Medical Billing Software

Medical practices are under great pressure to produce revenue and stay viable. Yet, many practices, especially smaller ones, are struggling to stay afloat, partially due to the complexity of medical billing processes and the challenges to get decent first-pass claim acceptance rate levels. Read more.


Compare Medical Billing Software Providers

AdvancedMD

Freedom to Practice

End-to-end claim process

Track & manage A/R

Automatic Charges from AdvancedEHR

Average rating

3.6

CureMD

Practice Without Boundaries

96% claims paid on first submission

16 days average Medicare turnaround

24/7 access to financial reports

Average rating

4.1

eClinicalWorks

Improving Healthcare Together

Collection of 2.9% after you get paid

Payer & State Incentive

CodeCorrect Rules and Clearinghouse

Average rating

3.4

McKesson

Empowering Healthcare

Process > 160 million procedures/year

Code 150M ICD/CPT diagnosis/procedures

Serve >30,000 FTE Physicians

Average rating

2.7

athenaCollector

Improving your medical billing process

Get paid 6% more, and 32% faster

Database of over 40 million payer rules

Error-free claims

Average rating

3.3

Care360

Leave Your Billing To Us

Vast knowledge in various specialties

Certified coders and experienced billers

EDI and ERA enrollment with EFT setup

Average rating

4.1

CareCloud Concierge

Modernize Your Medical Group

All-in-one revenue cycle solution

Millions of integrated billing rules

Advanced analytics with 100+ key metrics

Average rating

4.4

Kareo

Go Practice

Network of 30,000+ providers

Billing Rules Engine

Built-in Eligibility verification

Average rating

4.3

MedicsRCM

Advanced Technology. Simple Solutions

99% Success on first attempt claims

EDI for revenue protection

AR management and claim tracking

Not Yet Rated

Meditab

Meet future healthcare needs today.

Dedicated in-house billing experts

24/6 accessibility to our support team

Wide network of payers & clearinghouses

Average rating

4.9

MediTouch

Trusted by Doctors Since 1998

Billing, Scheduling and Clearinghouse

Integrated EHR and Patient Portal

Continuously Updated Payer Rules

Average rating

4.0

NowMD

Advanced Medical Billing Software

Easier Data Entry

Electronic and Paper Claims & Statements

Collection Tools

Not Yet Rated

NueMD

See patients. Get paid.

Quickly recoup outstanding claims

Rely on up-to-date credentialing

Pay only on amounts received

Average rating

4.5

ChartLogic

Tailored For You

Custom-Tailored Solutions

Performance & Profit Management

Included EMR + PM

Average rating

4.2

e-MDs

Leave the Billing & Collections to Us

ICD-10 compliant

99% claims accepted the first time

Customizable payor specific rules

Average rating

3.4

GE Healthcare

Imagination at Work

Flexible standard reporting package

High-integrity database

PCMH pre-validated by NCQA

Not Yet Rated

Greenway Health

Committed to Better Health

First acceptance pass ratio of 99%

Decreased days in A/R by 1/3

Secondary claim filing

Average rating

3.2

iPatientCare

Better Outcome Reduced Costs.

