competitively priced service that has the flexibility and expertise to serve practices of varying sizes across a wide range of specialties. For these reasons, AdvancedMD is our best pick for large practices, which likely have the resources to overcome the company's lack of coding services.
\r\nLike 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 low as 2% of monthly collections or as high as 9%. The typical contract term for AdvancedMD's RCM service is one year, which is shorter than many other medical billing services in our review.
\r\nIncluded in AdvancedMD's medical billing service pricing is access to the full healthcare IT platform, including the EMR system and practice management software. It is required for RCM clients to use AdvancedMD's healthcare IT products, which is a standard requirement across the medical billing services we reviewed.
\r\nSince 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.
\r\nAdvancedMD's high first-pass claims rate means there are relatively few denials to deal with, but 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.
\r\nIf 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.
\r\nAll 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 when it comes to claims scrubbing.
\r\nAdvancedMD works with a wide range of clients, including small, independent practices and larger, multi-location 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. The company's wide range of experience makes it a flexible service that can work with smaller practices, but also excel at revenue cycle management for large practices.
\r\nAdvancedMD 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 prior to submission, increasing the likelihood that claims make it through to payers and are accepted the first time they're submitted.
\r\nIn the event of a denial, AdvancedMD guarantees a rapid turnaround time 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.
\r\nAdvancedMD's RCM service includes access to its exceptional EMR system and practice management software for no additional cost. To learn more about AdvancedMD's medical practice management software or AdvancedMD's electronic medical records systems, read our reviews.
\r\nThe clear drawback to AdvancedMD's medical billing service is its lack of coding services. 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.
","fullReview":"Medical billing services need to be adaptive to a variety of specialties and practice sizes. AdvancedMD has historically served independent practices with just one to 10 providers, but it has more recently moved into the 100-provider space. AdvancedMD's billing services include access to its electronic medical records (EMR) system and practice management software for a percentage of monthly collections. The company can work with virtually any specialty and currently boasts a first-pass claims rate of 98.4%, one of the most competitive rates among the services we reviewed. For all these reasons, AdvancedMD is our best pick for medical billing service for large practices.
\r\nView all our recommendations for medical billing services on our best picks page.
\r\nAdvancedMD does not perform coding services, which is one of the few limitations we noted in its services. Instead, the company's billing process starts after claims have already been generated through charge entry and coding. The client practice then passes the claims to AdvancedMD, and the company scrubs the claims for any errors and submits them to the proper payers. AdvancedMD's 98.4% first-pass claims rate means there are relatively few denials to deal with, but if a claim is denied, the service will work to revise and resubmit it until the claim is ultimately accepted and paid. In addition, if a payer or patient has not paid their outstanding balance, AdvancedMD billers will follow up to secure the payment.
\r\nAll billers on AdvancedMD's staff must have at least one year of experience working in the industry. Between 10% and 20% of the company's billers are also certified coders, which helps when it comes to claims scrubbing.
\r\nAdvancedMD works with a wide range of clients, including small independent practices and larger multiple-location practices with up to 100 providers. The average AdvancedMD client has about 3,000 patient encounters per month, while larger clients have as many as 30,000 encounters per month. The company's wide range of experience makes it a flexible service that can work with smaller practices, but also excel at revenue cycle management for large practices.
\r\nAdvancedMD's average client can expect to pay 4% to 6% of net monthly collections, although there are some outliers that pay as low as 2% or as high as 8% of collections. The fluctuation in pricing is due to the nature of the medical billing service industry, in which pricing models are largely dependent upon practice size, specialty, billing complexity, claims volume and more.
\r\nThe cloud-based system does mean that if the software experiences any problems, it affects all practices using the system. When this happens with AdvancedMD, it posts updates about any software issues in its website's support section.
\r\nAdvancedMD offers thorough resources on the ICD-10 implementation, including training videos and webinars. The software supports both hospital procedure codes and clinical modification diagnosis codes, making AdvancedMD compatible with multiple clinical settings and specialties.
\r\nYou can run reports through AdvancedMD and customize them to best fit your practice's specialty; however, the initial setup for the software can be time-consuming and difficult depending on how much customization you need. The interface is heavy on features, and while that's great for flexibility, it does mean it has a learning curve. Regardless, AdvancedMD is an excellent service to consider, especially if you are looking for advanced software.
\r\nAdvancedMD is a thorough medical billing solution for any ambulatory practice. The software is conveniently cloud-based and combines a great practice management system with a certified EHR. AdvancedMD follows HIPAA guidelines, so you know that your patient and practice data is protected and secure.
\r\nThe biggest drawback of AdvancedMD's medical billing service is that the company does not manage charge entry or coding. These aspects of claim generation must be completed in-house by the practice or outsourced to a separate company, neither of which is ideal for a practice that wants seamless billing. Once claims are generated, AdvancedMD takes over, but the burden of managing coding and the complications that comes along with it remain squarely as the practice's responsibility. Many of the other medical billing services we reviewed do offer coding services, though it's not unusual in the industry for a company to only manage claims after they've been created. While the lack of charge entry and coding is notable, large practices often have certified coders in-house, so AdvancedMD remains our best pick for medical billing service for large practices.
