AdvancedMD Review

• AdvancedMD has a first-pass claims rate of 97%; only 3% of claims submitted are rejected by payers.
• AdvancedMD is competitively priced, ranging from 3% to 8% of monthly practice collections for the average client.
• AdvancedMD does not perform coding services, which could be a drawback for small medical practices looking to outsource their billing department.
• This article is for medical practices that want to learn more about AdvancedMD, our pick as the medical billing service for large practices.

After researching dozens of medical billing services, we recommend AdvancedMD as the best medical billing service for large practices. AdvancedMD is capable of handling revenue cycle management for practices of all sizes, but it excels at managing billing for practices with 100 or more providers.

AdvancedMD's outsourced revenue cycle management includes access to its electronic medical record (EMR) software and practice management platform. AdvancedMD charges a monthly percentage of clients' net collections. AdvancedMD has a first-pass claims rate of 97%, which is one of the highest rates of the services we reviewed.

To learn more about our review methodology and for a list of medical billing companies, see Business News Daily's best picks.

Editor's note: Looking for a medical billing service for your practice? Fill out the below questionnaire to have our vendor partners contact you about your needs.

Advanced MD's Medical Billing Process

AdvancedMD's billing process begins after the charge entry and coding phase has been completed. AdvancedMD does not perform charge entry or coding services. (That responsibility falls on the practice to complete in house or to outsource to a third party.) This is the biggest drawback to AdvancedMD's medical billing service, however, many large practices have the resources to keep coding in house. [

Once claims are generated, practices submit them to AdvancedMD for claims scrubbing to catch any errors before AdvancedMD submits claims to the clearinghouse. AdvancedMD relies on the same scrubbing tool used by its preferred clearinghouse partner, which means AdvancedMD catches the same errors that are likely to be flagged by the clearinghouse, improving the approval rate the first time claims are submitted. According to AdvancedMD, approximately 3% of claims are denied by payers.

Once claims are scrubbed, AdvancedMD submits them to the proper payer through its clearinghouse partners. The company primarily works with Change Healthcare clearinghouse. Any clearinghouse fees incurred are built into the company's pricing and are not charged to your practice.

If a claim is denied, AdvancedMD's medical billing team informs the practice why the claim was rejected and then revises and resubmits the claim. The company also follows up with patients and payers with an outstanding balance.

While AdvancedMD is our best pick for medical billing service for large practices, it also works with smaller practices and across all specialties. The average client has roughly 3,000 patient encounters per month, although some of its larger clients submit claims for more than 30,000 encounters per month. AdvancedMD can adapt its services to your practice's specific needs, though the volume of claims you submit could ultimately influence the price you pay.

Key takeaway: AdvancedMD does not perform coding services, but it can handle the majority of a practice's billing operations, including claims scrubbing and denial management.

AdvancedMD Pricing

The average AdvancedMD client pays between 3% and 8% of the net monthly collections the company secures on its behalf. However, company representatives told Business News Daily there are some outliers that pay as low as 2% or as high as 9% of collections.

AdvancedMD's pricing model takes into account a variety of factors, including:

• Monthly collections: The ultimate price will be the higher of either the monthly minimum (which is set during contract negotiation) or a percentage of your monthly collections; to provide you with a precise quote, AdvancedMD needs to know how much your practice generates per month.
  
  
• Patient encounters: Pricing also depends on the number of total patients seen by physicians.
  
  
• Specialty: Since the billing process and specific rules vary significantly from specialty to specialty, AdvancedMD incorporates the complexity of your specialty into its final percentage.
  
  
• Number of providers: Finally, the total number of providers also influences the quote.

Armed with this information, an AdvancedMD sales representative will return a custom quote for you that includes the medical billing services it will perform and access to the company's full healthcare IT software suite, including electronic health record (EHR) and practice management software.

Key takeaway: AdvancedMD charges a percentage of monthly practice collections, which typically ranges from 3% to 8%.

