Medical billing services charge their clients by three methods:
- Per claim
The percentage basis is generally used by medical insurance billers (MIBs) who do full-practice management or a combination of patient billing and claims billing, and just as it sounds, the MIB charges the provider a percentage of the money they collect per month as opposed to the amount of money they bill.
Follow is the review of some of the top medical billing services to help about how the prices differ from one company to the next.
DrChrono's medical billing service is geared toward small and midsize practices, primarily in the range of one to 15 providers or 16 to 25 providers.
The company works with practices across all specialties, charging a percentage of their clients' net collections.
DrChrono boasts a competitive first-pass claims rate of 97%, meaning only 3% of the claims its billers submit are denied by payers and require additional work and resubmission.
Besides, DrChrono's percentage of collections includes access to its electronic medical records (EMR) software and practice management software.
DrChrono's billing team starts the revenue cycle management process from the very beginning, generating claims by entering charges and coding them properly based on clinical documentation from the practice. Once the claims are generated, DrChrono scrubs each one for common errors that would lead to rejection by the payers. If any errors are flagged, the company's medical billers and coders revise the claim accordingly before submission.
The only drawback is that clients are required to use both the EMR and practice management software, whereas most medical billing services only require clients to use their practice management system.
CareCloud's medical billing service has three different tiers, each of which offers a different scope of service for practices with different billing needs.
Concierge: With Concierge, CareCloud will take over the claims submission and denial management process, getting claims to the appropriate payers promptly and then monitoring for any rejections. If a claim is rejected, CareCloud's billing team will work to revise and resubmit the claim as needed.
Concierge Plus: The second tier is similar to the first, except CareCloud adds a claims scrubbing step to the process. Using its rules engine, CollectiveIQ, CareCloud checks each claim against a database of more than 120 million common errors. If a potential mistake is flagged, its billing team will more closely review that claim before submission.
Concierge Pro: Concierge Pro is CareCloud's full revenue cycle management tier of service. CareCloud will access clinical documentation from the practice to generate claims by performing charge entry and coding services. Once created, those claims are put through the CollectiveIQ claims scrubbing system and adjusted if needed. Once scrubbed, the claims are submitted through the appropriate clearinghouse or directly to the proper payer. CareCloud billers will follow up on unpaid claims and work any denials to the point of payment.
CareCloud offers both a proprietary electronic health records (EHR) system and practice management software. Revenue cycle management clients must use CareCloud's practice management platform because all billing is performed through that system. Use of the company's EHR software is optional, although it is included in the price of the billing service.
The main limitation we discovered with CareCloud is its significant setup fees, which are steep compared to other medical billing services we reviewed. Even among companies that do charge setup fees, CareCloud is the most expensive. While these fees are one-time costs incurred during onboarding, they can become a significant upfront expense, especially for a practice on a tight budget.
AdvancedMD's medical billing service is capable of handling all the revenue cycle management for large and small practices alike.
The company excels in managing billing for practices in the 100-provider space, making it best for medical billing service for large practices.
AdvancedMD's outsourced revenue cycle management comes with access to its electronic medical record (EMR) software and practice management platform for a monthly percentage of clients' net collections.
Currently, AdvancedMD boasts an organization-wide first-pass claims rate of 98.4%, which is one of the highest of the services we reviewed.
The company will also contractually guarantee a minimum first-pass claims rate of 95% for all clients, and it is the only company we reviewed that provides such a guarantee.
AdvancedMD begins the billing process after the charge entry and coding phase has already been completed. AdvancedMD does not perform charge entry or coding services at all so that responsibility falls on the practice to complete in-house or outsource to a third party.
Currently, the organization-wide first-pass claims rate for AdvancedMD is 98.4%, which is one of the highest rates. That means only 2.6% of claims submitted by AdvancedMD are denied by payers.
AdvancedMD's pricing model takes into account a variety of factors, including practice size, the number of claims submitted, the number of patient encounters, the specialty and the complexity of the billing process.
Monthly collections: The ultimate price will be the higher of a monthly minimum (set during contract negotiation) or a percentage of your monthly collections, so to offer a precise quote AdvancedMD needs to know how much your practice brings in per month.
Patient encounters: Pricing will also depend on the number of total patients seen by physicians.
Specialty: Because the billing process and specific rules can vary so much from specialty to specialty, AdvancedMD incorporates the complexity of your specialty into the final percentage.
The number of providers: Finally, your total number of providers can also influence the quote.
AdvancedMD's largest limitation is the fact that it does not manage charge entry or the coding of claims. These are important aspects of the medical billing process that require experienced, certified coders to perform properly.