Best Medical Billing Software
Buyer's Guide
Health care processes create a considerable pile of paperwork for medical practices and billing companies. Everything from administrative tasks to patient data collection to managing insurance claims can become a burden, diverting you from what matters most — providing patient care. Medical billing software can significantly improve the financial health of your practice.
Whether leveraged as a stand-alone solution or as part of a medical practice management system or an integrated EHR solution, medical billing software helps you perform multiple tasks to ensure accurate, cost-effective and timely payment for your services.
We know it’s difficult to assess hundreds of products and select the perfect application. We’ve designed this buyer’s guide to help make your software selection journey a breeze.
Executive Summary
- Medical billing software simplifies financial and administrative activities for your medical practice or company.
- Some core features you should look for in digital billing software are medical coding, insurance verification, claim submission, denial resolution and reporting.
- Some main industry trends you should know about include ICD-11 coding standards, artificial intelligence and computer-assisted coding, outsourcing billing services, blockchain technology, and virtual care.
- Before selecting a medical billing program, you should ask a range of questions to yourself and shortlisted vendors to select a product that best suits your business needs.
- What Is Medical Billing Software?
- Deployment Methods
- Primary Benefits
- Implementation Goals
- Basic Features & Functionality
- Advanced Features To Consider
- Current & Upcoming Trends
- Software Comparison Strategy
- Cost & Pricing Considerations
- The Best Medical Billing Software
- Questions To Ask Yourself
- Questions To Ask Vendors
- Next Steps
- Product Comparisons
- Additional Resources
What Is Medical Billing Software?
Medical billing software is a medical solution that automates billing tasks to help practices get paid faster, improve workflow efficiencies and keep patient information up to date.
They enable you to verify insurance coverage, process payments and submit claims for reimbursement. They help you manage invoices and follow up on denied claims. Furthermore, they help cut down on paperwork, creating smooth digital workflows for critical processes.
They encourage you to automate patient registration, verify insurance plans and eligibility, and translate reports and diagnoses into codes.
These solutions assist you in accommodating different needs and reducing billing errors to enhance patient experiences and boost satisfaction.
Advanced billing systems offer features like reporting, profitability analysis and workflow management.
Some vendors offer custom billing products for your specialty. Some of these include:
- Anesthesia medical billing software
- Chiropractic medical billing applications
- Dental medical billing tools
- Massage medical billing systems
- Vision medical billing platforms
Medical billing is an important part of your revenue cycle management process. Medical billing tools simplify revenue cycle operations, including all administrative and clinical functions that contribute to the capture, management and collection of patient service payments.
What Buyer Type Are You?
Vendors categorize their products according to company size and service type. If you select a solution that doesn’t suffice your organization’s needs, you might end up spending extra for features or services that you probably don’t require.
Generally, providers offer medical billing systems for the below-mentioned buyer types.
- Small Companies: If you run a small practice or clinic, you should look for medical billing software for small businesses. These solutions provide basic scheduling, documentation, billing and insurance verification functionalities.
- Mid-sized Businesses: It’s a bit challenging to find billing products for mid-sized organizations. You need some basic as well as advanced modules to run your practice or company. You should ask vendors about what feature set they offer for such businesses.
- Large Organizations: Running a large business? You should consider a solution that serves large companies. These products usually provide charge capture, billing, coding, eligibility verification, claim submission, denial resolution and integrative modules.
- Billing Companies: As a medical billing firm, you submit claims on behalf of practices or hospitals. You should consider investing in medical billing services software to simplify your billing workflows. Medical billing software for billing companies usually offer claim scrubbing, credentialing, eligibility verification, payment processing and reporting features.
- Inpatient Care Providers: In-patient care providers need a system to submit claims on UB-40 forms. You should look for a system that allows you to do the same.
- Outpatient Care Providers: Outpatient providers submit their claims using CMS-1500 forms to Medicare, Medicaid and private companies. You should look for a robust and scalable medical billing system.
- Specialists: Specialists such as psychologists, psychiatrists and chiropractors have more lightweight requirements, with fewer insurance claims to submit. If you fall under a specialist category, you should look for a system that can fulfill your specialty requirements. For instance, if you own a physical therapy clinic, we recommend you invest in physical therapy medical billing software.
