In the United States healthcare system, medical billing stands out as one of the most challenging aspects for providers. This is because they struggle with delayed payments due to complex coding, frequent payer rule changes, and constant claim denials.
In fact, nearly 1 in 5 in-network medical claims in the US were denied in 2023. This shows just how common billing challenges have become. The right medical billing solution can turn this around by speeding up reimbursements.
With so many options, it’s not always clear which path is best. This guide will explore each type of billing solution in detail, with examples. After reading the guide, you’ll have the clarity to choose the model that fits your practice’s needs.
What Are the Types of Medical Billing Solutions?
There’s not a specific billing solution that fits all practices. This is because every practice has different requirements, budget, and staffing resources. Broadly, medical billing solutions fall into three main categories. Here are the most common types you’ll encounter:
Software-Related Billing Solutions
Software-related billing solutions are applications that automate charge capture, coding, claim scrubbing, submission, payment posting, and reporting. They can be cloud or on-premise, standalone or tightly integrated with an EHR.
Most importantly, they are designed to reduce manual work, lower denials, and speed reimbursements while keeping billing inside the practice. Below are some common types of software-related billing solutions:
1. Practice Management Tools
Software that helps run the non-clinical side of a practice. It typically includes scheduling, charge entry, claim submission, patient billing, and payment posting, and may also integrate with an EHR.
Key Features:
- Automated scheduling and appointment reminders.
- Claim scrubbing before submissions to reduce denial risk.
- Payment posting and reconciliation (handling ERAs, remittances).
- Reporting & dashboards (financial health, A/R aging, denials, payer performance).
- Insurance eligibility verification & patient statements.
Examples: PracticeSuite, RXNT, AdvancedMD.
2. EHR-Integrated Billing Modules
These are billing components built into an EHR system. When clinicians document patient care in the EHR, relevant billing codes, diagnoses/procedures, and patient demographics are transmitted into billing workflows automatically.
Key Features:
- Automatic charge capture from visit documentation (superbills, note workflows) so the billing team doesn’t re-enter data manually.
- Real-time claim generation inside EHR + built-in rules engines for claim validation and error detection.
- Integrated E&M coding support or guidance to speed up coding and reduce under- or over-coding.
- Instant visibility of payer rejections or denials with the ability to correct and resubmit within the EHR workflow.
Examples: Athenahealth’s athenaOne, WRS Health Integrated EHR Billing
3. Cloud-Based RCM Platforms
Platforms delivered via cloud that manage the entire revenue lifecycle. This includes eligibility, charge capture, claim scrubbing & submission, denials & appeals, payment posting, reporting, often with analytics and sometimes with optional outsourced help.
Key Features:
- Automation of multiple steps, like eligibility checks, claim edits, and denial workflows.
- Real-time dashboards & advanced analytics for tracking first-pass acceptance and days in A/R.
- Connects with EHRs, clearinghouses, and portal systems.
- Flexible deployment and scaling, since the cloud eliminates much of the IT infrastructure burden.
Examples: eClinicalWorks, RCM Matter
4. Clearinghouses and Transmission Tools
They are not full software suites, but tools/services that focus on validating, formatting, and transmitting claims between the practice’s billing system and insurers. Such tools often ensure data standards, reduce technical rejections, and sometimes handle remittance advice (ERAs).
Key Features:
- Ensure claims follow the correct format like X12, UB-04, or CMS-1500, so they meet payer requirements.
- Real-time claim validation or error check before sending.
- Handling remittance advice (ERA) and aligning payment data with claims.
Examples: Optum, Waystar, Availity
Outsourced Medical Billing Solutions
Managing billing inside a practice can become difficult due to limited staff, complex coding updates, or high claim denial rates. In this case, outsourced medical billing solutions provide an option by handing over billing processes to specialized third-party companies.
These providers use their own software, certified coders, and billing experts to manage everything from charge entry and coding to claim submission, denial management, and collections. Next are the top three companies that provide the best medical billing solution services in the U.S.
1. Transcure
Transcure is the top-rated medical billing and coding solution company in the U.S., fully HIPAA-compliant and ISO 27001 certified. With over two decades of specialized experience in billing, Transcure provides end-to-end Robotic Process Automation (RPA) powered revenue cycle management for practices across the U.S.
A key strength is that our billing experts are proficient in 40+ EHR/EMR software, including Athenahealth, Kareo, and others. So, practices can outsource their billing operations to Transcure, whatever software they use.
We support more than 40+ medical specialties, including cardiology, orthopedics, behavioral health, internal medicine, and more. This means no matter your speciality, our AAPC coders apply the speciality-specific coding to ensure compliance.
2. CareCloud
CareCloud offers a comprehensive suite of RCM services combined with modern cloud-based software. Their billing experts handle coding, claims management, and collections, while providing practices with real-time financial dashboards.
One of CareCloud’s key advantages is its scalability in providing customized medical billing solutions. This makes it suitable for both small practices and large medical groups. It also offers strong analytics tools that help providers track denial trends, payer performance, and revenue growth opportunities.
