Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for healthcare services rendered by a healthcare provider. It involves the use of medical codes to represent medical diagnoses and procedures, as well as the submission of claims to insurance companies and the management of payment collections. The goal of medical billing is to ensure that healthcare providers receive accurate and timely payment for their services while complying with insurance regulations and guidelines. Medical billing is an essential part of the healthcare industry and helps to ensure that patients receive the care they need while providers are compensated for their work.
Medical coding and medical billing are two critical functions in the healthcare industry that are interdependent and necessary for ensuring proper patient care and accurate revenue management. Although distinct, medical coding and billing are closely related, as both are involved in reporting medical diagnoses, procedures, and supplies to commercial and federal payers, including insurance companies such as Aetna and government programs like Medicare.
Medical coders and billers work with clinical staff, including physicians, nurses, and other healthcare professionals. They must have a deep understanding of medical terminology, anatomy, and pathophysiology to properly interpret and translate physician notes and operative reports into medical codes that accurately reflect the services provided to the patient. Medical coders also work closely with billing companies and may participate in the billing process.
In some small physician practices, the same person may serve as both the medical coder and medical biller. However, in larger healthcare organizations, these roles are often separated, with medical coders responsible for translating clinical documentation into standardized medical codes and medical billers responsible for submitting claims and managing revenue collection.
Although medical coding and medical billing are separate functions, they are both essential parts of the healthcare revenue cycle. Accurate and timely medical coding ensures that healthcare providers are properly reimbursed for the services they provide, while medical billing ensures that insurance companies and other payers are billed correctly for the services rendered to patients. Both processes require precision, attention to detail, and a thorough understanding of medical terminology and billing regulations.
Here is a general outline of medical billing workflow:
We have identified the top medical billing companies that stand out in terms of pricing, usability, and technology. These companies have proven to be reliable, efficient, and effective partners for medical practices seeking to streamline their billing processes.
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.
Charting / Document management
Easily train staff to use the software
Intuitive design and easy to use
Slow processing while uploading
Outsourced Customer support
Scheduling is fee-based
Value For money
Cerner 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.
Cerner probably has the most forward-looking functionality in the industry. One would appreciate the innovativeness they have shown, if only the team at Cerner 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 (Cerner 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, Cerner 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)
Charting / Document management
No control over your information
Not Fully Automation
Not Recommended for Non Emergency Medical Services
Value For money
Sharing my most honest review, CureMD remains one of my favorite on the list of medical billing companies. I have already reviewed CureMD’s software in one of my previous analysis. With respect to their product, I found their EHR and vaccine administration management system relatively user-friendly and easy to navigate through, their solution is specialty-specific and offers ample customization for a practice to personalize it as per its size and workflow. However, since they do not cater to inpatient facilities, I personally do not think that their system is a good fit for hospitals.
On a similar note, CureMD has done equally well in terms of support. They offer a variety of support options such as chat, ticket and telephone, with the primary objective to cater to their clientele. CureMD medical billing and coding 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 a devoted implementation manager who will be your go-to-person for all sorts of queries.
They also offer a comprehensive medical billing software, which allows you to print useful financial reports. Moreover, 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.
The integrated EHR and PM is a way better solution than most of their competitors in the market. Their focus on usability and ease of use are the two important features of their solutions that physicians tend to enjoy over other EHR vendors.
Charting / Document management
Interactive Reporting Framework
Intutative PMO Features
Adequate KPIs definition
Better Alternative Available
Value For money
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.
Charting / Document management
Reporting and Analytics
Absence of a test environment
Not meant for behavioral health
Value For money
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.
Charting / Document management
Combined Business Office
Lacks transparent pricing
Third-party software integrations with a fee
Starting price doesn’t include PM or medical billing tools
Value For money
The content presented on CureMD is intended solely for educational purposes. It should be noted that your financial circumstances are distinctive, and therefore, the products and services reviewed by us may not be appropriate for your particular situation. We do not provide financial advice, nor do we offer any advisory or brokerage services. Furthermore, we do not suggest or recommend that individuals purchase or sell specific stocks or securities. It is important to bear in mind that the performance information provided may have undergone changes subsequent to its publication, and past results do not guarantee future outcomes.
Use clinical info to drive financial outcomes within a clinically driven revenue cycle. Streamline revenue cycle management and help enhance patient access to care. Learn how.
Highly flexible & affordable billing experience with unprecedented financial transparency.
Meaningful Use stage 3
MIPS / MACRA
PQRS / P4P / MIPS
As a physician, you can now experience a more streamlined payment process with reduced workload and lower expenses by utilizing CureMD's revenue cycle management solution. Our optimized system is specifically designed for hospitals, billing services, health systems, and large practices, and it guarantees to minimize redundancies, increase automation, and enforce best practices, all leading to reduced A/R days and lower collection costs.
Free your staff from routine A/R follow-up tasks with our powerful automation tools. Our low-touch solution ensures maximum efficiency, improves cash flow, and allows your team to focus on new challenges.
