Since the 21st Century Cures Act and HIPAA became law, the flow of electronic medical information between healthcare practitioners, insurance companies, and patients has improved considerably. In their rush to be compliant, many hospitals and other healthcare businesses changed to electronic billing. Moreover, they realized how expensive was the cost of medical billing software if you didn’t choose wisely.
Medical billing software pricing varies with the chosen features and influences whether you access it via the cloud or in-house service. Usually, cloud-based medical billing software costs about $25 to $150/month. In comparison, an in-house service ranges from $500 to $10,000. Furthermore, sometimes, the software provider takes a commission based on the size of the bill.
But, apart from the legal requirements, is medical software, and particularly billing software, necessary?
When medical practitioners use electronic billing, their efficiency improves by reducing hours spent billing the insurance company or patient. Thereby, saving money by allowing more time for other activities. Therefore, medical billing software allows practices to automatically submit insurance claims, communicate with insurance companies about claims, and improve patient revenue cycle management.
However, one of the most significant factors against using medical billing software is the cost of some plans offered by the software suppliers, especially as one of the main pricing factors is the size of your practice. But, the increased availability of SaaS (Software as a Service) via the cloud or a web-based browser has significantly made the purchase more affordable with fewer hardware requirements. Hopefully, this guide outlines the benefits and shows you can find a low-cost medical billing software quote to suit your medical facility.
Topics
Top Medical Billing Software Providers
There are many medical billing software providers to choose from. Below is a quick comparison list of some of the best known in the US.
| Company | Cheapest Plan (monthly) |
| Athena Health | $140 |
| EZ Claim | $139 |
| Kareo | $150 |
| MediSoft | $100 |
| My Client Plus | $25 |
| NueMD | $149 |
| Practice Suite | $95 |
| PrognoCIS | $250 |
| Total MD | $79 |
*Disclaimer: We don’t endorse or prefer any medical billing software companies in the table above and the following profiles. Instead, we’ve ranked them in alphabetical order. Information was accurate at the time of writing (August 2021); however, prices may change. Therefore, use this guide as a starting point for your research.
Athena Health
Athena Health offers multiple services that would benefit a small medical office. A one-stop-shop, the Athena Collector plan includes many useful and essential features, such as:
- Appointment scheduling optimizes the practice appointment density.
- Automated appointment confirmation and reminders.
- Claims management and claims-scrubbing catch errors before submission.
- Patient check-in. Collect payments and verify insurance claim eligibility at the time of check-in.
- Revenue cycle features and patient data accessed from the customizable dashboard.
The basic license starts at $140/provider/month. For further information, contact the company to decide on a plan to suit your business. Additionally, there are extra charges such as data migration, training, hardware, maintenance, set up, and upgrades.
EZ Claim
EZ Claim’s medical billing software is ideal for one or two physicians in practice, and smaller clinics,
The company provides a free trial to help you along the way to make life easy when running your medical practice. Furthermore, they include many easy to use and valuable features, such as:
- Appointment scheduler.
- HIPAA compliant.
- Integrated with EHR and scheduling applications.
- Patient statements.
- Processing credit cards.
The company provides tiered plans depending on the size of the practice and your choice of features. Typically, a single-user plan starts from $139/month, with more advanced billing packages reaching as high as $400. If you wish, you can also choose to add additional features to the plan. For example, adding paper claims costs $49/month extra. In comparison, you can also add an appointment scheduler for $30/month.
Kareo
Kareo cloud-based medical billing software can be customized to suit your practice’s requirements and offers features that include medical records billing for physicians and billing specialists. In addition to billing, Kareo also provides:
- Electronic medical records (EMR).
- Marketing software integrations.
- Patient analytics.
- Telehealth services.
Typical features include:
- Appointment scheduling.
- One-to-one messaging within the network.
- Patient data storage.
- Task tracker.
