Medical billing software provides practice management tools that speed up claims processing, improve the patient experience and provide valuable insight into the workings of your practice.
There are scores of medical billing software solutions on the market today, ranging from the most basic programs designed for one person practices, to state of the art systems that will restore order to the data stream of a busy hospital or clinic.
We spent long hours evaluating the state of the medical billing and practice management software landscape and determined that the following represent the best medical billing software of 2021.
75Health is state of the art Electronic Health Record software. It enhances the doctor/patient relationship by making sense of the blizzard of information generated by 21st-century healthcare.
What we like: 75Health offers trouble-free interoperability, knowledgeable support, and a first-rate patient portal and app. It is easy to learn, presents relevant information in a clear, well-ordered manner, and produces error-free claims.
Flaws: Some of the functions seem unnecessarily step-heavy. The free trial does not really do the system justice.
2. EpicCare EMR
EpicCare offers both EMR and EHR solutions to practices large and small. The company has more than 40 years of experience in the medical billing field. That experience is apparent in the comprehensive way they approach all aspects of practice management.
What we like: The system covers just about every conceivable angle of a medical practice. Insurance verification is fast. Claims scrubbing produces error-free submissions less likely to be denied. Robust interoperability.
Flaws: A lot of pages seem unnecessarily cluttered. For whatever reason the system seems to lag from time to time. And there is no free trial.
AllegianceMD EMR software is suited to small practices with little compelling need for broad interoperability. The company has been around since the late 90s and offers practice management solutions at reasonable prices.
What we like: The patient portal gets generally high marks. The app is also very easy to set up and use. They offer a ton of videos that are a big help when you get stuck and do not have time to wait in the support queue.
Flaws: There is no dashboard from which to customize the interface. And no allowance is made for quotes or estimates.
4. EMR Bear
Despite its name EMR Bear offers state of the art, cloud-based EHR solutions as well as their flagship EMR practice management software. EMR Bear is designed by behavioral specialists for behavioral specialists.
What we like: The system is updated regularly, so you are always on top of the latest regulatory changes. The support staff is knowledgeable and patient. Customization is easier than with some other medical billing software.
Flaws: Their way of handling old information is cumbersome and unintuitive. And can make it difficult to maintain accurate patient histories.
NEXconnex offers full-service EHR and EMR software solutions for practices large and small. Their software solutions are fully customizable, and their patient web portal is one of the best. Intuitive and powerful, NEXconnex software lets you concentrate on your patients.
What we like: Information is presented clearly with little muss or fuss. Plenty of helpful notifications throughout the program. The patient portal is first-rate. The system as a whole is glitch-free and catches most errors.
Flaws: Support staff are generally helpful, if you can get through to them. Any sort of customization takes work.
6. EDI Autoclaim
EDI Autoclaim puts a premium on improving cash flow and generating error-proof claims. They make dependable EMR software that comes with a knowledgeable support staff who get you on your feet in no time. Best for home and community based healthcare services.
What we like: You do not need a degree in engineering to understand the system. It is not the most flexible medical billing software, but error rates are very low. The support and training staff are knowledgeable and friendly.
Flaws: The system does not encourage or allow much in the way of customization. It is what it is, take it or leave it.
7. Healthpac HPlusPro
HPlusPro aspires to be your primary practice management tool, not just your medical billing tool. As such, it places as much emphasis on the mundane aspects of office management as it does on patient care and patient experience.
What we like: The support and training staff are helpful and patient. They offer a variety of EMR and EHR medical billing software solutions. The various program interfaces are clear and easy to understand.
Flaws: It is not as easy to pick up on as some other systems. Their website is a mishmash of fairly useless sales jargon.
Nextech is a specialty-oriented system designed for dermatologists, ophthalmologists, cosmetic surgeons, and spa owners. They offer easy to learn EMR software solutions for clients with a limited need for broad interoperability.
What we like: The system draws praise for the intuitive nature of the patient portal. There is plenty of well-ordered support documentation. Support staff, in general, seem knowledgeable and friendly.