- Medical Collection Businesses: Such organizations should invest in medical collection systems or medical collection services software. These products provide features like asset discovery, skip tracing, reporting, billing and collections management.
Before investing in software, always ask vendors whether or not their products will serve your business requirements.
Regulatory and Reimbursement Considerations
Given the importance of reimbursement and compliance, it’s important to review how a medical billing solution will keep pace with the changing regulatory environment.
Medicine has witnessed a shift away from a volume-based, fee-for-service payment model and toward data-driven, value-based care, which places additional demands on your billing team.In this reimbursement model, your patients’ health matters more than the number of tests and procedures you perform or the patients you see.
- Acupuncture EHR
- Anesthesia EMR
- Anesthesia Medical Billing
- Assisted Living
- Cardiology EMR
- Chiropractic EHR
- Chiropractic Medical Billing
- Chronic Care Management
- Community Health Systems EHR
- Dental EMR
- Dental Imaging
- Dental Medical Billing
- Dental Scheduling
- Dental
- Dermatology EMR Systems
- e-Prescribing
- EHR
- eMAR
- EMR
- Family Practice EHR
- Gastroenterology EMR
- HIPAA Compliant Video Conferencing
- Home Health
- Hospice
- Hospital EMR Systems
- Long Term Care
- Massage Medical Billing
- Medical Billing Services
- Medical Collection Services
- Medical Collections
- Medical Offices
- Medical Practice Management
- Medical
- Medical Spa
- Medical Transcription
- Mental Health
- Occupational Health
- Occupational Therapy
- Oncology EHR
- Ophthalmology EMR/EHR
- Optometry EHR
- PACS
- Pain Management EMR
- Patient Check-In Kiosk
- Patient Engagement
- Patient Portal
- Patient Scheduling
- Pediatric EHR
- Physical Therapy Medical Billing
- Physical Therapy
- Physician Scheduling
- Plastic Surgery
- Podiatry EMR
- Prescription Writing
- Private Duty Home Care
- Psychiatry EHR
- Radiology Information
- Speech Therapy
- Telehealth Platforms
- Telemedicine
- Telepsychiatry
- Therapy Note
- Therapy
- Urgent Care EMR
- Urology EMR
- Vision Medical Billing
As part of the transition toward value-based reimbursement, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
Among its provisions, MACRA establishes new ways to pay physicians who successfully demonstrate quality and effectiveness over volume in treating Medicare beneficiaries.
Under MACRA, eligible clinicians can participate in Merit-based Incentive Payments Systems (MIPS) or Advanced Advanced Alternative Payment Models (APMs).
Among the challenges of the quality of care reimbursement model, physicians have to take into account a full range of patient’s health issues and chronic diseases that aren’t reflected in their claims. This is vital to avoid federal penalties for poor patient conditions documentation.
We’ll address features and considerations in further detail, but it’s important to understand how your selection enhances workflow. Performance and morale will suffer if your staff finds your new system disruptive.
Deployment Methods
The most popular deployment options are cloud-based and on-premise, though some vendors provide hybrid and hosted options too.
In this section, we’ll discuss some of the benefits and pitfalls associated with cloud-based and on-premise deployment strategies.
Cloud-based
Several health care organizations prefer cloud products today. Some reasons to choose cloud-based software include:
- Mobile accessibility
- Elastic scalability to scale up and down as needed
- Easy deployment
- No infrastructure or IT presence needed
- Cost-effective pricing models
- Integrative capabilities
Its limitations include:
- Accumulated costs over time
- Disrupted performance due to limited bandwidth or poor connection
- Limited customization options
On-premise
Some facilities still prefer an on-premise billing solution to keep data in-house. Its advantages are:
- High customizability
- One-time upfront licensing fee
- Complete security and management control
- Offline access
Its disadvantages include:
- Large expenditure and infrastructure costs
- Difficult to implement
- Challenging and costly scaling
- In-house IT team requirements
Expert recommendations and analysis on the top Medical Billing Software
Primary Benefits
We’ve outlined some of the key advantages of implementing medical billing and coding software below.
Reduce Errors
Most medical billing software programs serve as a clearinghouse that checks for duplicate data and helps you catch potential errors on a patient’s bill or insurance claim.