Furthermore, Kareo doesn’t charge a setup fee. Instead, subscribing to different plans provides you with different services.
Kareo EMR plans start at $150/month and reach a maximum of $500/month. Also, its EHR package goes from $150 to $300/month. Compared to this, the Marketing plan ranges from $150 to $350/month. Finally, practice management services cost $150 to $350/month.
Plus, the company charges between 4% and 9% on all collections.
MediSoft
Medisoft is a medical software company specializing in medical billing, practice management, and HER. The company also offers installation, training, and troubleshooting. Furthermore, they provide data conversion and other software-related professional services.
Medisoft provides in-house billing software in tiered plans to suit most requirements. Moreover, some of the critical features available include:
- Alerts for the presence of co-pays and overdue balances.
- Patient appointment viewing.
- Reporting and analytics.
- Scheduling management. Cancellations, confirmation, and reminders, among others.
MediSoft provides an in-house software solution, starting at $1,300 for a single-user license. In comparison, if you have a mid-sized or large office, unlimited users cost just under $12,000. However, if you prefer the cloud version, prices range from $100/month.
My Clients Plus
My Client Plus provides cloud-based medical billing software that is probably the best and most affordable choice for small businesses. Typically, medical startups and one or two-physician practices don’t have much money to spare. If this sounds familiar, you won’t go far wrong by using My Client Plus.
Typical features available with this billing software include:
- Account allows multi-user access.
- Insurance claims status check.
- Primary and secondary insurance billing.
- Processes credit cards.
- Reporting of revenue tracking, number and type of appointments, and other essential practice analytics.
The standard plan starts at $25/month for the first provider. But, you add the services you require, not those that the company thinks you need.
There is a 21-day free trial and no setup fees. There are also no long-term contracts; you can cancel the agreement at any time. And if you decide to pay annually, you will receive a 15% discount.
The electronic billing service makes the following charges:
- 1-50 claims/month, you pay $12.50/month.
- 51-300 claims/month, you pay $20.00/month.
- 301+ claims/month, you pay $40.00/month.
NueMD
As with many cloud-based software plans, you can bundle essential services like scheduling, reporting, medical charting, and analytics.
Usually, NueMD doesn’t publish prices, preferring to deal with customers individually and build a bespoke package for the practice. However, one of the reviews we found mentions that the NueMD standard medical billing software prices begin at around $149/user/month.
Probably, one of the essential features of NueMD software is the app for authorized users to maintain HIPAA compliant access to their patient’s data.
Other features include:
- Appointment Management.
- Claims Scrubbing and Management.
- Confidential Patient Record Management.
- E-Prescribing medication.
- Staff and Patient Scheduling.
Practice Suite
Many healthcare practices use Practice Suite’s technology to help them run their clinics, practices, hospitals, and rehab centers.
To make things even easier for you, the company offers 30 days free trial to get you accustomed to their way of working. There aren’t many companies offering the chance to try such essential features as financial reporting and billing management free of charge. However, once you start paying, you’re charged depending on the tier you choose.
The software has many good features such as:
- Appointment scheduling, confirmation, and reminders.
- Care plan management.
- Claims management and scrubbing.
- E-Prescribing medication.
- Staff management.
Prices are affordable too. The Free Plus edition starts at $95/provider/month, with two users per provider. In comparison, the Complete edition costs $195/provider/month for unlimited users.
PrognoCIS
PrognoCIS specializes in practice management, EHR, and medical billing software. The company’s software caters to the entire spectrum, from individual medical practitioners to large multi-specialty clinics.
This company doesn’t have a free version or a free trial. But, the cloud-based plans start at $250/user/month. Furthermore, if you’re new to this type of medical billing software, they have 24-hour tech support to ensure you get the most use of the features from the minute you log on.
The software plans have a range of features for you to choose from. Including:
- Appointment scheduling, confirmation, and reminders.
- E-Prescribing medication.
- Handwriting recognition.