Flaws: There is no support for scheduling automatic monthly payments. No interoperability with other healthcare systems. Some customers complain about having to wait in long queues for support.
9. PulsePro Practice Management
PulsePro is at the other end of the software spectrum from Nextech. Where Nextech offers simple software billing solutions for small to mid-sized specialty practices, PulsePro targets large, complex operations and provides the means to tackle the data beast.
What we like: Once you can get some help from support, learning the system is relatively easy. There is fluid integration of credit cards with patient accounts. Patients seem to have no issues with the patient portal. All data is easily accessible.
Flaws: Not the most robust support. Also, parts of the scheduling component seem like they were tacked on at the last minute.
Providers of Durable Medical Equipment need billing software solutions too. BFlow provides them with an easy to use suite of cloud-based tools. If you operate a Homecare business, you too will also find BFlow a powerful ally.
What we like: The system is very easy to understand and offers quick and easy insurance verification, claims tracking, and more. The program is relatively new, so there are no legacy quirks to deal with. Monthly rates are also reasonable.
Flaws: Customer service can be spotty. Good today, not so good tomorrow. You also have to keep your eye on claims and make sure they were transmitted.
Who Needs Medical Billing Software?
Perhaps a better question is: Who can manage without medical billing software? Over the past 40 years, medical billing has become one of the most complex and contentious issues in American life. There have been repeated attempts by Congress to bring it under control, demands for greater transparency from patient’s rights organizations, and declarations from politicians that ‘the madness must stop’.
With the healthcare focus shifting decidedly in the direction of improving the patient experience, taming the medical billing dragon should be at the forefront of concerns for any new or established practice. Medical billing software can help you do that. But it does more than that as well. It also helps you get a grip on where your money is going, who is paying and who is not, and what aspects of your practice are dragging the rest of it down.
In addition, medical billing software greatly reduces coding errors, which ensures fewer denied claims and faster payment. And it provides access to the larger healthcare universe, so you can obtain a clearer picture of your patients and their history.
How We Ranked
Medical billing software is only as good as the training and support team that comes with it. Because, while you can gain access to your new medical billing software system as soon as your payment clears, actually being able to make sense of what you are seeing is another matter altogether. So the support and training team should understand every nuance of the system, be patient, friendly, and solution-oriented.
Features are every bit as important as support because medical billing is not getting any simpler these days, and you need a system that can keep up with it. At the same time, not every practice wants or needs the same feature set. So we endeavored to present a range of the best medical billing software options for different types of practices.
It is also crucial that the medical billing software be user-friendly for both staff and patients. That includes the patient portal and any associate apps. As such, any systems that seemed unnecessarily complex, or which required staff or patients to jump through too many hoops, did not rank for our list. Comprehensive claims management was another prerequisite for inclusion.
It should go without saying that every medical billing software system that made our list is HIPAA compliant and offers a minimum of 128-bit data encryption. Also, every system that ranked for our list is ONC Certified. Meaning it is in full compliance with government regulations regarding Medicare access.
Medical billing software allows you to automate the invoicing and claims process. Doctors have enough to worry about these days without also having to sweat over invoicing. Medical billing software automates the invoice generation and claims process, saving you time and reducing errors. The same software can alert you when an invoice is in arrears and can generate a reminder for the patient or their insurance company.
Medical billing software simplifies and expands access to records. Medical billing software enables authorized access from anywhere you can get an internet connection. So, if you are attending a medical convention across the country and a serious issue arises regarding a patient, you can log into the medical billing software from wherever you are and help expedite a resolution.
Medical billing software improves patient interactions. When staff do not have access to a patient’s complete medical records, it can lead to uncomfortable interactions. Patients want answers to their questions regardless of whether staff members remember the particulars of their situation or not. Robust medical billing software systems put virtually every aspect of a patient’s history right at your fingertips.