They aid in reducing billing discrepancies by providing the right costs and terminologies attached to a particular code. This helps prevent costly mistakes and takes human error out of the equation.
Boost Productivity
By shifting billing to an electronic platform, your practice can manage more claims with increased efficiency. Instead of filling out time-consuming forms and chasing down patients to obtain payments, staff can spend time delivering patient care.
Increase Revenue
By reducing administrative tasks and paperwork, these systems help your practice provide better care to patients. They enable you to automate processes to minimize claim denials and maximize reimbursements, helping your practice generate higher revenues.
Today, patients prefer paying online. According to Salucro’s 2022 Patient Payment Technology report, younger generations prefer paying bills through PayPal, Venmo and digital wallets, whereas older patients pay by cash or credit/debit cards.
Medical billing solutions provide a patient portal to help clients clear their medical debts online, helping you deliver better patient financial experiences and boost collection rates.
Maintain Regulatory Compliance
The health care industry keeps evolving, making it difficult to keep up with its regulations and compliances. These billing programs offer a range of security features and reminders to ensure you’re up to date with HIPAA, adopted standards and operating rules, and ICD code compliance.
Gain Real-time Visibility
Medical billing systems provide instant access to bills, claims or patient data in real time. They integrate with EHRs, helping you store lab reports, X-rays, insurance details, payment information and care histories in a secure cloud environment.
Expert recommendations and analysis on the top Medical Billing Software
Implementation Goals
| Goal 1 Reduce Staffing Needs | Paper records are inefficient and can get stolen or lost. Moving from paper records to digital billing makes it easy for you to transfer, search and store files. Medical billing solutions can reduce the number of employees who’d otherwise need to manage claims, billing and collections manually. Automated entries reduce the number of errors. They help improve health outcomes and reduce data-entry mistakes. |
|---|---|
| Goal 2 Track and Measure Practice Performance | While EHR systems support reporting and analytics, medical billing software helps track your practice’s revenue and compare it across selected periods. They provide detailed information about your financial operations, patient insights and other organizational trends to help you evaluate your company’s performance. You can leverage data to identify key areas of improvement. With reporting and business intelligence tools, digital billing systems enable you to make informed decisions. |
| Goal 3 Manage Cash Flow | Tracking cash flow is important as you collect payments from patients and insurance companies. Health care billing solutions offer claims management, collection and billing capabilities that help you monitor and track revenue flow. You can track financial activities across various categories and departments to improve revenue cycle workflows. |
| Goal 4 Accelerate Payments | The claims management module processes and executes insurance claims to facilitate interactions with both patients and insurance companies. It also keeps track of denied claims and lets you follow up on them, preventing reimbursement delays. |
Expert recommendations and analysis on the top Medical Billing Software
Basic Features & Functionality
We’ve listed some basic capabilities you should look for in medical billing systems in the table below.
| Insurance Validation and Verification | Medical billing applications enable you to verify insurance eligibility to help you minimize billing delays and denials, making managing claims from code capturing to receiving reimbursements seamless. The average health care facility exhausts large amounts of its revenue due to non-payment. The reasons can vary from payers not receiving claims to small discrepancies. Fortunately, you can prevent most claim denials using medical billing software programs. They scrub claims for errors before you submit them to insurance providers. |
|---|---|
| Payment Processing | The medical billing process is tedious. But medical invoicing systems can easily handle such tasks. With payment processing functionality, you can process co-pays, deductibles or coinsurance payments at the time of the office visit via cash, online wallets or credit/debit cards. You can generate statements using customized or default plan groups. Furthermore, you can preview and modify statements before sending them to clients. |
| Collection Letters | You can save money by removing third-party agencies from the payment collection process. Medical billing software manages and produces customizable collection letters for various payers. |
| Charge Capture/Medical Coding | The charge capture feature renders medical services into billable charges. It allows you to input the correct diagnosis (ICD-11) and procedure (CPT) codes used in a medical claim, reducing coding mistakes and preventing denials. Most medical billing solutions update their coding databases annually. |
| Claim Submissions | Medical billing software helps you detect claim errors before submitting the claim to payers. They also enable you to send claims to clearinghouses to ensure they meet requirements and stipulations. |
| Reimbursement Tracking | Billing solutions let you track revenues from claims reimbursements as well as the portion of your patient services that comes from patient self-pay, co-pays and deductibles. They create and maintain a detailed record of all transactions for analysis. |
| Remittance Processing and Electronic Remittance Advice | You can approve or reject payments through the remittance processing functionality. You can import electronic remittance advice documents supplied by the insurance payer that provide notices and explanations of reasons for payment, adjustment, denial and/or uncovered charges of a medical claim. You don’t need to chase EOBs or even match payments manually. This feature lets you post payments with a single click. |
| Collections/Billing | With electronic billing solutions, you can collect payments from third-party payers, track claim statuses, monitor A/R days and follow up with patients carrying balances after insurer payments (as well as patient non-payment/bad debt). They help you create customizable, paperless superbills for patients that consolidate all the transactions, diagnoses, services and insurance procedures in a single bill. |
Expert recommendations and analysis on the top Medical Billing Software
Advanced Features To Consider
These features may be key to your business, but not all medical billing software systems will offer them all. Some vendors may provide them at an extra cost.