- Patient Charting.
- Practice and staff management.
Total MD
Total MD has affordable medical billing software plans for medical practices as cloud-based or in-house server versions. If you’re new to medical billing, TotalMD offers an introductory cloud-based option to get you started with the essentials for $99/user/month.
Features include:
- Electronic data storage.
- Medical billing.
- Reporting and analytics.
- Patient scheduling.
The company offers tiered pricing plans with the in-house $500/user/month plan as the most popular. Although the cloud-based Essentials plan at $99 is the cheapest, an in-house version costs $199/month. For more than four users, the company recommends you get in touch for customized pricing.
For a growing company, this is ideal because you can seamlessly change from cloud to in-house software as your business requirements change.
What is Medical Billing Software?
Medical billing software programs help medical practitioners bill their patients and insurance companies and all the associated processes that go with it. Even a small medical practice can have many hundreds of patients, and billing each for a myriad of medical procedures and drug prescriptions, can take many hours from a typical working day. Furthermore, medical billing can be very complex because of the different billing procedures needed by various insurance companies, government agencies, and private patients.
But, the software’s usefulness doesn’t end here. It can also track payments, overall patient trends and advise the practice management team of the types of medical procedures currently in demand. It also keeps track of drug costs from pharmaceutical vendors and adds the appropriate price mark-up when selling these to your patients.
Probably, you already know how much salary you pay for an in-house medical biller. Also, you know that usually, you need at least two of these skilled employees to keep up with the continual management of the patient revenue cycle. Using good quality medical billing software can reduce the overheads of two employees, both working full forty-hour weeks, down to one person working around five hours per week.
Let’s look at a few of the main tasks suitable for billing software:
Verifying eligibility
Sometimes, you might be uncertain whether a particular patient is eligible for procedures. Medical billing software can verify whether the patient’s insurance company will pay for a procedure before arriving for their appointment. This prescreening prevents an uncomfortable and humiliating episode for the patient and ensures the practice minimizes lost appointments.
Claim processing
Dealing with an insurance company isn’t easy at the best of times. Usually, it takes a lot of time and energy to unravel its intricacies. Perhaps, it’s better to leave this to a computer program rather than a person? People can make mistakes and typos when entering procedure and claim codes, whereas software won’t misspell a code and validate it before submission to the insurance company.
Creating the bill
Billing software can create a fully itemized bill detailing all procedures and prescribed medicines. Furthermore, if your practice has multiple physicians, each can include their services, and the software will incorporate the items from each physician into the total bill.
Remittance
Medical billing software can track payments and update the information after processing payments. Therefore, you can keep track of outstanding payments and look at the entire payment history.
Payment reminders
Many people miss payments, and it’s often difficult to keep up with these manually. However, the software can automatically flag these and send gentle payment reminders to the recipients’ email addresses.
Patient management
Many software systems offer you the ability to include appointment scheduling, workflow and timekeeping management, and patient record storage.
Electronic medical records
More expensive systems also offer other services, such as electronic medical records (EMR) and electronic health records (EHR).
HIPAA
As you’d expect, handling confidential medical records requires highly secure systems and strict compliance with federal government regulations. But, what many people don’t realize is that medical billing must also be HIPAA compliant. Always look for medical billing software that protects your clients’ data in line with the regulations.
Operating system compatibility
There are different operating systems in use on various devices, and you need the billing software to be compatible with the equipment you already have. You might have Apple or Windows machines in the office, and your new software must run on either. Moreover, many cloud-based systems use mobile apps to access the cloud. Therefore, the app must run on your phone or tablet using Windows, Android, or iOS.
Types of Medical Billing Systems & Pricing Models
Medical software providers have various bill systems and pricing models that you should know about before choosing the right system for your practice. But, these usually depend on whether the system is in-house or in the cloud.