"},"pricing":{"isCapped":false,"isFeatured":false,"primary":true,"selected":"widget","widgetId":"10104","widget":{"id":"10104","cta":"Compare Quotes","isExclusive":false},"affiliate":{"cta":"Visit Site","link":"https://www.advancedmd.com/","name":""}},"thumbnail":{"path":"https://staging.business.com/images/rev/prod/ce/57234-adp-advancedmd-box.jpg"}}},{"bullets":["Exceptional usability","High flexibility","Consultative approach"],"description":"February 2020 update: Earlier this year, CareCloud was acquired by MTBC, a company that provides healthcare IT solutions (including electronic medical records systems and practice management software) as well as medical billing services. It is unclear how the acquisition will affect CareCloud's existing medical billing services, if at all, as MTBC offers revenue cycle management services as well. We will take this into consideration the next time we give this category a full update.\r\n\r\nCareCloud is our pick for the most flexible medical billing service because it offers three tiers of services to suit the needs of practices of all sizes. At its lowest tier, Concierge, CareCloud takes claims generated and coded by the client practice and submits them to the relevant payers. It also monitors those claims after submission to ensure they are paid, following up on any denials or rejections and revising those claims accordingly. At the next level, Concierge Plus, CareCloud adds a claims scrubbing process prior to submission to increase the likelihood of claims being accepted by payers on the first pass. Finally, at the Concierge Pro tier, CareCloud takes over the full RCM process, generating and coding claims, submitting them, following up on denials, and posting payments. CareCloud typically charges 3% to 7% of a practice's collections. CareCloud purports a first-pass claims rate of 94%. It uses a business intelligence tool known as CollectiveIQ, a rules engine with more than 120 million billing rules to check claims against. CollectiveIQ helps CareCloud thoroughly scrub claims, and new rules can be added as it encounters specific errors or new rejections across specialties and payers. ","descriptionTest":"","fullTitle":"Best Flexible Medical Billing Service","isFeaturedBestPick":false,"isJumpLink":true,"tabTitle":"Best Flexible Medical Billing Service","review":{"displayName":"CareCloud","canonical":"https://staging.business.com/reviews/carecloud-revenue/","id":"b1f2c355481442ca09d3570b4370734b","url":"https://businesscom.go2cloud.org/aff_c?offer_id=260&aff_id=1000&source=best-medical-billing-services&aff_sub=bestpick|flexible&aff_sub2=lineuprank|2&aff_sub3=deal|getapp&aff_sub4=revenue|network&aff_sub5=pos|text&url_id=1","review":{"pros":["CareCloud is an extremely flexible RCM service that can be used with any EMR or practice management software, as well as to outsource part or all of your medical billing.","CareCloud takes a consultative approach to help grow your practice over time."],"cons":["CareCloud has a high implementation fee of $1,000 per provider and a lengthy contract term of three years."],"fullReviewTest":"CareCloud offers a medical billing service, healthcare IT suite, and consultative approach that is extremely flexible and tailored to the needs of each client. After CareCloud was acquired by MTBC earlier this year, the company revamped its software to be platform agnostic. Also, you can choose to outsource all of your medical billing to it or just a particular segment, making CareCloud the most flexible medical billing service we reviewed. For these reasons, it is our best pick for flexible medical billing service.
\r\nCareCloud's pricing largely depends on the same criteria other medical billing services use to determine their percentage of collections: practice size, specialty, claims volume and complexity of billing operations. Pricing is also significantly impacted by which of the three service tiers your practice selects. CareCloud's average costs range from 3% to 7% of net collections, which is lower than many of the other medical billing services in our review.
\r\nHowever, CareCloud also charges setup, implementation and training fees. These fees vary by the circumstances of a client practice, but a company representative estimated an average cost of $1,000 per provider. CareCloud also typically requires a minimum contract commitment of three years, one of the longer terms we found in our reviews.
\r\nCareCloud's onboarding process helps ensure practices are enrolled in Electronic Data Interchange (EDI) with payers, which allows practices or third parties acting on their behalf to submit claims and receive payments electronically. CareCloud's billing team includes coders with certifications from organizations such as the AAPC and AHIMA. CareCloud works with several clearinghouses, including Change Healthcare, TriZetto, Availity and Optum. The company also works directly with Medicare-associated payers.
\r\nThe precise process depends on whether you choose to outsource all or some of your billing department to CareCloud. CareCloud can perform these tasks:
\r\nCareCloud generates and codes the claims from superbills or other clinical documentation gathered by the practice during the patient encounter. CareCloud then scrubs the claims it has generated, submits them to the appropriate payers, follows up on unpaid claims, and manages rejections and denials.
\r\nCareCloud's billing rules engine, CollectiveIQ, scrubs claims for more than 120 million errors. The engine is regularly updated with new errors encountered by any of CareCloud's clients, which reduces common rejections and denials. Currently, CareCloud reports an organization-wide first-pass claims rate of 94%.
\r\nIn addition to working on claims for payers like insurance companies, CareCloud's billing process includes work on patient statements. In the same way that CareCloud billers follow up on unpaid claims with payers, staff will follow up with patients. When funds are collected, CareCloud takes its percentage and deposits the money directly in the practice's accounts.
