Finding software can be overwhelming. Software Advice has helped thousands of medical billers choose the right billing software so they can generate statements and submit claims electronically.

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athenaOne

athenahealth currently works with a network of more than 160,000 providers. The EHR offers a homepage that allows users to review the daily schedule and patient information, manage orders, and view incoming lab results. The billin... Read more

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Recent recommendations: 389 recommendations

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RXNTFrontRunners 2021

RXNT’s integrated suite of EHR, Practice Management, and Medical Billing software optimizes clinical outcomes and revenue management and includes free setup, training, and ongoing support. RXNT’s affordable pricing is predictable,... Read more

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Recent recommendations: 366 recommendations

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DrChrono

DrChrono’s iPad and iPhone compatible EHR and medical billing platform allows medical practices and healthcare providers to manage patient intake, patient care, clinical charting, billing and revenue cycle management. It includes ... Read more

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Recent recommendations: 245 recommendations

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Kareo BillingFrontRunners 2021

Kareo is a web-based medical billing and practice management solution used by medical practitioners and physicians across the United States. The system suits small practices and billing companies. With Kareo, practices can schedul... Read more

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Recent recommendations: 165 recommendations

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Compulink Healthcare SolutionsFrontRunners 2021

Compulink’s Advantage SMART Practice® is an all-in-one database EHR solution for specialty practices such as optometry, ophthalmology, orthopaedics, ENT, mental health, podiatry, and more. Available cloud-based or server, Advantag... Read more

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Recent recommendations: 57 recommendations

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NextGen Healthcare

NextGen Healthcare offers NextGen Office—a cloud-based EHR – specifically designed for private practices. NextGen Office is a fully integrated practice management solution that includes specialty-specific content, a claims clearin... Read more

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Recent recommendations: 56 recommendations

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ChARM EHRFrontRunners 2021

ChARM Health is a MU certified, cloud-based EHR, Practice Management and Medical Billing solution that helps healthcare organizations ranging from large multi-specialty groups to small independent medical offices function efficien... Read more

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Recent recommendations: 31 recommendations

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ChartLogic EHR

ChartLogic offers an ambulatory EHR suite that includes electronic medical record, practice management, revenue cycle management, e-prescribing and patient portal. The solution caters to primary care, surgical care and other compl... Read more

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Recent recommendations: 31 recommendations

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Modernizing Medicine

Modernizing Medicine offers an integrated telehealth platform within its specialty-specific EHR system, EMA. Called modmed Telehealth, it offers synchronous audio and video telemedicine capabilities for specialty physicians as wel... Read more

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Recent recommendations: 27 recommendations

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AdvancedMD Billing Services

AdvancedMD is one of the leaders in web-based electronic health records and practice management systems. The company offers a range of applications, all delivered over the web, for small, medium and large organizations. ... Read more

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Recent recommendations: 27 recommendations

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AllegianceMD

AllegianceMD is a cloud-based medical software system that is designed to serve the needs of small and midsize practices, as well as ambulatory surgery centers. The solution includes practice management functionality for billing a... Read more

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Recent recommendations: 23 recommendations

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CareCloudFrontRunners 2021

CareCloud Charts is an integrated electronic health recording (EHR) solution offering collective benefits of EMR, practice management and medical billing services. The solution helps physicians to streamline clinical operations an... Read more

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Recent recommendations: 22 recommendations

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Euclid

Euclid is a medical management solution that helps hospitals and healthcare providers streamline various clinical operations such as claims processing, scheduling, billing and more. With its administrative dashboard, professionals... Read more

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Recent recommendations: 22 recommendations

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HARMONY Medical

Harmony e/Notes is a hybrid integrated solution that offers functionalities for electronic medical records, practice management, billing and revenue cycle management. Specialities that the solution caters to include cardiology, ge... Read more

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Recent recommendations: 19 recommendations

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MedicsPremierFrontRunners 2021

MedicsPremier supports comprehensive financial/operational/workflow management and a nearly 100% success rate on first attempt HCFA/UB clearinghouse claims with a utility for workers compensation/no-fault claims/documentation. ED... Read more

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Recent recommendations: 11 recommendations

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DuxWare

DuxWare is a cloud-based practice management solution built for healthcare providers. This solution allows medical practices to track/manage patient information, file claims electronically, manage appointments for multiple provide... Read more

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Recent recommendations: 7 recommendations

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Azalea Health

Azalea provides cloud-based electronic health records (EHR), practice management (PM), revenue cycle management (RCM) and telehealth solutions for ambulatory and hospital care settings. Azalea is suitable for community and rural h... Read more

