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 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.
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.
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.
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)
Sharing my most honest review, CureMD remains one of my most favorite medical billing companies amongst the rest. 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.
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.
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.