Cloud Medical records
Cloud-based medical software, or SaaS, provides useful medical billing software for small practices. Your practice subscribes to the system with a monthly payment. But, the affordable rates provide a cheap, low-cost payment system suitable for startups and small businesses.
Typically, the starting fee for a cloud-based system ranges from $30 to $100/user/month, whereas higher-priced plans range between $200 and $600/user/month. Notice the fees are for one user. Therefore, if your practice employs many practitioners, the payments soon escalate.
Apart from the low monthly subscriptions, the best part is that you don’t need to buy additional hardware and don’t have to maintain it. Instead, the software provider keeps it on their premises, and you access it remotely from your PC, Mac, smartphone, or tablet. However, you will have problems with an internet outage or inadequate quality coverage, so it might be worth upgrading your broadband to maintain the best connection possible.
Hosted medical records
Hosted (or in-house) medical software is computer software installed on a server owned by the medical practice. However, you also need a data center and the software necessary to integrate everything. Unfortunately, you don’t just buy the software. Instead, you must also make a substantial investment when buying the hardware. To ensure a hosted system operates successfully, you need the following:
- A room dedicated to the server and its ancillary equipment.
- Backup drives.
- Bandwidth cables and routers.
- An IT specialist whose job is to manage and maintain the system and hardware, perform updates, and regularly back up the hard drives at daily and weekly intervals.
A server sophisticated enough to run this software might cost anything between $3000 and $5000. But, it might cost more than this if you own a large clinic or hospital. The ethernet equipment needed to connect the computer to the server might cost $50 to $200. Finally, a backup hard drive will cost between $500 and $1000, depending on its sophistication and whether it carries out backups automatically at set intervals.
On the plus side, you only need to buy the software once, except when you need updates, rather than pay an ongoing monthly amount.
For these reasons, larger medical practices and hospitals tend to use hosted or in-house systems, as they have the resources necessary to keep them up to date. Therefore, leaving cloud-based medical billing software for small businesses.
Additional costs
Apart from the costs we’ve previously mentioned, other additional payments are associated with cloud and hosted software systems. Here are some of the significant additional costs related to your medical billing software:
- Training to use the software will cost from $1000 to $5000.
- A software license costs from $1500 to $4000.
- IT technical support is optional. But if you don’t employ an IT team, it’s worth it. Typically, IT support costs around $200/hour.
- Annual upgrades and maintenance are essential if you own a hosted system. Typically, these cost from $1500 to $4000/year.
How To Compare Medical Billing Software
Usually, unless you have professional help, choosing the correct software for your medical practice can be a nightmare, especially when you need a budget version.
Features
To assist with the comparison and eventually the choice, you should look at the following features:
- Is the software cloud-based or in-house?
- How easy is it to learn the software? Is it intuitive, and what’s the learning curve?
- Is the EMR compatible with EHR software?
- Do all parts of the software comply with HIPAA regulations?
- How much does it cost? Remember to take into account the cost to buy and maintain hardware.
- How often are software upgrades available if it’s a hosted system? And how much will they cost?
- Usually, upgrades happen automatically if it’s a cloud-based system, and you won’t even know it’s happened. But, this has to be paid for by someone. So, will the subscription fees change during the contract’s lifetime?
- How easy is it to cancel?
- Will there be a problem scaling your system if your practice grows or shrinks throughout the contract?
- Does the supplier take a commission on each transaction?
- How does the price vary with the size of your organization?
If you’ve found some inexpensive software, ask yourself why it’s so cheap. Are there additional costs in the small print? Such as:
- Are you charged for submitting a claim electronically?
- Does the provider charge an administration fee for handling the contract?
- Does the provider receive a fee based on a commission for each transaction?
- Are there excessive setup fees payable?
Of course, the software might be cheap because it hasn’t been adequately tested, or it might be complicated to use. Always check these before signing on the dotted line.
Many types of inexpensive or free medical billing software restrict its use to certain basic features. You might find that the software is challenging to use effectively until you pay the total price.