Medical billing software reduces paperwork. The promise of the paperless office has been little more than an empty promise for decades now (1). But with the right medical billing software, it is not only possible but likely that you will see a significant reduction in paper records generated by your practice. That will not only reduce paper costs, but the costs of storing and managing those records as well (2).
Medical billing software improves office efficiency. Once the EHR or EMR software is integrated with your billing and other processes, there is no need to keep re-entering basic information. This can have a dramatic effect on office efficiency. Reducing the number of data transfer episodes also greatly reduces the number of possible human errors that can occur. That, too, has a positive effect on efficiency.
Medical billing software enables you to track follow-up appointments. In a busy practice, it is not uncommon for patients to forget about follow-up visits. It is also not uncommon for staff to forget to remind patients about pending follow-up visits. Medical billing software can remove the possibility of these costly oversights by generating automatic reminders to patients and providing a way for them to acknowledge the reminder.
Medical billing software helps you save money. Paying people to track down and correct errors, to keep patient records up to date, and to create invoices costs money. Paying for their health insurance, social security, and other benefits costs money. And training them costs money (3). Then, if they decide to move on, you have to start over with someone else. Medical billing software is a more cost-effective way to improve your practice.
Medical billing software ensures your bills are accurate. It is not unusual for healthcare providers to overlook some aspect of treatment when billing for their services. Medical billing software uses patient histories to alert you to likely oversights or draw attention to treatment inconsistencies that may indicate an error. In addition, most will scrub a claim for HIPAA, CCI, and other errors prior to submission, ensuring a higher rate of claim acceptance.
Medical billing software reduces authorization errors. It is only too common for a claim to be denied because the authorization for a service has expired, or agreed-upon service levels have been exceeded. Medical billing software can alert you to pending authorization cutoffs in a timely fashion. That way, the issue can be resolved before it creates tension between doctor and patient, or negatively impacts the efficiency of your practice.
Medical billing software reduce overall error rates. Medical coding is a difficult job, and most coders are excellent at what they do. But mistakes can and do happen, even to the best of us. Because there are literally thousands of different medical codes today, errors can easily be overlooked. The right medical billing software will draw attention to likely errors, thereby elevating efficiency and profitability.
Medical billing software helps reduce coding errors. Medical coding (4) errors are a major cause of lost income. They are also often responsible for the development of adversarial relationships between doctors and their patients. Coding inconsistencies can lead to incorrect billing, denied claims, lawsuits, lost time trying to track down the error, and lost patients. Medical billing software alerts you to coding inconsistencies, so errors are minimized.
Medical billing software makes it easier to track claims. Sometimes denied claims are the result of coding errors. Other times, they are the result of incorrect patient information. Without medical billing software you may even be unaware a claim has been denied until payment fails to show up on the books. Medical billing software can alert you to a denied claim, help you correct the issue, and guide you through the resubmission process.
Medical billing software provides you with a clearer picture of your practice. Medical billing software can generate reports regarding the financial performance of your practice. These enable you to plan ahead with a high degree of confidence and, if necessary, make changes to your practice that increase efficiency. You can also determine where and why losses are occurring and make adjustments.
Medical billing software makes it easy to update patient information. Without medical billing software, keeping patient information up to date can be a hassle. Patients may move without informing anyone in the doctor’s office. That can lead to billing problems, collection agencies getting involved, and things devolving into acrimony. Medical billing software enables patients to login from wherever they are and update their information in a timely fashion.
Medical billing software improves transparency. The complexity of billing for healthcare services can boggle the mind (5)(6) and tends to lead to mistrust among patients. When you integrate your billing services with your EHR or EMR software, the entire process is simplified, medical coding errors are reduced, and cleaner bills are issued that patients can actually understand. This enhanced transparency builds a better doctor/patient relationships.
Medical billing software ensures you are getting paid for the work performed. Medical billing is a complex process, and humans, being human, make mistakes. Coding errors oftentimes lead to a lower level of compensation than you are due. You may never even be aware of the error or errors that are costing you money. Sophisticated medical billing software can eliminate these errors and ensure you are properly compensated for your work.