Includes free EHR and PMS technology

98 % first-pass acceptance

Claims Entry/Submission/Reconciliation

Average rating

4.3

Nextech

Your practice is our specialty

E-Eligibility, E-Remittance

Batch Payments

Generate Bills Directly from the EMR

Average rating

4.2

Optum

Changing health care from the inside out

Optimized front-end processes

Rules-based automation

Electronic payments and statements

Not Yet Rated

PrognoCIS

More Than a Great EHR

Integrated EHR and PM solution

Clearing house fees

1,000+ man-hours in payment experience

Average rating

4.1

Raintree

Solving Real Problems for Real People

Built-in self-audit checks

Track authorized visits & dollar amounts

Built-in collection worksheets

Not Yet Rated

WRS Health

Take Your Practice to a New Level

Lowest claim denial rate in the industry

Customizable Electronic Superbill

Over 50,000+ rules

Average rating

4.6

AllegianceMD

The Most Inclusive EHR and PM Software

Charge capture from EHR

Check insurance eligibility

Claim scrubbing using AI

Average rating

4.7

Allscripts

Build on the power of Allscripts

98% first pass clean claims rate

Claim scrubbing & validation

Integrated business intelligence

Average rating

2.8

Benchmark Systems

The Solution for Your Practice

95% first submission cycle payment

1st-year 10-15% increase in collections

Payment based on successful transactions

Average rating

4.7

Cortex EDI

The Electronic Biller

Supports ALL insurance companies

Medicare Secondary Payer

FREE software, FREE installation

Average rating

5.0

Easy Billing Professional

Leading-edge medical billing software

5010 electronic submission requirements

Unlimited billing entities and providers

Integrated scheduler

Average rating

3.0

EZClaim

Medical software made simply powerful

Download, set up and process in 30 min

Electronic billing with TriZetto

DMERC, Ambulance & Chiropractic billing

Average rating

4.4

iSalus

Billing & Scheduling That Works.

Encounters Safety Net

Automated ERA Payments

Customized Superbills

Average rating

4.2

Leonardo MD

Always Available. Always Accessible.

Electronic superbills

Collections workflow tools

Automated claims management

Average rating

4.4

Nextgen

We simplify practice operations.

All-in-one billing and collections

Decrease A/R days and claims denials

Eliminate regulatory compliance headache

Average rating

2.7

PracticeSuite

All-in-one Solution for Practices

98% customer retention

Monitoring A/R for accurate payments

Automated claims scrubbing

Average rating

5.0

SOAPware

#1 in Quality of Care!

SMARText-“Coding

Updated Coding Library

Multiple Fee Schedules

Average rating

4.0

Source Medical

#1 provider of ACS & Therapy software

Coding Compliance

Receivables Management

Lower rate than clearinghouses

Not Yet Rated


Medical Billing Software Buyer's Guide

Indeed, when practices grow and the number of patients increases, it becomes critical to streamline processes and achieve a good first-pass resolution rate: any medical practice that sees more than 10 to 20 patients a day and does not have an electronic medical billing solution in place is likely to be losing a fair amount of its revenue to unpaid claims.

Regulatory provisions are becoming more and more complex, insurance companies update rules and criteria for medical coverage frequently, and claims are being denied regularly. Medical bills now go through a complete cycle: from e-claim creation, to electronic submission, and successive denials and re-submissions, until the bill is finally paid.

A simple medical billing software is sometimes not sufficient: practices need to manage this entire cycle to increase payments and revenue. Depending on their needs and requirements, they have a few options: medical billing software solutions handle claim management and billing; Revenue Cycle Management (RCM) systems focus on the entire lifecycle of a practice’s revenue and are far more comprehensive.

Medical Billing Software vs. Revenue Cycle Management

Small practices often opt for a stand-alone medical billing or RCM solution. These are often online or web-based, and very easy to acquire and use. No complex servers or databases need to be set up and managed. Payment generally is based on a percentage of collections: if no money is collected on a bill, the service provider does not get paid.

Large practices tend to acquire software solution packages that include medical billing, practice management and EHR/EMR. Two deployment options are available: on-premise solutions are purchased outright, generating a higher up-front cost and smaller recurring costs (maintenance and upgrades). Web-based solutions are more flexible; payment is sometimes calculated on a per-provider, per-month basis, or as a percentage of received payments.

Creating and managing the entire payment course of a medical bill is a multi-step process. These steps form the essential features that all medical billing solutions must have to be able to get a high first-pass claim acceptance rate. While almost all solutions will demonstrate these steps, the key lies in how well they are implemented.