Identify which advanced features your practice will need ahead of time to guide your selection from the table below.
| Insurance Relationships | Medical billing software enables you to track different contract rates and discounts of accepted payers. They integrate with CRM tools to help you manage relationships with payers and insurance companies alike. |
|---|---|
| Reporting | Generating reports can give important insights into the overall productivity and profitability of your practice. You can filter report data by individual providers, codes and procedures. This helps you set benchmarks for your practice, measuring against the company’s norms and identifying key performance indicators. Billing solutions enable you to conduct risk assessments to identify the likelihood of patients paying their bills depending on their prior history, so you can stay on top of high-risk dues. |
| Payment Reminders | Medical billing software allows you to send automated reminders to patients of upcoming or overdue payments to facilitate timely collections. |
| Workflow Management | Some medical billing tools provide workflow dashboards, a rules management engine, and scheduling and pre-registration modules, assisting you in streamlining staff tasks and promoting organized business operations. |
| Accounting and Financial Management | The accounting and financial management functionality helps you track and manage employee payroll, timesheets, accounts payable and receivable, outstanding payments, and other administrative tasks, reducing double entries and staff workload. |
Expert recommendations and analysis on the top Medical Billing Software
Current & Upcoming Trends
Due to the constant evolution of the health care industry, the need for innovations in medical billing rose too. According to a Data Bridge Market Research report, the medical billing software market is anticipated to grow at a CAGR of 12% through 2029.
With so many new technologies and regulations coming into the picture, it can be difficult to keep up with the latest trends or get a clear picture of which direction things are moving.
We’ve summarized a list of upcoming trends that you should look out for below.
ICD-11 Implementation
WHO released ICD-11 that came into effect in January 2022. ICD-11 comprises 55,000 codes, almost four times as much as ICD-10, which listed 14,400 codes.
ICD-11 addresses code duplication and confusion using a content model with 13 parameters, making it easy for non-medical entities to get a better understanding of medical billing.
The enhanced U.S. version of ICD-11 has over 17,000 unique classification codes, and it’s safe to assume that the number will increase exponentially.
Artificial Intelligence and Computer-assisted Coding
It’s not humanly possible to remember all of the necessary medical billing codes. Thankfully, you don’t have to anymore. You can use AI and NLP-enhanced coding systems to analyze charts and documents to identify correct classification codes with unparalleled agility.
These systems with the help of machine learning technology train themselves on massive amounts of medical keywords, learning to recognize and code them.
Computer-assisted coding technology helps eliminate billing errors and increases efficiency compared to manual coding. It also reduces coding time without sacrificing accuracy, learning to be more precise over time.
According to a Verified Market Research report, the computer-assisted coding market is predicted to grow at a CAGR of 13.3% from 2023–2030.
Some points worth considering are as follows:
- According to the State of Claims 2022 survey, 73% of respondents said payers denied claims 5%–15% of the time. When you understand that insurance companies have an economic incentive to deny claims, it’s easy to see why this statistic never drops to zero. Denial handling requires recognizing patterns specific to insurers, which you can streamline with AI.
- Today, several billing systems automate text extraction with AI.
