Question 1

What is a medical billing company?

Accepted Answer

A medical billing company is a company that works on behalf of healthcare providers, such as hospitals, clinics, and medical practices to ensure accurate and timely billing for patient services. Medical billing services include accounts receivable (AR) collection, following up on unpaid claims, sending timely reminders or inquiries to insurers and patients, and negotiating settlements.

Healthcare providers often encounter difficulties when it comes to patient billing, and medical billing services have the specialization to handle these challenges:

Difficulty navigating complex billing systems leading to errors and delays
Maintaining a consistent and efficient billing process
Staying up to date with changing insurance clearance regulations
Lacking automation in insurance claims submission and denial prevention
Limited access to legal counsel and experts to appeal claims denial
Difficulty collecting payments from delinquent patients
Struggling to avoid healthcare fraud and abuse
Dealing with inaccurate coding that leads to denied claims or underpayments
Limited resources to invest in billing staff and technology

Studies have shown that 80% of medical bills contain errors, which results in $68 billion in unnecessary healthcare spending annually. When healthcare practices were surveyed, 46% cited coding errors and inaccuracies as one of the top 3 reasons for medical insurance claims denials.

However, more concerning statistics show that 15% of all submitted claims are initially denied by unscrupulous private insurers, even after giving pre-approval. Filing an appeal against denied claims is very costly, with providers spending $19.7 billion yearly on appeals.

These reports highlight the benefits of working with a medical billing company to help healthcare providers streamline their billing process and prevent significant revenue losses.

Success story

This case study illustrates how hiring a medical billing service successfully improved a healthcare provider's billing process and increased its revenue.

Challenge: Dr. Max’s highly respected chronic pain management practice in Los Angeles was experiencing high denial rates, inefficient billing systems, and delayed reimbursements. These issues were straining the practice's cash flow, directly impacting its growth and ability to provide optimal patient care.
Solution: GreenSense Billing conducted a comprehensive review of Dr. Max's revenue cycle, identifying areas for improvement. The medical billing company then streamlined the practice's coding and documentation practices to ensure compliance and accuracy. Finally, it implemented a rigorous claims management process to minimize denials and appeals, which will lead the practice to financial growth.
Results: The partnership with GreenSense Billing successfully transformed the practice's revenue cycle, leading to a staggering 200% increase in collections. This achievement was driven by a significant reduction in denials, improved reimbursement rates, and a substantial cash flow enhancement.

Question 2

What do medical billing companies do?

Accepted Answer

Medical billing companies handle the complex task of managing patient payments and insurance claims. They verify patient insurance coverage, prepare accurate bills, and follow up on denied claims to maximize reimbursement. They work behind the scenes to ensure that healthcare providers receive the appropriate payments for services rendered.

Medical billers can be found in a wide range of healthcare settings, from small family practices to big hospitals. Their core services include:

Compliance
Assisting hospitals and healthcare providers in adhering to all relevant medical billing regulations and guidelines.
Accounts receivable (AR) collections
Managing and collecting unpaid bills from patients, insurance companies, and other third-party payers for medical services.
Insurance claim processing
Submitting and following up on insurance claims to ensure timely reimbursement for patient services.
Patient eligibility verification
Confirming a patient's insurance coverage details, including policy status and coverage limits, to ensure accurate billing and reimbursement.
Securing prior authorization
Obtaining pre-approval from insurance companies for specific medical procedures or treatments. This confirms coverage and minimizes the risk of claim denials.
Denial management
Filing appeals for denied insurance claims. Medical billing companies have the expertise and resources to advocate for patients and healthcare providers, ensuring that every claim is reviewed thoroughly and that all eligible reimbursements are secured.
Medical coding
Assigning accurate medical codes to procedures and diagnoses. Medical billing companies have certified coders who carefully review patient records, clinical notes, and other relevant documentation.
Data entry and management
Maintaining accurate patient and billing records. This involves collecting, organizing, and updating patient information, as well as tracking billing data, payments, and insurance claims.
Reporting and analysis
Using advanced analytics tools to assess data, uncover inefficiencies, and recommend strategies to optimize billing practices and maximize revenue.
Auditing
Thoroughly examining billing records to identify discrepancies, errors, or potentially fraudulent activities. This step protects healthcare providers against financial losses.

Success story

Relying on medical billing services not only leads to expedited payment collection but also enhances a practice's operational efficiency. This case study shows the transformative power of partnering with a specialized medical billing company.

Challenge: Premier Dermatology struggled with mismanaged billings and couldn’t handle copays, which led to revenue losses. Its outdated systems also added to administrative overhead. The practice sought a solution to streamline its operations, improve billing accuracy, and reduce costs.
Solution: CareCloud stepped in and implemented CareCloud Concierge, its complete revenue cycle management (RCM) and practice management (PM) solution, within Premier Dermatology. The medical billing company managed the practice's billing and remittance, with daily electronic claim submissions. Premier Dermatology also started using the Advanced Analytics app built into the CareCloud platform to monitor practice performance closely.
Results: The practice improved its profitability by reducing the time to payment by 15 days and accounts receivable (AR) turnaround time from 47 to 21 days. The implementation of upfront copay collection and expedited claim payments within 7 to 10 days contributed to a remarkable first pass resolution rate (FPRR) of over 97%.