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Recent recommendations: 7 recommendations

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CGM DAQbilling

DAQbilling by CompuGroup Medical (CGM) is a medical billing and patient scheduling system designed to streamline medical billing. The solution covers eligibility inquiries, claim submission, and payment posting. The system has an ... Read more

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Recent recommendations: 7 recommendations

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MedEZ

MedEZ is an electronic health record (EHR) and billing suite suitable for most medical facilities, particularly behavioral health centers and substance abuse rehabilitation programs. On-premise and cloud-based deployments are avai... Read more

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Recent recommendations: 6 recommendations

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Sigmund Software

For nearly two decades, Sigmund Software has had the opportunity to create individualized Software Solutions for many diverse organizations. Sigmund’s enterprise, cloud-based platform, AURA, contains a robust features suite that ... Read more

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Recent recommendations: 6 recommendations

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2021 Medical Billing Software Pricing Guide

Learn about the key aspects of accurate software pricing before you make your purchase decision.

Includes:

  • Pricing models & ranges

  • Unexpected costs

  • Pricing of popular systems

Buyers guide


Last Updated: September 27, 2021

What is medical billing software?

 

Medical billing software is used by healthcare providers to automate their manual billing tasks, such as verifying patients’ insurance, processing and submitting claims, processing payments, and following up on denied claims. The software helps providers increase their collections by avoiding repetitive and cumbersome administrative tasks.

The software can be purchased either as a standalone system; as an integrated part of an electronic health records (EHR) solution; or as an integrated part of a practice management suite.

Medical billing software automates repetitive and error-prone billing tasks. It helps medical offices:

  • Increase collections
  • Code claims properly
  • Verify patients’ insurance coverage
  • Post payments and EOBs
  • Provide reports on collections and rejections
Claim Status Dashboard

 

Claim Status Dashboard in MediTouch by HealthFusion

 

There are hundreds of computerized medical billing systems on the market and they range from functionally simple to very sophisticated. The most basic systems help providers generate paper statements based on demographics and billing codes input by the user. Additionally, medical office billing software allows providers to submit claims electronically, scrub claims, post payments, pull advanced reports and more.

In this guide we discuss the following:

What is Medical Billing Software?
Common Features of Medical Billing Software
What Type of Buyer Are You?
Benefits of Medical Billing Software
Medical Coding Software
Cost and Return on Investment
Important Considerations
Popular Medical Billing Software Comparisons

Common Features of Medical Billing Software

When comparing different medical billing software, it’s helpful to have an understanding of the common features offered with this software. Here are some of the features you can typically expect in a medical billing system:

Claims processing

Automates the process of creating, submitting, tracking, and processing medical insurance claims in order to collect payment from providers.

Claims scrubbing

Run claims through an auditing procedure before submitting them to find and correct any errors in coding. This feature helps reduce denied or rejected claims and increase approval rates.

Insurance verification

Checks patient insurance eligibility ahead of appointments to ensure procedures and services will be covered by patient insurance.

What Type of Buyer Are You?

Most practices we speak with match one of these common buyer types:

Inpatient care providers. This category of buyer includes hospitals and long-term care facilities that need to submit claims using UB-04 forms. This type of form typically requires a system designed for inpatient billing, although some outpatient healthcare billing software systems do have a module for UB-04 billing.

Outpatient care providers. This category is made up of the private practices that submit claims on the CMS-1500 forms. These buyers need to submit electronic claims to Medicare, Medicaid and private insurance companies using Medicare billing software/Medicaid billing software. Software needs do not vary much by size of organization, although larger organizations will need a more robust, scalable medical insurance billing software program.

Specialists. Specialists such as chiropractors, naturopathic doctors and mental health providers of varying designations typically see patients that pay directly via cash or credit card. Moreover, their patients typically do not submit many (if any) claims to insurance companies or government payers. As a result, these providers have more lightweight needs.

Outsourced billing services. These buyers are third-party companies that submit claims on behalf of providers. They are typically paid a percentage of collections by providers. They have similar functional requirements to their respective provider clients, but may require a very broad, flexible system if they bill for clients of varying specialties or types of care.

Integrated suite buyers. These buyers require billing functionality, but would rather implement one integrated suite for scheduling and EMR. Their vendor selections are often driven by the EMR functionality, since most integrated systems are differentiated by their EMR offering, not their billing modules.