Medical billing software improves the patient experience. Over the past 20 years, the healthcare focus has shifted toward enhancing the patient experience. Numerous forces are driving this movement, including a need to reduce malpractice costs, pressure to do a better job of patient retention, the prevalence of the CAHPS Health Plan Survey (7), and the dictates of the ACA (8). Medical billing software can help in all these areas.
Medical billing software enhances interoperability. The interoperability of EHR systems enables relevant information to be securely shared with multiple providers. This interoperability enables healthcare providers at every level to coordinate their efforts in a way never before possible. That, in turn, leads to a higher level of patient care and greater patient safety (since there are no mysteries regarding what a patient might or might not be taking).
Q: What is medical billing software?
A: Medical billing software is computer software that enables streamlined billing for medical services, enhances the patient experience, enables robust claims tracking, allows for e-scripting, and much more. In many cases, it provides interoperability with multiple healthcare providers who have useful information to share about a specific patient. Medical billing software often enables faster reimbursement, and can provide valuable insight into the revenue cycles of your practice.
Q: What should I bother with medical billing software?
A: Medical billing software makes scheduling appointments easier. It makes tracking claims easier. It allows patients to request refills online and allows you to glean useful information regarding a patient from other healthcare providers. It automates invoicing, ensures you are HIPAA compliant, provides helpful reminders regarding the needs of specific patients, and cuts down on costly human errors.
Q: How much does medical billing software cost?
A: The days of purchasing software on CD or DVD and installing it on your office computer are over. While a few developers continue to offer that type of perpetual license option, the vast majority – including all the best medical billing software developers – have moved to a cloud-based, subscription system. Exactly how much you pay will depend on which medical billing software system you choose to subscribe to.
Q: Is there a difference between EMR and EHR software?
A: There is. EHRs tend to be more fully integrated into the larger healthcare network than EMRs. Whereas an EMR may focus on data generated by and relevant to a particular practice, EHRs facilitate interoperability with outside sources, including labs, other healthcare providers, hospitals, insurance companies, and more. The goal is to produce a more fully fleshed out profile of each patient, their history, and their needs.
Q: Should I use EHR or EMR medical billing software?
A: For the most part, whether you will be better served by EHR or EMR software depends on the nature of your practice, and the type of patients you deal with. In most cases, older patients have longer, more complex medical histories than younger patients. In which case, you will likely want the interoperability of EHR. On the other hand, if you are a medical specialist or a spa owner, EMR software may fulfill all your medical billing needs.
Q: Is medical billing software secure?
A: This is a major concern for medical billing software companies. It is of paramount importance to maintain the safety and confidentiality of patient information. HIPAA demands it, and the reputation of the software company depends on it. As such, medical billing software developers use state of the art encryption technology to ensure the security of patient data, whether it is being accessed in the office or externally via a patient portal or other means.
Q: What are some common medical billing software features?
A: Features will vary depending on the developer. Most, however, will offer robust charting, which collates all patient information into a single, master chart. Most will also provide for e-scripting, where prescriptions are automatically forwarded to the patient’s preferred pharmacy. In addition, most allow doctors to order lab tests. And, most offer decision support (9) that provides reminders, warnings, or other information based on patient history.
Q: Does medical billing software include a patient portal?
A: Most medical billing software today includes a patient portal. It is roughly analogous to portals used to enable internet banking. Patients log into the system, and from there, they can update their contact information, request prescription refills, make payments, and request appointments. If patient portals have a weakness, it is that older adults, who could typically benefit the most from them, are often the least likely to use them (10).
Q: What kind of customer support does medical billing software provide?
A: Customer support is vital to the proper implementation of medical billing software. When implementations fail, it is often because communication between the software provider and the client is wanting. Before you decide to sign on with a particular medical billing software provider, make sure you ask them about their customer support system. And just as important, make sure you get clear answers. Also, talk to others who have used the software.