\r\nCareCloud's biggest strength is its adaptability. You could outsource particular segments of your medical billing (such as unpaid claims follow-up and denial management), or opt for a comprehensive outsourcing plan in which CareCloud handles the entire process, from claims generation to denial management. This flexibility avails CareCloud to practices both small and large across any number of specialties.
\r\nCareCloud's software suite is extremely intuitive, designed with the typical patient visit in mind. The platform is included in the cost of the medical billing service but is not a requirement. Most medical billing services at least require clients to use their practice management software, but CareCloud is platform agnostic. However, if you do choose to use CareCloud's software, you will have access to an exceptional system. To learn more about CareCloud's electronic medical records systems or CareCloud's practice management software, read our reviews.
\r\nCareCloud's major drawback is its high upfront expense, which is typically about $1,000 per provider. Additionally, CareCloud's three-year contract term is among the longer terms in our review. A CareCloud representative explained the implementation charge as part of the company's consultative model, stating that the company wants to serve as a partner with medical practices and, therefore, want a long-term commitment and \"skin in the game.\" While CareCloud indeed offers a consultative approach that can help practices grow over the long term, these upfront fees could make an initial investment untenable for small practices on a tight budget.
","fullReview":"CareCloud's outsourced medical billing, called Concierge, offers three different tiers of service, which include limited billing work as well as full revenue cycle management. This model allows practices to select the tier best suited to their needs – whether they want to augment their in-house billing or fully outsource their billing department. Either way, the cost is affordable and competitive with other top medical billing services we researched during our review.
\r\nCareCloud takes a percentage of collections, and that percentage varies depending on the tier selected, the size and specialty of the practice, and the complexity of its billing operations. CareCloud Concierge is available to practices of varying sizes and specialties, and the company offers a solid organization-wide first-pass claims rate of 94%. For these reasons, CareCloud is our pick for the best flexible medical billing service.
\r\nView all our recommendations for medical billing services on our best picks page.
\r\nCareCloud's billing process depends on which tier of service your practice selects. Clients at the lowest tier outsource a small portion of their billing, which includes the submission of practice-generated claims and denial management in the event any of those claims are rejected. At this level, practices are responsible for charge entry and coding of claims.
\r\nThe next level, Concierge Plus, adds claims scrubbing services through the company's CollectiveIQ billing rules engine to reduce denial; however, practices are still responsible for generating their own claims at this level.
\r\nThe third tier of service, Concierge Pro, is a full revenue cycle management outsourcing solution, in which CareCloud generates and codes the claims from superbills or other clinical documentation gathered by the practice during the patient encounter. CareCloud then scrubs the claims it has generated, submits them to the appropriate payers, follows up on unpaid claims, and manages rejections and denials.
\r\nCareCloud's billing rules engine, CollectiveIQ, scrubs claims for more than 120 million errors. The engine is regularly updated with new errors encountered by any of CareCloud's clients, which reduces common rejections or denials. Currently, CareCloud reports an organization-wide first-pass claims rate of 94%.
\r\nIn addition to working on claims for payers like insurance companies, CareCloud's billing process includes work on patient statements. In the same way that CareCloud billers follow up on unpaid claims with payers, staff will follow up with patients. When funds are collected, CareCloud takes its percentage and deposits the money directly in the practice's accounts.
\r\nAt all levels, CareCloud helps ensure practices are enrolled in Electronic Data Interchange (EDI) with payers, which allows practices or third parties acting on their behalf to submit claims and receive payments electronically. CareCloud's billing team includes coders with certifications from organizations such as the AAPC and AHIMA. CareCloud works with several clearinghouses, including Change Healthcare, TriZetto, Availity and Optum. The company also works directly with Medicare-associated payers.
\r\nCareCloud's pricing is largely dependent on the same criteria other medical billing services use to determine their percentage of collections: practice size, specialty, claims volume and complexity of billing operations. In addition, pricing is significantly impacted by which of the three service tiers your practice selects. CareCloud's average costs range from 3% of net collections to 7% of net collections, which is lower than many of the other medical billing services in our review.
\r\nHowever, CareCloud also charges additional setup, implementation and training fees beyond this percentage of collections. These fees include a $5,000 setup fee for each of the first three providers and $2,750 per provider after that. Those are among the highest fees in our review.
\r\nCareCloud requires a minimum contract commitment of one year, though many of its clients are contracted for as long as three years. The company cites its implementation and training period requirements as a primary reason for signing a longer contract, though it is not required. It also includes a minimum payment amount each month that is calculated based on the expected monthly collections of a practice. Minimum monthly payments were not uncommon in our review, though not every company includes monthly minimums in their contracts.
\r\nCareCloud maintains its own electronic medical records (EMR) software and practice management software. Medical billing service clients are not required to use CareCloud's EMR, but they must be on the practice management software through which CareCloud billers conduct all revenue cycle management operations. Because CareCloud billers work directly within the practice management system, clients can monitor the billers' activities in real time, just as they would any in-house staff member using the software. The practice management software also includes claim error alerts, an audit log and a reporting tool for analyzing practice data.
