Medical Billing Reviews

Everything you need to know about the Top Medical Billing Companies

Why Outsource?

If introducing EHR technology and selecting the right electronic medical record vendor, attesting for meaningful use/PQRS was not enough, physicians must now undertake one of the biggest healthcare reforms in the US to date- the transition to ICD-10.

Even if the transition is delayed, there are enough reforms being made to physician reimbursements such as the rise in deductibles, the move towards pay for performance model; that warrant a reform to the way you practice medicine.

It is only logical then to look for a partner that will relieve you from managing the revenue stream of your practice. It also makes financial sense, as a professional in-house biller costs you around $ 50,000 per annum while a third party team of billers comes at a fraction of this cost.

According to the latest Black Book Survey, 50 to 60 % of practices are already considering outsourcing billing to a third party. This page is your guide for selecting the best medical billing company for your practice.

Things to remember before outsourcing

Before I get into dissecting each medical billing company, let’s explore some of the options out there for you. You can choose either of the following to bill on your behalf.

• Local company

If it’s a local company, you will have the benefit of on-site support. It’s always nice knowing that if things are not working out; you can actually walk up to their office and push them into action. That’s one of the reasons why many physicians have signed contracts with their local vendors. However, how do you find out if things are not going well for your practice?

With local vendors, many practices are unable to monitor the performance of their billing company as there is no reporting mechanism in place through which practices can look at the aging of their claims. There is no real time financial aging summary, ability to view pending patient responsibility to name a few. Leaving that aside, these practices must still resort to calling insurances to verify insurance eligibility rather than relying on their billing software to do this task for them. Thus, not only do you have a very basic billing functionality but you are literally dependent on these vendors without any way of analyzing how they are performing. Thus, all you get with a local vendor is a face but no quality. Moreover, this option is generally more expensive than the other two.

• Offshore Billing vendor

With offshore billing companies, your problems are two folds.
a. Abominable support – the accents , lack of understanding the US insurance system , keeping up to date with payer payment changes , the misfortune of being transferred from one support representative to another rather than having your own billing account manager
b. Privacy Concerns - Are you willing to risk sharing your patient’s financials across shores in this environment of ever increasing focus on protection of patient health information and the penalties associated with it? I think not.

The positives though, these are less costly alternatives. Many of these companies charge you per claim rather than the standard percentage of collections model used across the industry.

• Your own EHR vendor (provided they offer billing services as well)

The third option is the one that I personally prefer. Outsource billing to your Electronic health Record (EHR) vendor. You will have the obvious advantage of dealing with a single vendor, saving you the hassle of following up or monitoring different vendors to ensure that they are delivering on their promises. Moreover, most vendors with billing service will offer you their best EHR Software and Practice Management System (Medical Billing software) for free, which will allow you to have some control/ insight into how your third party biller is performing. Be cautious however; don’t get stuck into the worst of both worlds.

If you are willing to take this plunge make sure that the EHR vendor you choose is a good one. You don’t want to land up using a substandard system with a substandard service as it will affect your revenue as much as a bad billing company. Please read EHR vendor Analysis to evaluate a few of the top vendors in the industry.

AVOID PREDATORY BUSINESS PRACTICES

Do not select a billing company solely on low rates without considering the risks attached to it

Things to remember before outsourcing

Before I get into dissecting each medical billing company, let’s explore some of the options out there for you. You can choose either of the following to bill on your behalf.

• Read the contract – How does the company define Collections?

You should only pay for the amount that the billing company will work on i.e., payer reimbursement or patient balances, nothing more. Many billing companies define collections as your practice’s complete revenue and charge you even for revenue they did not help you collect. Don’t fall for this practice; else you will end up paying significantly more. If you find yourself dealing with such a company, this is a good indicator to leave them.