Q: Will I be charged a huge setup fee?
A: There typically no setup fees involved with medical billing software. That said, there are two different pricing models: perpetual license and subscription. With a perpetual license, you purchase a lifetime license for the software for one flat fee. This used to be SOP. In recent years, however, software developers shifted to a ‘Software as a Service’ business model. With SaaS, you pay a monthly subscription fee to access the software online.
Q: How often is medical billing software updated?
A: Some medical billing software is updated regularly. Some is not. As with most software, medical billing software that is updated regularly tends to offer a better user experience. It stays up to date with changing regulations, and provides faster, more convenient methods of interacting with the software as they are developed. It is important to ask the company how often they update before signing on.
Q: What does it mean if a service is ‘cloud-based’?
A: Cloud-based software is software installed on a developer’s server in a remote location (11). The developer controls access, provides security, performs updates to the software, and performs all necessary maintenance and backups. In the past, when software was installed on a PC in the doctor’s office, the doctor would be responsible for updating that software and keeping it secure. If a virus infected their PC, all their patient data could be lost.
Q: Is there free medical billing software available?
A: There is, and some of it is relatively sophisticated. It is mostly used by small, private practices and by those who outsource billing. As is the case with most free software, functionality is limited with free medical billing software. There is no patient portal, no interoperability with outside providers, and customer support is typically a forgotten concept. It is a classic case of ‘you get what you pay for’.
Q: Does all medical billing software adhere to government regulations?
A: ‘Meaningful Use’ is a concept that was upended by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA is nearly 1,000 pages of very specific guidelines, and your EHR or EMR software needs to operate in lockstep with MACRA, or you could find yourself in deep trouble with regulators. As such, make sure any software system is ‘ONC Certified’. This indicates it has passed muster with government watchdogs.
Q: Is medical billing software HIPAA compliant?
A: The Health Insurance Portability and Accountability Act (12), or HIPAA for short, called for the creation of nationwide standards regarding how, when, and by whom patient information could be disseminated. It also provided ways for individuals to control the way their private information is used. HIPAA is still very much in force today, and all medical billing software on the above list is HIPAA compliant.
Q: What is the upside to using medical billing software?
A: Medical billing software enables a more satisfying, productive patient experience. It also provides timely information to healthcare providers regarding the state of their practice. This, in turn, enables them to chart a growth strategy with the highest probability of success. Medical billing software also allows patients to update their own personal information, reduces paperwork, reduces human error, and makes it easy to track claims.
Q: What is the downside of using medical billing software?
A: The biggest potential downside of medical billing software involves internet access. Most developers have adopted cloud-based service models. That does not seem like much of an issue on the surface. But if the internet goes out, so does your medical billing software system. The longer it stays out, the worse things get. While internet connections tend to be more reliable than ever today, outages still happen. And you need to consider that.
Q: How long does EMR software take to setup?
A: As most EMR software in use today is cloud-based, there is no setup. What you get instead is access to an existing software system. Once you purchase access to the system, you can start to use it immediately. In theory, anyway. In practice, you are going to need some assistance from customer support who will teach you how to use the various features. For this reason, it is critical you choose a software provider with a proven record of outstanding customer service.
Q: Is there a penalty for canceling my medical billing software subscription?
A: Most medical billing software subscriptions are provided on a month by month basis. As such, if you decide you want to cancel your subscription, simply inform the developer in advance. You should not incur any penalties for canceling your subscription, regardless of the reasons for your cancellation.
With so much emphasis on enhancing the patient experience today, medical billing software is no longer a luxury. It is an absolute necessity for any practice that hopes to thrive in the coming decade.
State of the art medical billing software will simplify the process of submitting claims, reduce costly errors, enable easier, more productive communication with patients, and allow you to chart a path toward financial success. It will also enhance security, save time, and reduce the number of denied claims.
Use the information provided above to help you determine which medical billing software is right for your practice.
For cpoe.org’s #1 recommended medical billing software, click here.