\r\nCareCloud offers practices several ways to gain insights from their financial data. The first level includes scheduled reports, along with on-demand reporting that can be pulled from the system on an ad hoc basis. The next level down features a command center dashboard that displays practice KPIs, such as revenue goals, expenses, collections and denials. The system includes more than 150 templates for generating reports on demand, but for practices that want to take an even deeper dive, CareCloud offers an advanced analytics tool – essentially a massive spreadsheet that contains all the data stored on the system. Providers can sort and filter that data in any way they'd like, creating custom tables that can be turned into daily, weekly or monthly reports. All data gleaned from the advanced analytics tool can be exported to Microsoft Excel.
\r\nWith CareCloud, you're assigned a dedicated account manager who offers both support and advice. The company maintains a U.S.-based support team that is available Monday through Friday from 8 a.m. to 9 p.m. EST. The company also offers a ticket system when technical issues arise, as well as a tool that lets you check the status of existing support tickets. In addition, CareCloud clients have access to a community forum for discussing issues, offering tips, asking questions or finding answers to frequently asked questions.
\r\nWhen a practice signs up with CareCloud, part of the implementation costs are applied to EDI enrollment and ensuring that providers are properly credentialed with the appropriate payers. CareCloud also offers training to in-house staff on how to properly use its systems.
\r\nCareCloud's biggest limitation is its significant setup fees, which can run a small practice into five-figure expenses very quickly. While these are one-time costs (unless you add more providers after signing up), they do represent a hefty expenditure when signing up for the service. CareCloud's limited billing outsourcing is a great option for practices that want to keep costs low over the long term, but any practices considering working with CareCloud should be aware that startup costs will likely be higher than average and could prove cost-prohibitive to a small practice on a budget. However, the total cost (including setup fees) for medical billing services should be calculated against the cost of maintaining in-house employees to fulfill the roles an outsourced biller will be conducting. Despite the high setup fees, CareCloud remains our best pick for flexible medical billing services because of its versatile offerings and ability to adapt to a wide range of billing operations and workflows.
"},"pricing":{"isCapped":false,"isFeatured":false,"primary":true,"selected":"widget","widgetId":"10104","widget":{"id":"10104","cta":"Compare Quotes","isExclusive":false},"affiliate":{"cta":"Visit Site","link":"https://businesscom.go2cloud.org/aff_c?offer_id=260&aff_id=1000&source=best-medical-billing-services&aff_sub=bestpick|flexible&aff_sub2=lineuprank|2&aff_sub3=deal|getapp&aff_sub4=revenue|network&aff_sub5=pos|text&url_id=1","name":""}},"thumbnail":{"path":"https://staging.business.com/images/rz/5b6b22761039ebc6368b45c4/cc-logo-pr.png"}}},{"bullets":["Low cost","Certified coders and billers","Free implementation and training"],"description":".","descriptionTest":"","fullTitle":"Best RCM Service for Small Practices","isFeaturedBestPick":false,"isJumpLink":true,"tabTitle":"Best RCM Service for Small Practices","review":{"displayName":"ChartLogic","canonical":"https://staging.business.com/reviews/chartlogic/","id":"a97dad5b4d908b7e87335888886c9c09","url":"https://businesscom.go2cloud.org/aff_c?offer_id=259&aff_id=1000&source=best-medical-billing-services&aff_sub=bestpick|best-rcm-service-for-small-practices&aff_sub2=lineuprank|3&aff_sub3=deal|no&aff_sub4=revenue|bz-rfq&aff_sub5=pos|bbc&url_id=1","review":{"pros":["ChartLogic is a low-cost solution, with typical pricing ranging from 3% to 6% of monthly collections.","ChartLogic's staff of medical coders and billers are all required to be certified through a reputable medical billing and coding association."],"cons":["ChartLogic's RCM clients are required to be on both the vendor's EMR and practice management software unless there are special circumstances."],"fullReviewTest":"ChartLogic is a low-cost medical billing service that maintains a fully certified staff of medical coders and billers. The company assigns a dedicated account manager to help onboard clients, who must also use the company's healthcare IT platform, including the EMR system, practice management software and patient portal solution. A series of pre- and post-implementation check-ins means any issues can be addressed directly by the practice's one-to-one contact in the dedicated account manager, all of which is included in the competitively priced medical billing service percentage.
\r\nNot only are ChartLogic's coders and billers all certified, but they have experience working in certain specialties and are assigned to you based on your practice's specialty and the complexity of your billing processes. Similarly, ChartLogic pairs coders and billers with client practices based on their understanding of the geographic region and local insurance company policies. ChartLogic is our best pick for small practices for its holistic approach and \"one-stop shop\" philosophy, which simplifies the complex process of selecting a medical billing service provider and healthcare IT platform.
\r\nChartLogic's pricing is an industry-standard percentage of monthly collections captured on behalf of your practice. It starts at 3% of your collections, which is common for its competitors, but tends to top out around a low-cost 6% of monthly collections. This makes ChartLogic one of the most cost-effective medical billing services in our review. ChartLogic typically requires a two-year contract term for its RCM services.