• Avoid Bait Marketing Tactics

Many companies advertise low rates to attract uneducated buyers and build a market share. These companies generally do not provide you with full suite revenue cycle management services or have an elevator clause associated with the low rate. Always read the fine print in any billing service contract.

a) Many low rate vendors have a minimum revenue requirement, which is set high, thereby making the low offer ineligible or unattainable.

b) Some low cost vendors only offer one time submission for each claim and do not provide services such as working on denials or resubmitting claims. In these cases the burden of working denied claims and collecting unpaid balances shifts back to the physician’s staff. If your billing company can’t work your denials they are truly not worth your money.

• Term of Contract

Be wary of vendors who may want to lock you into long-term agreements without any history with your practice or accountability or performance metrics in place. Standard contract lengths are 24, 36, 48, and 60 months. Billing contracts ideally should be for a year with renewal subject to the performance of the company.

• Who owns the data?

When the agreement is terminated, who owns the data? In some situations the data is held hostage by the RCM vendor to avoid or discourage termination.

• No performance guarantees

Most reputable RCM vendors offer some type of performance guarantee. However, some RCM vendors do not offer any type of performance guarantee or stand behind their services at all. Those are the types of RCM vendors that you’ll want to avoid.

Medical Billing Companies being evaluated



Kareo

Kareo has grown immensely over the past years and one of the main reasons for their growth has been their billing support staff. They invest time to ensure that their clients get paid by regularly conducting sessions with the practice owners regarding ways of improving their billing and by keeping up to date with payer payment changes.


With Kareo, a physician’s work ends at the creation of the super bill. The Kareo team takes it over from there, scrubbing the claims for errors before sending it out to ensure that the denial rate is reduced. If however a rejection is received, the Kareo team works with the practice to ensure that the errors are fixed and the claim can be resubmitted again to expedite payment.


The company also assists a practice in handling patient statements. It posts patient statements via email or regular mail if needed. It also handles any customer support regarding billing; relieving your front desk from answering complicated billing related queries. Thus three thumbs up to Kareo for their billing service.


However, as robust as their billing service is -their EHR is a letdown. It is a small system built with very basic functionality. Honestly, expecting more from a system that is free would be asking too much.


Kareo has ventured recently into the EHR market and will take time to develop a sophisticated system. This is a red signal for those of you who want to outsource billing to a company supported by a good EHR system as well. Kareo EHR does not support specialties; they don’t provide you with customized templates for your practice, you can either create your own by using their “Template Editor Tool” or pay extra to get assistance from Kareo.


Moreover, their trainings are in the form of recorded tutorials or weekly webinars rather than a one-on –one training program with the practice. To me this is a big no. All practices have their own learning curve and should have their training programs designed in a way that suits them. My advice to the company would be to address this issue so that they can offer their clients a complete deal rather than a good service not supported by an equally good product.

advancedmd

AdvanceMD is another popular billing company in the market though they seem to be slightly over priced. Before we analyze their billing services a few words about their product.


AdvanceMD probably has the most forward-looking functionality in the industry. One would appreciate the innovativeness they have shown, if only the team at AdvanceMD had found a way to tone down the complexity that these features have added to the system. The system has a very steep learning curve. Some of their clients complained that their implementation period stretched to 40 weeks rather than the standard 8 weeks, just because the system was too hard.


In my assessment, here again we have a large practice system being sold to small and medium sized practices. It clearly is not the best fit and is costing the company in the form of bad reviews both for the product and the services, despite the effort they have put in creating their solutions.


On the billing side, they provide you a comprehensive revenue cycle management service just like Kareo. They post your charges, scrub your claims, submit them through a clearing house (AdvanceMD integrates with McKesson Clearing House) and follow up on your denials. They also cover patient collections. Their support however, has not received a lot of positive reviews. There have been complaints that a practice’s account is continuously transferred from one billing manager to another rather than having a dedicated person who is aware of the practice’s workflow.