Question 3

How much do medical billing services cost?

Accepted Answer

The cost of medical billing services will depend on the scope of services provided. However, medical billing companies charge, on average, 4%-10% of the total revenue generated by the healthcare provider. This percentage includes all associated costs, like technology, staff, and operating expenses.

Several factors affect a medical billing company's rate, like the size of the medical practice, complexity of claims, and billing model, but providers can generally expect to pay:

For a flat fee model: $4-$7 per claim
For an hourly fee model: $20-$30 per hour
For insurance billing: 4%-9% of the collections
For patient billing: 2%-6% of the collections

The top 50 medical billing companies on DesignRush charge an average of $32/hour. 26.% of the companies on DesignRush accept projects with a budget of less than $1,000, typically focusing on basic billing tasks. Meanwhile, 1.4% require a minimum budget of $50,000 for comprehensive billing solutions that include advanced features and extensive support.

Question 4

Why should I hire a medical billing company?

Accepted Answer

You should hire a medical billing company to ensure or improve your healthcare practice’s financial health. These companies will streamline your billing processes, maximize reimbursement rates, and reduce claim denials, which will maximize your profitability. Partnering with a credible medical billing service will also free up your staff to focus on effective patient care.

Outsource to medical billing services because they:

Streamline the billing and claims processes
Reduce coding and billing errors
Give you faster reimbursements
Ensure your compliance with the latest regulation changes
Have the expertise to negotiate with insurance companies
Can maximize reimbursement rates and reduce claim denials
Protect the practice against fraud and abuse
Strengthen cash flow and increase revenue
Reduce the workload of healthcare staff
Help improve patient satisfaction

Success story

We chose this case study to illustrate how outsourcing medical billing services can reduce critical coding errors and eliminate the inefficiencies and added costs often associated with in-house teams:

Challenge: A healthcare practice experienced an increase in claim denials due to coding errors by its in-house team. It sought AnnexMed's help to address this issue and improve its reimbursement rates.
Solution: Through a root cause analysis, AnnexMed identified the primary contributors to the increased denial rate. Improper use of modifiers, inaccurate diagnosis pointers, non-adherence to payer specifications, and incorrect point of service (POS) coding for telephone and telehealth visits caused the denials. The medical billing company implemented targeted denial solutions and provided extensive training to improve the practice's coding processes.
Results: AnnexMed impressively reduced the practice's coding-related denials by 50% within 45 days, which accelerated its cash flow. Meanwhile, the accounts receivable (AR) and reimbursement days significantly decreased by 20%, and the practice received valuable assistance in improving its documentation practices.

Question 5

How do I choose the best medical billing service for my business?

Accepted Answer

Choosing the best medical billing service for your practice can help improve your financial health and operational efficiency.

Follow these steps to pick the right medical billing company for your healthcare business:

Define your goals
Thoroughly evaluate your billing challenges and set clear goals for your practice. This will help you identify the specific services you’ll need from a medical billing company.
Search for companies
Start your search on Google and credible agency directories like DesignRush. Industry publications are also a good source to find top medical billing services, or you can ask for recommendations from your peers.
Create a shortlist
Make a list of potential candidates, and then send detailed requests for proposal (RFP) to learn more about their services, fees, and expected outcomes.
Assess their experience and specialization
Look for a company that specializes in your type of medical practice so you can make sure they understand your billing needs and challenges.
Check the technology they use
Medical billing services that use up-to-date tools and software can easily enhance billing efficiency and reduce errors. But make sure they will integrate well with your system or processes.
Look for relevant certifications
Verify if their employees have relevant certifications, including Medical Billing and Coding Certification, Certified Coding Associate (CCA), and Certified Professional Biller (CPB).
Inquire about compliance and security
Make sure the company follows the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations and has robust security measures in place to protect patient data.
Understand their pricing structure
Get clarity on their pricing model, whether it’s a percentage of collections, hourly rate, a flat fee, and any additional charges. Compare costs to find a company that fits your budget.
Ask about their claim denial management
Inquire about their success rates in this area. A good medical billing service should have effective processes for managing and appealing denied claims.
Assess their customer support quality
Ask if they offer dedicated support to address your inquiries and provide timely updates. Look for accessible communication channels, such as phone, email, and live chat, to facilitate efficient communication.
Look for customization options
Your practice may have unique needs, so finding a flexible medical billing company that can tailor its services to fit your requirements is ideal.
Consider turnaround times
Ask about their average billing cycle times and how quickly they can submit claims. Faster processing can improve your cash flow.

Find the right medical billing company for your practice by visiting our Marketplace. Share a brief overview of your business, and we'll provide a list of five top-rated companies that match your specific needs — for free.

Question 6

How do I find the best medical billing company on DesignRush that fits my budget?