\r\nChartLogic charges no additional implementation or training fees and includes its EMR and practice management software in the percentage of monthly collections. Included in implementation is a billing analysis of your practice's past performance and the assignment of a dedicated account manager, who oversees implementation and offers a post-implementation evaluation.
\r\nChartLogic's process begins with a full review of your past billing activity and collections. The process is designed to identify where your practice is at in terms of financials and opportunities for immediate growth or improvement.
\r\nOnce the analysis is complete, if your practice and the company choose to move forward, ChartLogic provides a full agreement outlining its responsibilities as well as yours. Once that agreement is signed, the implementation and onboarding team takes over. Software implementation and training occurs in tandem with provider credentialing with the necessary payers, as well as logistics like setting up bank account information for direct remittance of funds. ChartLogic does not use a lockbox system in which practice funds first flow to the company and then into the bank account; instead, collected funds are directly deposited minus ChartLogic's rate.
\r\nOnce billing begins in earnest, your practice is assigned a billing account manager, who serves as a direct point of contact between your practice and ChartLogic. ChartLogic's team of certified coders and billers reviews, codes and edits all your claims. Claims also go through a claims scrubber, which flags any errors that could potentially lead to denial by payers.
\r\nChartLogic maintains full integrations with Change Healthcare and RelayHealth clearinghouses. The company offers insurance eligibility verification services prior to patient appointments through those organizations.
\r\nOnce claims are submitted, ChartLogic continues to monitor them until they are paid or rejected, following up on unpaid claims regularly and revising and resubmitting denials. The timeline for follow-ups and denial management varies by practice. ChartLogic also manages patient billing and follow-ups. The company can also refer patient balances to collections, but it allows your practice to set policies regarding if and when it's allowed to do so.
\r\nChartLogic stands out for its full certification requirements for coders and billers on its staff. Many medical billing services maintain some certified staff, but they don't necessarily require certifications for new hires. A completely certified staff guarantees that your claims will be handled by staff members with up-to-date knowledge of best practices and insurance company policies.
\r\nChartLogic is a low-cost solution suitable for small practices, especially those looking for a complete healthcare IT suite that includes an EMR system and practice management software. The dedicated billing manager serves as a point person to help your practice from start to finish, including the post-implementation evaluation. This onboarding process can ease what is often a challenging and costly step.
\r\nAdditionally, ChartLogic directly remits payments into your practice's account without holding funds in a third-party account or \"lockbox\" like many other medical billing services do. This means faster delivery of funds after payers accept claims and remit payment.
\r\nThe biggest drawback to ChartLogic's medical billing service is its requirement that you also use its EMR system and practice management software. This means that practices using other platforms typically cannot use ChartLogic for medical billing unless they are willing to switch healthcare IT suites, which can be an arduous, expensive and time-consuming process. However, a representative of ChartLogic told business.com that there are some exceptions in which a client practice might be able to keep its existing practice management software; the ChartLogic EMR system, though, is generally always required. Luckily, the cost of the EMR and practice management software is included in the monthly percentage of collections charged for RCM services.
","fullReview":"ChartLogic's medical billing service is focused on reducing errors that happen prior to submission to boost total revenue and reduce the number of time claims are spent in accounts receivable. This makes it a good solution for practices that aren't collecting as much as they could due to errors related to inexperience or an overburdened workload in-house.
\r\nView all our recommendations for medical billing services on our best picks page.
\r\nChartLogic has experience billing for more than 80 specialties and maintains a team of certified medical coders to ensure your claims are properly generated from the beginning. ChartLogic is a complete medical billing service that takes the entire revenue cycle management (RCM) process off your practice's plate.
\r\nChartLogic offers an end-to-end medical billing service that begins with claims coding and ends with denial follow ups and resubmission. ChartLogic also handles patient payments by sending two statements and following up with phone calls when the balance goes unpaid.
\r\nChartLogic maintains a team of certified American Academy of Professional Coders (AAPC) coding specialists on staff to ensure accurate coding. The company also offers a Chart Audit that identifies any recurring coding errors that have resulted in incorrect payments or otherwise unwarranted denials.
\r\nOne of the most central aspects of ChartLogic's medical billing process is the patient eligibility check, which ensures that patient's insurance policies are not only valid, but which type of coverage the patient has, what the policy includes, and what type of services will ultimately be reimbursed by the payer. After a fully analysis, ChartLogic sends the results of the patient eligibility check to the practice three days prior to the patient visit. This measure is also intended to reduce the number of claims denials.
\r\nThe company claims it can achieve the following with the billing process it has set up:
\r\nChartLogic's price range begins on the higher end, but is still largely in average territory compared with other companies in our review. The company charges 6 to 8 percent of the practice's net collections. The pricing includes credentialing assistance for practice's that have not yet set their credentials with insurance providers.
\r\nChartLogic provides medical billing clients with access to their own suite of healthcare IT products, including the ChartLogic electronic health record (EHR) system and practice management software. The software suite also includes a patient portal, which makes it easier for patients to schedule appointments and make payments.