- AI can automate pre-authorization and other repetitive tasks.
- AI chatbots help you answer patient queries.
- AI-enhanced systems constantly accumulate knowledge and continually become more valuable.
Outsourcing Billing Services
Many health care providers opt to outsource their billing services to focus solely on patient care. In fact, many smaller practices outsource these tasks due to their limited staff and resources. However, many practices use in-house billing to retain control over their operations.
Blockchain
Blockchain is a database that stores data in blocks or chunks, chained together. Data entered in blockchains are decentralized, irreversible, immutable, incorruptible and transparent, making it ideal for security applications.
According to an article posted by the HIPAA Journal, the 13 years between 2009 and 2022 saw more than 3,000+ data breaches and patient record exposures.
Several health care applications leverage blockchain technology to provide enhanced protection.
Adopting blockchain reduces billing errors and fraud by providing transaction transparency. Increasing visibility into transactions makes the records kept in blockchain a reliable source to resolve claim disputes.
Combined with computer-assisted coding tools, blockchain streamlines and speeds up the medical billing process. It also helps with payment processing, thanks to its decentralized nature.
Rising at a CAGR of 61.3%, blockchain adoption in health care is expected to reach $1.18 billion by 2028.
It’s easy to see the growing importance of blockchain technology with such a high projected market growth rate.
Virtual Care
The greatest benefit of virtual care is that it reduces contact in this post-pandemic era, along with being efficient and affordable.
As the health care continues to embrace a value-based care model, offering virtual services could provide a high return on investment. But you must be careful, as billing a virtual visit isn’t the same as in-person appointments. The billing rules can vary from payer to payer.
To ensure correct reimbursement for virtual services, medical billers and practices leverage telemedicine software and telehealth solutions.
Growing at an unprecedented pace, the global telehealth market is expected to reach $455.3 billion by 2030.
Adopting telehealth methods is no longer optional if you want to reduce billing errors and avoid legal troubles.
Telehealth and telemedicine might sound the same, but they slightly differ. Read our article — Telehealth vs. Telemedicine — to learn about the differences between the two.
For an in-depth look at where the industry is headed, check out our article on Top Health Care Technology Trends.
Expert recommendations and analysis on the top Medical Billing Software
Software Comparison Strategy
With several medical billing applications on the market, it becomes difficult to evaluate them. We recommend you start by listing your business needs. How many employees will use the software? What features do you need to resolve existing problems?
You should look for a solution that offers core billing functionalities like insurance verification, claim submission, denial resolution and charge capture.
You should ensure that the platform integrates with other third-party medical solutions like EHRs and practice management tools.
You need to decide on the deployment type. You can access cloud solutions via internet-enabled devices. Some even offer offline data accessibility (information gets updated once the connection’s restored.)
If you prefer cloud-based products, you should ensure that it provides SSL/TLS encryption capabilities to secure confidential files.
You need to install on-premise applications on your company servers.
In discussions with potential vendors, understand their solution’s ability to handle the dual requirements of fee-for-service and value-based reimbursements.
Once you cut your list down to the top two or three vendors, ask them to demonstrate how their system will work and how it performs when in action.
See if they offer trials, and test the software to make sure it’s easy to use and meets your practice’s needs.
Be thorough and talk to references for each vendor. Don’t only rely on your providers’ references, who are likely to offer the most positive reviews.
Ideally, you should reach out to additional contacts for more information and opinions to get a complete picture of your candidates.
The key is selecting a medical billing solution that suits your practice’s unique needs now and as it evolves. It would be a lot easier if there were a one-size-fits-all solution, but unfortunately, one probably doesn’t exist. That’s why you need to be careful while conducting software evaluations.
Still wondering where to begin? Check out our Lean Selection methodology to choose a solution that best suits your company's requirements.
Cost & Pricing Considerations
Prices differ exponentially depending on a system’s deployment strategy.
Self-hosted platforms tend to be on the higher end of the pricing scale due to the capital investment required for installing the system, making it cost-effective for large-scale operations in the long run.
Cloud-based systems, the more accepted and widely used strategy, have much different costs associated with them as they only require you to buy in-app purchases and pay annual or monthly subscription prices.