Accepted Answer

Use DesignRush's advanced filters to efficiently find a medical billing company that meets your specific requirements. You can refine your choices based on your budget — ranging from $1,000 to over $50,000 — and other criteria.

Low Budget: 1k above	Certified Healthcare Billing Info Hub Consultancy Services Quality Med Billing &Consulting
Mid Budget: 10k above	CEOVerge Tru Performance devabit
High Budget: 50k above	Werklflo Auxis

Question 7

What are the key success metrics in medical billing?

Accepted Answer

Here are some of the key success metrics to track to measure the efficiency and success rate of the medical billing service:

Revenue cycle time
The average amount of time it takes to bill for services, receive payment, and collect the revenue
Days in accounts receivable (A/R)
The number of days it takes to collect outstanding patient bills; a key indicator of the efficiency of revenue cycle management (RCM)
The 0-60 percentage
The anticipated cash flow from insurance claims within the first 60 days after billing
Gross collection ratio (GCR)
The effectiveness of a healthcare facility in collecting revenue for the services provided
Net collections ratio (NCR)
The percentage of actual reimbursement received compared to the total allowable amount
Clean claims ratio (CCR)
The percentage of claims submitted without any errors or omissions, or the percentage of claims paid on the first submission; also called First Pass Rate (FPR)
Denial rate
The percentage of claims denied out of the total number of claims submitted
Bad debt rate
The rate of patient bills that are deemed uncollectible and written off

Question 8

What questions should I ask medical billing companies before hiring one?

Accepted Answer

These are the questions to ask when interviewing a medical billing company:

Its Relevant Background

How long have you been in the medical billing business?
What is your client retention rate?
Can you provide information about your current client base and their sizes?
What certifications and qualifications do your staff have?
What software and technology do you use for medical billing and reporting?
How do you ensure compliance with all relevant medical billing regulations?

Its Services and Processes

What specific billing services do you offer (e.g., claims submission, denial management, follow-up)?
What is your average turnaround time for claim processing and payment posting?
What is your process for managing claim denials and appeals?
Do you provide full-service billing, or do you offer a la carte options?
Do you charge flat fees or hourly rates? Are there any additional charges or hidden costs?
What kind of reports and analytics do you provide?
Do you understand the importance of HIPAA’S security and privacy regulations?
What performance metrics do you use to measure your billing success?

Relevant to Your Project

Do you have experience working with practices in my specialty?
Was there an instance wherein you had to correct a claim mistake?
How often will you communicate with me and provide updates on the billing process?
What measures do you have in place to protect my patient data and prevent fraud?

Asking these questions will give you insights into the medical billing company's processes and capabilities, and help you decide on the ideal partner for your practice.

Question 9

What are the best medical billing companies in the US?

Accepted Answer

These are the best medical billing companies in the US:

HealthRescue Partners
- Top clients: AARP, UnitedHealthcare Inc, The Cigna Group, MetLife
Certified Healthcare Billing
- 4.8 stars on Google (16 reviews)
- Top clients: Kareo, Practice Fusion, PracticeSuite, Athena Health
Cube Therapy Billing, LLC
- 4.2 stars on Google (5 reviews)
- Top clients: Autism Centre Illinois, Behavioral Health Clinic, ABA Therapy Center, Jade Health
CEOVerge
- 5.0 stars on Google (1 review)
GreenSense Billing
- 4.8 stars on Google (6 reviews)

Low Budget: 1k above	Certified Healthcare Billing Info Hub Consultancy Services Quality Med Billing &Consulting
Mid Budget: 10k above	CEOVerge Tru Performance devabit
High Budget: 50k above	Werklflo Auxis

Table of Contents

What Are Medical Billing Companies?

Our Picks for the Best Medical Billing Companies in 2024

24/7 Medical Billing Services: Best Overall

P3 Healthcare Solutions: Best for MIPS Consulting

BillingParadise: Best for End-to-End RCM Automation

Quality Med Billing & Consulting: Best for Billing CPT and ICD10 Codes

Medcare MSO: Best for Aging AR Recovery

AnnexMed INC: Best for Coding and HIM Solutions

Kareo: Best for Specialized EHRs

Physician Billing Company: Best for AR Management

Revele: Best for eClinicalWorks EHR Users

Purview Healthcare: Best for Fortune 500 Companies

How We Picked the Best Medical Billing Companies

Best Medical Billing Services

Need Help Selecting The Right Agency For Your Project?

Need Help Selecting The Right Agency For Your Project?

Medical Billing Company Hiring Guide

What is a medical billing company?

What do medical billing companies do?

How much do medical billing services cost?

Why should I hire a medical billing company?

How do I choose the best medical billing service for my business?

How do I find the best medical billing company on DesignRush that fits my budget?

What are the key success metrics in medical billing?

What questions should I ask medical billing companies before hiring one?

Its Relevant Background

Its Services and Processes

Relevant to Your Project

What are the best medical billing companies in the US?

Why People Trust DesignRush

Sources

Top BPO Companies by Expertise:

Other Service Providers:

Latest Trends Related to Medical Billing