\r\nChartLogic's EHR is an easy to use system that doesn't require many clicks to accomplish most tasks. It includes a one-screen charting feature that makes it easy to fill out a complete chart during a patient encounter without navigating to several different screens. This addresses a major complaint in the EHR industry around the software interrupting a provider's engagement with the patient. The EHR also includes a custom template builder that can further expedite the charting process.
\r\nThe practice management solution effectively acts as an additional layer of communication between ChartLogic and the practice. Practice management solutions maintain detailed information about the revenue cycle management process and how well the practice is collecting on its claims. ChartLogic will keep your practice management software up to date so you can view your practice's financial health and contact the company if you're dissatisfied or concerned there might be a problem.
\r\nChartLogic support includes provider credentialing and contract negotiation with insurance companies, which is especially useful for new practices that still need to get set up. You'll also receive custom reporting from ChartLogic, which includes information about outstanding claims, revenue collected, denials, and so on.
\r\nChartLogic maintains a help center on its website for 24/7 access to useful materials and resources. It also includes product training for bringing staff members up to speed or offering a refresher course. The company maintains a live chat and service hotline, as well as a remote service ticket system in the event you need a technician to take control and solve any problems you might be having with your software.
\r\nEditor's note: Looking for a medical billing solution? Click the Compare Quotes button below to be connected with vendors that can help.
"},"pricing":{"isCapped":false,"isFeatured":false,"primary":true,"selected":"widget","widgetId":"10104","widget":{"id":"10104","cta":"Compare Quotes","isExclusive":false},"affiliate":{"cta":"Visit Site","link":"https://businesscom.go2cloud.org/aff_c?offer_id=259&aff_id=1000&source=best-medical-billing-services&aff_sub=bestpick|best-rcm-service-for-small-practices&aff_sub2=lineuprank|3&aff_sub3=deal|no&aff_sub4=revenue|bz-rfq&aff_sub5=pos|bbc&url_id=1","name":""}},"thumbnail":{"path":"https://staging.business.com/images/rz/5f243e009c658a43338b4567/chartlogic_logo.png"}}}]},{"__typename":"SectionWidget","id":"get-a-quote","isInToc":false,"type":"widget","title":"Find the Right Medical Billing Service for Your Business","widget":{"widgetId":"10104"}},{"__typename":"SectionContainer","id":"overview","isInToc":false,"type":"container","title":"","container":{"isBuyingGuide":false,"html":"\nMedical billing services remove the burden of revenue cycle management. With integrations for an organization's electronic medical records (EMR) systems and practice management software, claims can be generated by third-party staff or even automated systems. Outsourcing revenue cycle management also puts a dedicated team in charge of chasing denials and underpayments, reducing the workload of monitoring submitted claims in-house. Best of all, most services operate directly within a medical practice's existing practice management software, allowing staff to monitor progress on submitted claims.
\r\nWhile medical billing services offer a significant benefit to medical practices, it's important to choose the right one. Selecting the wrong partner can tie up the practice's money and possibly cause payments to fall through the cracks.
To ensure that revenue continues to flow smoothly, medical billing departments need to quickly and efficiently capture charges to create claims, properly code those claims, and submit them through the right channels to the proper payers. Even as new charges are coming in, billers must keep tabs on previously submitted claims, ensuring they are not rejected or denied by payers. If they are, billers must revise those claims and resubmit them, as new charges continue to pile up. Clearly, there's a lot that can go wrong.
The challenges associated with medical revenue cycle management (RCM) require billing departments to be nimble and adaptable. Billing departments are also responsible for staying abreast of the latest updates, whether that's changing regulations or shifts in payers' policies. No matter which way you slice it, medical billing demands a lot of time, energy and money to run in-house. That's why many medical practices choose to outsource their revenue cycle management to third-party medical billing services, sometimes called RCM services. Unfortunately, it's a crowded space with many disreputable companies; finding a good one can be tough but is important, because the right service can take the burden of billing off your practice, ideally reducing your expenses while also boosting revenue.
\r\nBusiness.com researched some of the leading medical billing services to help you cut through the clutter. We've reviewed several quality services we encountered in our research and selected some as best picks, such as the best medical billing service for small practices, the best medical billing service for large practices and the most flexible medical billing service.
\n"}},{"__typename":"SectionOurApproach","id":null,"isInToc":false,"type":"ourapproach","isActive":null,"ourapproach":{"isClonable":false,"servicesConsidered":"28","servicesTested":"8","servicesSelected":"3","linkText":"How we evaluate products and services","linkUrl":"mailto:editor@business.com"}},{"__typename":"SectionContainer","id":"compare-our-best-picks","isInToc":true,"type":"container","title":"Compare Our Best Picks","container":{"isBuyingGuide":false,"html":"\n| \r\n | AdvancedMD | \r\nChartLogic | \r\nCareCloud | \r\n
| Pricing (% monthly collections) | \r\n~3% to 8% | \r\n~3% to 6% | \r\n~3% to 7% | \r\n
| Implementation/training | \r\nIncluded | \r\nIncluded | \r\n~$1,000 per provider | \r\n
| First-pass claims rate | \r\n~95% to 97% | \r\n>95% | \r\n~97%* | \r\n
| EMR/PMS requirements | \r\nEMR/PMS required | \r\nEMR/PMS required | \r\nEMR/PMS agnostic | \r\n
| Contract requirements | \r\n1 Year | \r\n2 years | \r\n3 years | \r\n
*Composite resolution rate (first and second pass)
\n"}},{"__typename":"SectionReviews","id":"our-reviews","isInToc":true,"type":"reviews","title":"Our Reviews","reviews":[{"title":"DrChrono"},{"title":"AdvancedMD - Medical Billing Services"},{"title":"CareCloud"},{"title":"Kareo - Medical Billing Services"},{"title":"athenaCollector"},{"title":"ChartLogic"},{"title":"Iris Medical"},{"title":"NueMD - Medical Billing Services"}]},{"__typename":"SectionContainer","id":"pricing","isInToc":true,"type":"container","title":"Costs of Medical Billing Services","container":{"isBuyingGuide":false,"html":"\nPricing models are largely the same from company to company in the medical billing service industry. Most companies in our review charge a percentage of the 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 the low and high ends.