3. NextGen Healthcare
NextGen Healthcare is a well-established U.S. company offering custom medical billing solutions services. Their strength is that they provide an all-in-one platform that combines EHR, practice management, and billing with optional end-to-end RCM outsourcing.
With NextGen, practices can either use the software in-house or hand over billing operations to their specialized RCM team. This flexibility makes it a popular choice for practices that want to scale or facilitate their financial operations without managing multiple vendors.
Hybrid Models
Hybrid billing models are those in which a vendor provides its own billing software along with end-to-end billing services. This means your staff can use the software for scheduling, coding, or reporting, while the vendor’s billing team handles claim submission, denial management, and collections.
1. DrChrono
DrChrono gives medical practices its full-featured electronic health record and practice management software, and offers medical billing services as well. A practice might use DrChrono’s EHR and schedule patient visits, and at the same time, offload claims submission, payment posting, and denial management to DrChrono’s billing service.
2. athenaCollector (athenahealth)
athenaCollector integrates practice management and billing services into one cloud-based system. The platform helps in scheduling, charting, and reporting on the front end. On the other hand, athenahealth’s billing experts handle claims, resolve denials, and manage collections. Blending technology with service creates a collaborative model that enhances financial performance.
3. AdvancedMD
AdvancedMD provides an integrated EHR / practice management platform along with RCM services. Clinics may use their software tools for scheduling, charge capture, reporting, and also engage AdvancedMD to manage backend tasks like coding, claim submission, and AR follow-ups. This lets them control front-office workflows while outsourcing revenue recovery.
How to Choose the Right Medical Billing Solution?
Choosing the right billing solution depends on your practice size, specialty, staff resources, and financial goals. Next is a detailed breakdown to help you decide which solutions will work best for you:
1. Software Related Billing Solutions
Best for: Practices with an existing in-house billing team and moderate claim volume.
When to adopt: Adopt this solution when your practice wants to maintain full control over billing, automate workflows, and reduce manual errors without outsourcing. It is mostly best for practices that can manage software updates and conduct staff training.
2. Outsourced Medical Billing Solutions
Best for: Small to mid-sized practices with limited billing staff or high denial rates.
When to adopt: Go with this solution when you want to reduce administrative burden, improve revenue collection, and use specialized expertise without hiring or training a full in-house billing team.
3. Hybrid Models
Best for: Medium to large practices that want a mix of control and expert support.
When to adopt: This solution works best when you want your staff to handle front-office tasks while outsourcing complex backend billing tasks. It balances in-house control with outsourced efficiency.
Tip: Evaluate your practice workflow, claim volume, and budget. Practices can also transition between solutions as they grow or as billing complexity increases.
What are Medical Billing Challenges and How to Tackle Them?
Even with the right solutions, practices face many billing challenges that can delay revenue and create an administrative burden. Below are the common issues and the effective solutions that you can apply to overcome them.
1. High Claim Denials
Claims are often rejected by the insurers due to missing information, incorrect usage of codes, or non-compliance with payer rules.
Solution: Use automated claim scrubbing tools, certified coders, and make sure you do proper documentation to minimize denials.
2. Insurance Eligibility & Verification Errors
Submitting claims for patients with expired or incorrect insurance leads to rejections.
Solution: Verify patient insurance eligibility before the visit and maintain updated records in the billing system.
3. Delayed Payments
Payments in A/R for a longer period of time can negatively impact cash flow and delay reimbursements.
Solution: Track claims in real time, follow up promptly on unpaid claims, and use RCM tools or outsourcing to speed collections.
4. Complex Coding & Compliance Updates
CPT/ICD updates and changing payer rules make coding complex that increase the chances of errors.
Solution: Provide ongoing staff training, use EHR-integrated coding tools, and consider outsourced billing experts to ensure accuracy.
5. Limited Staff
Small practices often lack trained billing staff to manage all billing-related tasks.
Solution: Outsource billing to specialized companies or adopt hybrid models to combine in-house control with expert support.
Conclusion
To conclude, practices must select the right medical billing solution for managing efficient billing processes in practices. This article explored the main solutions that you can adopt to make your billing transparent and accurate. Software-based solutions work best for practices that want to automate certain billing tasks.
Hybrid models allow practices to combine in-house control with expert support for claims submission and denial management. Lastly, the professional medical billing outsourcing solutions mean practices can completely delegate billing operations to experts. However, choosing the appropriate solution depends on your practice’s needs.
FAQs
How much does outsourcing billing solutions cost?
Outsourced medical billing typically costs 4–10% of net collections per claim, but some companies also charge per claim or hourly rates.
What are common problems in medical billing?
The common problems in medical billing are delayed payments or denied claims, which are mostly due to inaccurate coding and non-adherence to the changing reimbursement policies.
Which company is best in medical billing?
Transcure is the best medical billing company in the U.S. due to its expertise in 40+ medical specialties and integration with 30+ EHR/EMR systems.
Which is the cheapest medical billing solution?
The cheapest medical billing solutions are usually software-based platforms with a monthly subscription. Outsourced services charge 4–10% of collections. Hybrid models cost more than software alone but provide a mix of in-house control and outsourced expertise.