Cloud products typically require maintenance, server, training and support fees. They generally charge based on the number of users, with discounts for a higher number of users. They can also include additional processing fees for each successful transaction.
Cheaper options might not be the best, as they might not provide crucial features for your practice. However, all-inclusive packages usually cost more. Features like claims scrubbing, benchmarking, scheduling and analytics can increase your ROI.
Generally, additional costs associated with training, maintenance, licensing, upgrades and support for both deployment options are common.
See prices for the top Medical Billing Software... Plus get important questions to ask.
The Best Medical Billing Software
Even when you have a rough idea of what to look for in a medical billing system, choosing one can be a daunting task. Here’s a list of the top solutions curated by our analysts to shorten your search for the ideal system:
DrChrono
DrChrono is an integrated solution providing customizable medical forms and claims management, reporting, e-prescribing, and scheduling functionalities. It enables you to monitor individual patient health with custom vitals.
Increase productivity with speech-to-text, dynamic charting and mobile EHR. Organizations of all sizes can use it to streamline their clinical workflows.
Analyze payment trends with DrChrono. Source
CureMD
CureMD is a cloud-based solution that offers robust billing and payment tools alongside core administrative features like scheduling. It supports practices, specialties and organizations of all sizes with a mobile EHR app to increase accessibility.
Stay compliant with security and interoperability measures like HIPAA, MIPS and MACRA while connecting and exchanging data with stakeholders and external practices.
Track vital key performance indicators with CureMD. Source
Kareo Billing
Kareo Billing serves independent practices and medical specialties. It helps you build relationships with patients while providing the highest quality of care.
You can leverage this system to handle daily operations such as scheduling and managing claims, billing, payment and revenue.
Monitor tasks, manage workflows, track KPIs and determine payment velocity with Kareo Billing. Source
CareCloud
CareCloud helps organizations of all sizes track, manage and optimize financial and administrative processes, helping you boost efficiency, increase patient volume, enhance patient experiences, deliver quality care and maximize revenue.
View patient data and account balances. Source
eClinicalWorks
eClinicalWorks provides clinical documentation, practice management, revenue cycle and patient engagement modules. It enables you to perform tasks like scheduling, managing finances and analyzing data.
You can prepare electronic medical charts to eliminate the need for hand-written items. This system helps you increase revenue as well as the quality of treatment and service.
Set custom claim statuses with eClinicalWorks. Source
Expert recommendations and analysis on the top Medical Billing Software
Questions To Ask Yourself
To gain clarity about your company’s needs, ask yourself these guiding questions:
- What’re our current pain points?
- Do we need a scalable solution?
- What’re our reporting requirements?
- What’s our budget?
- Do we require on-premise or cloud-based deployment?
- Do we need a flexible system?
- What technical resources do we need to implement the new application?
Questions To Ask Vendors
Use these questions as a starting point for conversations with vendors:
About the Software
- Is the solution HIPAA-compliant?
- What type of reports can the system generate?
- Is the software customizable to specific business needs?
- Does the app integrate with third-party systems?
- Does the solution provide real-time claim-tracking functionality?
About the Vendor
- How many years of expertise do you have in the industry?
- Do you have ONC-ATCB certification?
- What’s the annual cost of support?
- How do you handle updates? Will future updates change your databases?
- What training options do you provide?
Expert recommendations and analysis on the top Medical Billing Software
Next Steps
While EHR and medical billing software can have overlapping capabilities, their core focuses differ. Medical billing solutions help you maintain detailed records of billing-related financial and administrative tasks for diagnoses, tests, examinations and procedures.
Remember, a medical billing app is only as good as the billing team it supports. A well-trained and experienced billing team can help your practice avoid coding errors and incorrect data entry, which impact revenue.
Are you ready to drive your organization towards success with medical billing systems? If yes, get started today with our comparison report to gain insights about the top software leaders.
Need further assistance? Please don’t hesitate to reach out via email and phone mentioned on our website.
Product Comparisons
- DrChrono vs. CureMD
- CureMD vs. Kareo Billing
- CareCloud vs. CureMD
- CareCloud vs. Kareo Billing
- eClinicalWorks vs. DrChrono
Additional Resources
Top 10 Medical Billing Software Leaders by Analyst Rating (of 103 products)
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