Key Features of a Medical Billing Software

Patient Registration and Insurance Eligibility Check

While many eligibility checking tools are built into practice management solutions, every practice must have a means of checking insurance eligibility before the patient encounter begins. If the patient’s insurance plan does not cover the requested services, the patient needs to be told upfront that they will need to cover the bill. The solution must also check during registration whether there are any outstanding bills the patient needs to clear.

Claim Generation

As the patient is seen by the physician, a superbill is created - either on paper or electronically. This is transferred to the medical biller, which creates a claim and checks for a number of potential errors. Good medical billing solutions will sometimes use millions of rules to check that the claim meets the requirements of various insurers. Some solutions update their list of possible errors every time an insurer denies a bill, and so create a huge knowledge base of errors to check for. Naturally, these solutions will get better as their library of errors grows. Billing agencies also need to follow HIPAA guidelines; ensuring this is critical.

Claim Transmission

HIPAA guidelines require that all practices transmit their claims electronically. Manual claims are permitted under some special circumstances. Check that both methods are possible.

Use of Clearinghouses

In some cases, billers can send claims directly to a paying agency such as Medicaid or Medicare. In others, the claim is sent to a clearinghouse, which in turn sends it to the insurance after ensuring that it is in the correct format, as demanded by different agencies. In many cases, using a clearinghouse can help improve the first-pass claim ratio.

Claim Follow-up

Your billing solution must be able to follow up on individual claims to track their progress with the insurer. In case of undue delay, a query should be raised or the claim must be resubmitted. Claims can be accepted, rejected or denied. In case of rejection—often caused by an error in the bill—the solution must support claim correction and resubmission. Efficient solutions will go through that process within a day. In case of denial (the insurer refuses to process the claim due to the medical procedure not being covered in the policy or due to a pre-existing condition), appeals are filed. The solution must support all these actions.

Even when claims are approved, insurance will only pay the amount that is specified in the policy. The remaining amount can be recovered from a secondary insurance (if the patient has one) or from the patient. The software must be capable of handling this process.

Patient Statements Creation

Depending on how much the insurance company has paid, a statement is created and forwarded to the patient so that the balance can be recovered. The software must automatically reconcile payments received. Depending on patient preferences, it should send statements to patients by email or post.

Statement Follow-up and Collections

It is important that bills sent to patients are properly tracked and that the billing solution generates reminders and sends follow-up bills. When a bill is overdue beyond a certain point, a collection agency may have to become involved. Your practice should be able to customize these actions and decide how many reminders are to be sent, what the messaging should be, and when a collection agency takes over.

Reporting Features

While most medical billing solutions offer similar features, there can be wide disparities in their reporting capabilities. Reporting features are capital to good revenue management processes: practice administrators must know how their practice is doing. Any reports that the solution provides should be completely customizable without requiring any advanced programming knowledge.

Below is a list of the most critical reports:

Users should be able to email reports, export to MS Excel or PDF files, and drill down to individual items or data points. Report generation and sharing should also be restricted to specified users only.

Using an External Billing Service

Medical practices have the option to generate and handle their bills in-house, or to opt for a third-party billing service. Many small practices that have limited staff opt to outsource their billing to a third-party medical billing service provider. There are several advantages to this approach:

The only possible disadvantages to outsourcing your medical billing is the feeling of loss of control, or a fear of letting your revenue details be known outside of the practice. However, if you select a reputable service provider, the security and privacy of your data will be protected, and the service will help you bring your billing back in-house should you ever wish to.

Summary

All medical practices need excellent administration if they are to stay viable. A practice that does not use any electronic claim and billing solutions is quite possibly losing a lot of its revenue. One option is to outsource billing to a third-party service provider. Alternatively, practices can use online or web-based medical billing solutions to handle claims in-house. Almost all medical billing solutions have similar features, but the difference lies in the way they are implemented. Therefore, careful selection is important. A good solution, well implemented, will make a major difference to your revenue in just a few months.