Medical Billing Software Features
The features available in medical billing software depend on the plan you choose and the price you pay. Pay close attention to the advertised features, so you don’t finish up paying for something you never use. However, many providers offer a customizable package in addition to the tiered plans. This allows you to build a personal package with features that you will definitely use.
Features
Typical features include:
- Appointment scheduling.
- Billing and invoicing patients and insurance companies.
- Care plan management lists the support the patient needs to achieve their self-management targets. Alternatively, it coordinates care plans for patients with complex needs.
- Medical charting to ensure systematic documentation of a patient’s medical history and treatment.
- Claims management organizes billing, filing, and processing insurance claims related to medical procedures, diagnoses, treatment, and prescriptions.
- Claims scrubbing double-checks the insurance claim to ensure there are no mistakes in the claim submission.
- Confirmation and reminders. The system automatically sends out appointment confirmation and a reminder a few days before. The system uses email, text messages, or both.
- Compliance tracking ensures that the practice follows all HIPAA and other federal regulations. The system will maintain auditable records of compliance in case of an alleged breach.
- A customizable dashboard allows the healthcare practitioner to see at a glance all data relevant to a patient’s history. As everyone is different, the user can visually customize the dashboard as necessary.
- E-prescribing allows the software to issue electronic prescriptions either to be printed for the patient or, more commonly, sent electronically directly to the pharmacy.
- It makes sense that the patient’s EMR is compatible with their EHR. As you are probably aware, a single healthcare provider, such as the physician’s practice, keeps a patient’s electronic medical records (EMR). In comparison, the electronic health record (EHR) is an abridged version of the EMR. This allows the patient’s physician to share certain information with other healthcare providers such as dentists, physical therapists or dieticians, while only giving them the relevant information for their specialties.
- Staff management software allows the practice manager to build shift timetables, include vacations, training courses, and other relevant HR functions. These can then be shared with relevant staff members.
HIPAA Certified Software & Compliance
The federal government has introduced specific legislation regarding IT in health matters. The legislation incorporates:
- The 21st Century Cures Act – improves the flow and exchange of electronic health care data.
- The Health Insurance and Accountability Act (HIPAA) of 1996 – Among other things, requires national standards for electronic healthcare transactions.
- The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – encourages medical practitioners to provide high-quality Medicare by using electronic storage of medical data.
- The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 promotes health care quality, using electronic medical records and private information exchange between authorized providers.
HIPAA
The legislation that relates specifically to medical billing software is known as the HIPAA regulations.
For the medical practice to comply with its duties and obligations under the federal HIPAA laws, the medical software used by the practice must be compliant. The software provides a framework for the medical providers to follow to ensure the patients’ health information safety. The HIPAA framework usually integrates with other medical software such as medical billing, electronic medical records (EMR), and practice management.
The software has the following features:
- Limits user access to authorized employees.
- The software monitors and manages any data breaches that might occur.
- It will manage relationships with third-party companies such as pharmacies and insurance companies. It also monitors itself to ensure the IT security infrastructure is in place.
- Stores your compliance process documentation in a central place.
- Allows the practice to implement and manage organization-specific policies, usually identified following self-audits.
- Remediation plans for addressing gaps in compliance, possibly found during self-audits. These are unique to the practice and allow them to identify gaps and patch the problem procedures.
- Mandatory self-audits allow your practice to inspect the organization’s current compliance procedures and identify any security risk areas.
Next Steps
We’ve already stated that wading through the enormous quantity of information about medical billing software providers is a nightmare. So, you must examine each provider’s software, choose the features you need, consider the tiered medical billing software costs, and decide on a hosted or cloud-based plan. Probably, it’s much easier and saves a heap of time if you ask for professional help.
Complete the form on this page, and you will receive up to four quotes detailing the HIPAA-compliant software suitable for your company’s circumstances. Then, it’s up to you to make your choice.