Our interoperability approach ensures seamless integration with your EMR while updating your RCM. We invest in collaboration with leading standards bodies, ensuring your practice stays current with the latest industry changes.
With over 25 years of success in the market, our solution has a proven track record of accelerating revenue reimbursement and improving profitability for healthcare practices.
As your practice grows and adopts new reimbursement models, our solution scales with you, allowing you to manage growth and changes at your own pace without needing additional resources.
Our consolidated view of all hospital and professional financial data across your entire enterprise reduces redundancies and improves efficiencies. You can maximize profitability by making data-driven decisions.
Reduce errors and improve staff efficiency with our fully integrated workflows, revenue cycle monitoring, and proven FTE efficiencies. You can achieve better profitability and focus on providing quality care to your patients.
Physicians in the US have previously undergone concerns regarding the introduction of EHR technology, followed by the selection of the best electronic medical record vendor and attesting for meaningful use/PQRS. They are now necessitated
to undertake one of the biggest healthcare reforms in the US till date – the transition to ICD-10.
Even if the transition is delayed, there are enough reforms being made to physician reimbursements that merit changes to the way you practice medicine. These include the rise in deductibles, the move towards pay for performance model, and so forth.
Hence, it is perfectly logical to identify a medical billing company as your faithful partner that will ease the process of managing your revenue stream. At the same time, it makes perfect financial sense as well, essentially because the professional in-house biller will charge you approximately $50,000 per annum, while a third-party team of billers will only cost you a fraction of this amount. So why not hire from the top-notch medical billing services.
According to the latest Black Book Survey, 50 to 60 % of practices are already considering medical billing outsourcing to a third-party vendor. That is, they are seeking professional assistance from medical billing outsourcing companies. This page is your guide for selecting the best medical billing services for small practices.
Physicians can choose to outsource one or more of these services to medical billing vendors based on their specific needs. It's important to select a vendor that has experience in the relevant areas, is reliable, and can provide quality service at a reasonable cost.
Here are some of the most common types of medical billing services:
On-site support is the most prominent benefit of hiring a local medical billing company. It is actually comforting to know that in case things do not work out as planned, you can actually walk up to their office and get things fixed.
This is precisely one of the leading reasons why majority of the 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 medical billing companies as there is no reporting mechanism in place through which practices can look at the aging of their claims. Issues such as lack of real time financial aging summaries and the inability to review pending patient responsibilities are amongst the many concerns of physicians.
Apart from these, the practices must still resort to seeking insurances to verify insurance eligibility instead of relying on their billing software for the task. 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. The result is, a face without quality. Moreover, this option is generally more expensive than the other two.
With outsource medical billing companies, your problems are two folds.
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.
Having your own EHR vendor is perhaps my preferred option. Outsourcing EHR to your own dedicated vendor will fetch you the obvious advantage of dealing with a single vendor, saving you the hassle of follow-ups, monitoring different vendors,
and ensuring meeting milestones.
You enjoy the perks of owning devoted medical billing services. Moreover, most vendors with billing service will offer you their best EHR Software and Practice Management System (Medical Billing software) free of charge, which will allow you to exercise reasonable control/ insight into your third party biller’s performance. However, you must be careful to not get stuck into the worst of both worlds.
If you are ready to take decision in favor of the last option, you must ensure that the EHR vendor is the best amongst the rest and that you hire the top medical billing company. You obviously do not want to land up using a substandard system with a substandard service, since it will inevitably impact your revenues as much as a bad billing company. Please read EHR Vendor Analysis to evaluate some of the top medical billing companies in the industry.
Here is a detailed checklist of things to remember before you outsource your billing function:
You must make all plausible efforts to not to fall prey to predatory business practices. That is, do not select medical billing companies solely on the basis of low rates, without weighing the pros and cons and without considering the associated risks.
Make sure you read the contract thoroughly before entering into the outsourcing agreement with medical billing outsourcing companies. Clearly define collections and ensure that the medical billing companies only charge you for the amount
of work they do, that is, payer reimbursement or patient balances, nothing more.
Be mindful of the fact that many medical billing companies define collections as your practice’s complete revenue and charge you even for the revenue they did not help you collect. Hence, you must ensure that you do not fall for this practice; else you will end up paying significantly more. If you find yourself dealing with such a company, it is perhaps the best time to quit.
Many medical billing 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. Once again, reading the fine print in any billing service contract is the key to make the best decision. There are two important points that merit attention hereby:
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 vary between 24, 36, 48, and 60 months. Billing contracts ideally should be for a year with renewal subject to the performance of the vendor.
You must define at the outset of the contract as to who owns the data during the contract period as well as after the termination of the contract. In some unfortunate situations, the data is held hostage by the RCM vendor to avoid or at least discourage termination of the contract.
Majority of the reputable RCM vendors offer some sort of performance guarantee. However, many yet do not offer any type of performance guarantee or stand behind their services at all. Such are the types of RCM vendors that you want to avoid.