Benefits and Potential Issues

Billing software is an integral part of the overall revenue cycle management process. Billing and other administrative tasks are notoriously paper-laden and cumbersome. A modern medical billing software system allows billers to be as efficient as possible at coding, submitting and following up on claims.

Moreover, staff will find that medical billing and coding software helps them code claims accurately to avoid errors. As a result, most providers find their collection rates increase when going from manually submitting claims to using medical claim software.

Finally, advanced reporting tools typically provide insights that are tough to gain without a medical billing solution. By collecting important data around claims and payers, such as which claims get rejected most often and which payers pay the slowest, providers can make data-driven decisions to improve collections.

Most practices and billing services we speak with face a common set of billing challenges, and consequently, they’re considering purchasing (or replacing) software to address those challenges. Here are common scenarios we often hear about during our phone consultations:

Transitioning from paper claims. Typically, solo or small practices are making the move from paper claims to an electronic system (though that is not always the case). They have a difficult time keeping track of patients and who owes what. They will implement medical billing software for the first time to reduce paperwork, track all data in a central place and improve efficiency overall.

Bringing billing in-house. Another common scenario, most practices choose to bring billing in house—as opposed to outsourcing to a third-party service—to cut costs, have more control of their billing and accounts receivable and get everything centrally located.

Replacing antiquated software. Finally, offices replacing their existing system do so because it’s outdated and expensive to maintain, it doesn’t meet their technical requirements (e.g., integration with electronic medical record software) or they have a difficult time using it. In this scenario, Web-based medical billing software is an attractive option because it’s modern and easy to use, costs less up front and updates automatically as vendors release new versions and enhancements.

Medical Coding Software

Many medical billing software solutions include functionality that enables HIPAA-compliant medical coding. Users can enter procedure and diagnosis codes and even look up codes online to find the correct ones. This capability allows users to file and track claims more easily and helps in the tracking of data over time. Many medical billing software solutions will also update codes automatically to ensure the accurate ones are always being used. 

Costs and Return on Investment

The prices of medical billing software programs often depend on the application’s deployment model. On-premise systems will require upfront costs for licenses, servers and other necessary hardware, setup and training. Buyers of on-premise systems will also need to pay ongoing maintenance and support fees, which are typically 15-20 percent of the upfront licensing costs.

Software-as-a-Service (SaaS) applications typically require lower upfront costs and ongoing monthly fees that cover licensing, support and upgrades. Finally, there are free medical billing software options that are supported by alternative revenue streams, such as advertising.

Most buyers who have successfully implemented systems will be able to generate returns on their investments through improved accuracy of filings, improved billing efficiency, and subsequently, increased collections.

Collections Management in Kareo
Collections Management in Kareo speeds payment

Important Considerations

Integrated suites vs. stand-alone billing solutions. Buyers will need to decide if they want to implement a standalone system, a system integrated with patient scheduling (typically called “practice management”) or a fully integrated billing, scheduling and electronic medical records (EMR) system. Many vendors such as AdvancedMD and NueMD offer all three options. Medical billing solutions have long been the only or primary applications used in many doctors’ offices, and they are usually the first systems new practices will implement. Despite government legislation requiring the adoption of EMRs, we still hear from many practices looking for standalone billing or practice management systems.

On-premise vs. Web-based. SaaS or Web-based medical billing systems have become very popular and comprise well over 50 percent of new solution sales. Low upfront costs, greater accessibility and little to no IT requirements are contributing factors to so many buyers preferring Web-based systems. Assuming buyers have reliable Internet access, we typically recommend they consider these programs.

Security. A primary concern we hear from buyers regards data security. Since medical billing involves the storage and transmission of so much sensitive patient data, buyers will want to make sure they implement a secure system. Vendors are well aware of this need and offer HIPAA-compliant systems.

User adoption. Usability tends to be more a function of the end user and how the system is configured than the medical claims software itself. Users with medical experience can typically adopt most systems quickly. Many complaints regarding usability tend to be related to setup and maintenance of servers and other hardware, not the applications themselves.

Popular Medical Billing Software Comparisons

FrontRunners

Your Guide to Top Medical Billing Software, February 2021

Software Advice uses reviews from real software users to highlight the top-rated Medical Billing Software products in North America.

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Software Advice
“Usability” includes user ratings for Functionality and Ease of Use.“Customer Satisfaction” includes user ratings for Customer Support, Likelihood to Recommend and Value for Money.Reviews analysis period: The reviews analysis period spans two years and ends on the 15th of the month prior to publication.