\r\nSome companies charge additional fees, such as setup, implementation or clearinghouse fees. These fees can vary greatly by company, so it's important to question sales representatives to find out their companies' policies.
\r\nOccasionally, medical billing services will institute a monthly minimum that must be paid in case the percentage of a practice's revenue for the month isn't high enough. Other services charge a monthly per-provider base price, on top of which it takes a small percentage of collections, but this model is rare.
\n"}},{"__typename":"SectionBuyingGuide","id":"what-are-medical-billing-services","isInToc":true,"type":"buying-guide","title":"Buying Guide","containers":[{"title":"What Are Medical Billing Services?","html":"\nMedical billing services allow practices to outsource their medical coding and billing process. 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.
\r\nOutsourcing your RCM puts a dedicated team in charge of generating your claims, scrubbing them for errors, and chasing denials or underpayments, reducing or eliminating the workload associated with in-house billing. Best of all, most services operate directly within your medical practice's existing practice management software, allowing staff to monitor progress on submitted claims.
\r\nWhile medical billing services offer a significant benefit to medical practices, it's important to choose the right one for your practice. Selecting the wrong partner can tie up your practice's money and possibly allow patients' payments to fall through the cracks. To ensure that revenue continues to flow smoothly, medical billing departments need to quickly and efficiently capture charges to create claims, properly code those claims, and submit them through the right channels to the proper payers. Even as new charges are coming in, billers must keep tabs on previously submitted claims, ensuring they are not rejected or denied by payers. If they are, billers must revise those claims and resubmit them, as new charges continue to pile up. Medical billers are also responsible for sending patient statements for copayments or out-of-pocket expenses, as well as following up with unpaid patient accounts.
\r\nThe challenges associated with medical revenue cycle management require billing departments to be nimble and adaptable. Billing departments are also responsible for staying abreast of the latest updates, whether that's changing regulations or shifts in payers' policies. No matter which way you slice it, medical billing demands a lot of time, energy and money to run in-house. That's why many medical practices choose to outsource their revenue cycle management to third-party medical billing services, sometimes called RCM services.
\n"},{"title":"The Benefits of Medical Billing Services","html":"\nMedical billing services help medical practices in various ways. These are the major benefits of medical billing services:
\r\nWhile outsourcing isn't right for everyone, it can help medical practices that are having trouble operating the back office smoothly. Best of all, a good medical billing service can improve your overall cash flow.
\n"},{"title":"Outsourced Revenue Cycle Management vs. In-House Billing","html":"\nWhether 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.
\r\nCost 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 between 4% and 9%. Based on that guideline, you should be able to get 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.
\r\nOutsourced 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 with the number of patients the practice serves. For larger practices and hospitals, a billing service may not be worthwhile if you have the budget for medical coders, a large volume of claims and the resources to handle them internally.
\n"},{"title":"How Does Medical Billing and Coding Help Increase Cash Flow?","html":"\nA 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.\"
\r\nMany 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 moves through the clearinghouse to the payer and is 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, the better.
\r\nHowever, 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. Be sure to ask for clarification on how a company tracks its clean claims rate.
\r\nMedical 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 that can be fixed. 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 your claim gets paid in a timely manner.
\r\nSometimes claims sit with a payer without any response. In these cases, medical billing services often follow up (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.
\r\nEach of these elements of an RCM service contribute to downward pressure on the days in A/R, which means you get paid quicker for the services your practice has rendered, keeping your cash flow regular and healthy.
\n"},{"title":"Medical Billing Trends to Watch","html":"\nYou might have seen the flurry of news stories last year about the World Health Organization classifying burnout as a workplace phenomenon and identifying gaming addiction as a risk facing youth. Those headlines came out of the 22nd World Health Assembly, where the WHO presented a proposed draft of the ICD-11 diagnostic and procedural codes.
\r\nYou might be thinking, \"Wait, we just shifted to ICD-10. What gives?\" The transition to ICD-10 in the U.S. took place significantly after the rest of the world adopted the standards. In fact, most countries implemented ICD-10 in 1998, while the U.S. only meaningfully moved toward ICD-10 in 2015. Now that the proposed ICD-11 standards have been released, it's up to WHO member states whether they endorse the codes or not.