In summary, AdvanceMD has a good product that is let down by their support. They need to work on improving their user experience so that the product screens look less cluttered. Until then, this vendor is good for very large practices that need advanced functionality and can compromise on usability. (Epic users alert)

CureMD

Quite honestly, this one remains one of my favorite billing companies out of the lot. I have also reviewed CureMD’s software in one of my previous analysis. In terms of their product I found their EHR relatively easy to manage and navigate through. Their solution is specialty specific and offers enough customization for a practice to personalize it according to its size and workflow. However, I don’t think their system is a good fit for hospitals at this time (they don’t cater to inpatient facilities).

In terms of support, CureMD has done well. They provide numerous support options (chat, ticket and telephone) to cater to their clients. CureMD Medical Billing services also handle patient statements at their end relieving your staff to perform other meaningful activities. If you sign up with CureMD for your revenue cycle management you will not only receive a dedicated billing manager but also an implementation manager who will be your go-to person for any type of queries. They also have comprehensive medical billing software. It allows you to print meaningful financial reports. It also has a key performance dashboard with real time figures on A/R periods, revenue collection, common rejection reasons associated with payers etc. These features facilitate a physician in monitoring the performance of his practice without getting into complicated accounting details.

Advanced Claim scrubbing, de-coding difficult rejection responses and helping clients resolve rejections, even if they don’t outsource their billing to CureMD are value added services that are getting the company positive reviews in the industry.

If you outsource your billing to CureMD, you get their EHR and PM for free. This, I believe, is a good deal. Their integrated EHR and PM is a better solution than most of their competitors in the market. They have focused heavily on usability and ease of use, two things that physicians want and EHR vendors normally ignore.

eClinicalWorks

2.9% for your billing. That tag line there is a best seller. Who would not want to outsource billing to eClinical when other medical billing companies charge so much more?


My response: Why do you pay so much for an IPhone when there are so many Sony’s and Samsung’s doing the round?


I honestly tried looking at a few positives and except for their price there is nothing that I could find. Even in terms of the price, everything is not as hunky dory as it seems. To get the 2.9% rate a provider must be earning $ 57,000 or more per month. Frankly, hardly any provider earns that much in environment.


If you are content with such minimal functionality and support, Practice Fusion will give you the same thing for free!


eClinical does not offer you the best value for your buck. Their product is pedestrian, their support is horrible.


This should give you a general idea of their billing service as well. You might think that you are saving money with a 2.9% contract. However, eClinical customers have reported incidences where their claims were sent to the wrong payers or denials were not resolved as the billing staff was not up to date on payer payment rules.


In short, don’t fall for the 2.9% flat rate for billing. The pain of being stuck in a contract with suboptimal service is not worth the so called cost savings.

athenahealth

Athena remains one of the oldest billing companies out of the lot. I have already reviewed their product in one of my vendor pricing analysis but will present it here for people who have not read it.


Athena is a large practice product. The system is complicated, requires a lot of clicks and change of screens to get tasks done. This functionality works well for hospitals and large practices where each step of a patient’s clinical encounter is recorded by a different person, such as a nurse practitioner or a medical assistant. However, in small to medium sized practices, many times a physician is handling most of the clinical encounter and would like to record things on one screen rather than having to jump from one screen to another.


Athena takes HIPAA laws quiet seriously. However, they might have gone a little too overboard with it. Practices have complained that they have to sign in every single time that they see a new patient. This wastes time, especially when the navigation in the solution is not simple.


Implementation is another area where Athena does not work well. They promise to get you implemented in less than six weeks however, for most practices the implementation time period can stretch to 11 weeks. Again, a big practice or a hospital can spare staff and compromise on the revenue loss generated by such long periods of implementation but not small to medium practices.


In terms of their billing service, Athena either charges a flat rate per provider or a percentage of annual collections, whichever is greater. They offer you their EHR and PM for free in this case. Their support is professional and generally competent which is hard to come by nowadays.


On average as a billing company and a provider of medical billing software Athena is a good choice. However, the complete package which includes the EHR is not the best fit for small to medium sized practices.


Have a question?  Please contact docseanparker@gmail.com


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