Software and Reporting

AdvancedMD maintains a full suite of healthcare IT products, including EHR and integrated practice management software. It is our best overall pick for electronic medical record software, and you can read a full review of AdvancedMD's EHR software here.

Full access to the EHR and practice management software adds a great deal of value to AdvancedMD's revenue cycle management (RCM) service. Normally, the RCM costs more than $700 per month (plus thousands in implementation and training fees); however, it's included in the negotiated percentage of collections with AdvancedMD's medical billing service.

Highlights of AdvancedMD's EHR and practice management software include:

• Three tiers of implementation and training plans to suit different levels of experience
• An eight- to 11-week implementation period
• Extensive integrations with labs, pharmacies and hospitals nationwide
• Access to a 24/7 customer help desk

As a subscriber to AdvancedMD's medical billing service, you're not required to use its EHR software, but you must use the company's practice management system. This is because AdvancedMD's medical billers use the practice management software to submit and track claims. Practices can monitor the billing team's progress using the software just as they would monitor any in-house staff.

There are some additional benefits, though, with AdvancedMD's practice management solution. First, it has extensive reporting functions through the AdvancedInsight module. AdvancedInsight offers a complete view of your practice's financials. It also includes useful planning tools. Here's more about the features in AdvancedInsight:

• Practice benchmarking: Benchmarking is essential to understanding how your practice fits within the larger industry. AdvancedMD's benchmarking tool allows you to compare your numbers to other practices based on geographic region, specialty, or size to see how you stack up. Benchmarking shows you where your practice is performing strongly and where it needs improvement. When you outsource your medical billing, these insights help you see how the RCM team you've partnered with is delivering.
  
  
• Financial dashboard: AdvancedMD's financial dashboard brings your practice's most critical financial information to one central location. The data is displayed in charts and graphs, which can be filtered multiple ways to help you better understand your cash flow and the income sources.
  
  
• Data analytics: The data analytics tool takes the financial dashboard a step further – you can examine historical data and make projections to guide your business strategy. The tool shows recent trends in accounts receivable, practice productivity and reimbursements. You can also dig down into your referral network to see which relationships are paying off.

The tools in AdvancedInsight are easy to use, and you get on-screen advice that makes navigation easy when you're first learning the program. Overall, it adds a strong element of visibility into the effectiveness of your managed billing.

Key takeaway: AdvancedMD offers an integrated EMR system and practice management software that work effectively alongside its RCM services.

AdvancedMD Support

AdvancedMD offers a strong support system for practices that want to remain engaged with their billing operations even after outsourcing them to a third party. Even though the company doesn't perform charge entry and coding functions, it helps practices manage those tasks by providing thorough resources regarding the ICD-10 coding standards and how to abide by them.

Support is available through live and email. AdvancedMD provides how-to guides, tips and tricks articles, and webinars to help staff understand the ins and outs of the platform. Finally, there is a series of regulatory updates available on AdvancedMD's website.

Key takeaway: AdvancedMD offers support via email and live chat, as well as a series of self-guided learning materials. It also maintains a guide to ICD-10 standards.

Limitations

AdvancedMD's biggest limitation is that it does not manage charge entry or the coding of claims. These are important aspects of the medical billing process that require the expertise of certified coders. Certified coders represent a significant in-house cost, and many practices look to outsource this aspect of the medical billing process. Many of the other medical billing services we reviewed offer these services, so AdvancedMD is lacking in this regard.

Once claims are generated, AdvancedMD offers exceptional claims scrubbing services, and its medical billing team works to get your claims paid. Its high first-pass claims rate, competitive pricing, and comprehensive suite of software applications represent a significant value for large practices.

Key takeaway: AdvancedMD does not code claims on behalf of practices. Medical practices are responsible for claims generation and coding. 

Editor's note: Looking for a medical billing service for your practice? Fill out the below questionnaire to have our vendor partners contact you about your needs.