\r\nICD-11 builds on the ICD-10 coding standards, growing the list of codes in the library from 14,400 to 55,000. While that's a big expansion (likely stirring nightmares about yet another transition), healthcare IT vendors and healthcare providers likely have some time before an IDC-11 implementation is required. Assuming the standards are adopted by member states, they still wouldn't go into effect until January 2022. Still, keeping tabs on ICD-11 as it weaves its way through the regulatory process is key to prepare for any impending changes.
\r\nHealthcare IT is on the rise around the world, driving growth of the medical billing service industry forward as well. Market Research Engine issued a report projecting that the medical billing service industry will eclipse $16 billion in total value by 2024. According to the report, the growth will be driven by rapidly changing regulations that make third-party billing more attractive, and by the desire of healthcare providers to cut their in-house expenses while growing revenue.
\r\nData privacy will still be a drag on growth, however, giving pause to healthcare providers who are hesitant to provide sensitive patient records to a third party. Demonstrating staff certification and adherence to privacy best practices will be key for medical billing services to remain successful.
\n"},{"title":"Medical Billing Services FAQs","html":"\nThe answers to these frequently asked questions can shed additional light on the medical billing services space.
\r\nThe medical billing process is complex and involves several third parties. However, it can be broken down simply into these general components:
\r\nPart of the process is also tracking patient balances owed and following up on unpaid accounts. In some cases, a medical billing service will refer the balance to collections.
\r\nMedical 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 electronic medical records (EMR) systems and practice management software as part of the percentage costs. If you're in need of these platforms, a medical billing service could be the way to go.
\r\nBefore 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 on medical billing services they've successfully used.
\r\nOutsourced revenue cycle management is right for some medical practices but not for others. If you find that claims are languishing unpaid or that you are receiving a high rate of rejections, you might consider partnering with an experienced medical billing service. Additionally, if the cost of a medical billing service is lower than maintaining full-time coders and billers in-house, outsourcing could likely result in cost savings.
\n"},{"title":"Our Methodology","html":"\nWe researched dozens of prominent vendors in the medical billing space to determine which were worthy of our best picks. Our initial research included reviewing client testimonials, other reviews, company websites and Better Business Bureau ratings. We also examined brands' other offerings in the healthcare space; for example, we considered whether they offer electronic medical record software.
\r\nWe used the information we gathered to narrow down our initial vendors list to 10 finalists to be considered for reviews and best picks. We then considered the following factors to determine our best picks:
\r\nIn the end, we selected ChartLogic as the best medical billing service for small practices, AdvancedMD as the best medical billing service for large practices, and CareCloud as the most flexible medical billing service.
\n"}]},{"__typename":"SectionContainer","id":"related-services","isInToc":true,"type":"container","title":"Related Healthcare IT Solutions and Medical Practice Services","container":{"isBuyingGuide":false,"html":"\nMany medical practice software solutions and third-party services go hand in hand. For example, an electronic medical records (EMR) system 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.
\r\nIf you're looking for a full suite of healthcare IT solutions or additional medical practice services that could improve the way your practice runs, take a look at our other medical practice review categories.
\r\nSince 2014, 90% of solo practitioners and small medical practices say they plan to outsource their medical billing as a way to reduce their overhead and eliminate labor-intensive, in-house billing operations. It should come as no surprise that the medical billing service industry is projected to reach a market value of $16.9 billion by 2024. In 2020, more medical practices are expected to outsource their medical billing to third-party services.
\r\nAs technology improves, so do medical billing services' offerings. Automation has become 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 revenue cycle management providers.
\r\nAs cloud-based medical billing software and electronic claims processing become more common – especially with more effective integrations for EMR systems and practice management software – automation offers new opportunities so medical billers can quickly and easily scrub and submit claims through clearinghouses to payers.
\r\nFrom the moment a patient's insurance eligibility is verified to when payments are remitted, software is an essential element of the modern medical billing process. As healthcare IT products integrate machine learning algorithms, expect new opportunities for automation and increased accuracy in medical billing.
\r\nModern medical billing software and services also allow healthcare organizations to personalize the patient experience when it comes to delivering statements and capturing payments. Many services have begun implementing payment plans and other useful features that 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.
\r\nThe global spread of COVID-19, also known as the novel coronavirus, has led to questions among some medical billers and coders about how to classify the illness using ICD-10 codes. For medical billers, although COVID-19 is a new illness, there are existing codes within ICD-10 that apply to the condition. For most coronavirus patients, medical coders can use the B97.29 code, which indicates \"other coronavirus as the cause of diseases classified elsewhere.\" Additionally, the World Health Organization has released guidance to use the emergency ICD code U07.1 to refer to COVID-19 as an acute respiratory disease. The ICD-11 code for the illness is RA01.0.
\n"}},{"__typename":"SectionMoreCoverage","id":"","isInToc":false,"type":"morecoverage","isActive":null,"title":"More Coverage","articles":[{"title":"The Basics of Medical Billing and Coding","canonical":"https://staging.business.com/articles/medical-billing-and-coding-guide/","author":{"displayName":"Adam C. 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