In the last quarter of 2023, the U.S. Department of Commerce Economic Development Administration (EDA) designated the Greater Philadelphia area in Pennsylvania a regional technological hub and innovation center. With increased calls for funding, the government announced job creation for young tech workers.
Such initiatives have propelled the state’s health IT sector into mainstream focus, and with Pennsylvania leading the health-tech degree programs and research, the mushroom growth of technologically-driven medical billing companies in Pennsylvania seems understandable.
According to the Bureau of Labor Statistics (BLS), Pennsylvania’s workforce of skilled medical billers and coders amounts to nearly 9,120 people. And in the coming decade, the job market is projected to grow by 8.7%. So, if you are thinking about when is the right time to outsource medical billing services for your healthcare practice, it is now!
We have shortlisted the top 10 medical billing companies in Pennsylvania to help you become a part of this robust health-technology partnership.
Top 10 Medical Billing Companies in Pennsylvania
Besides a heavily regulated healthcare industry, Pennsylvania has one of the highest medical claim denial rates, approximately 3.6% higher than the national average. In 2022, the Pennsylvania Insurance Department (PID) released a report. It stated that out of 14.9 million claims received that year, 2.02 million medical claims were denied, which takes the state’s overall medical claim denial rate to 13.6%.
Denials adversely affect a medical practice’s financial health, leading to revenue downturns and worse – foreclosures! However, all of this can be avoided if healthcare providers focus on rendering the best possible patient care and leave the non-clinical aspects of their practice in the hands of competent medical billing companies in Pennsylvania.
The following 10 best medical billing companies in Pennsylvania use advanced tools and software to streamline the medical billing workflow, file error-free insurance claims, mitigate bad debts, and optimize revenue cycles to ensure a healthcare practice’s slow and steady success.
1. MediBill MD
MediBill MD may not be physically based in Pennsylvania, but it is the most cost-effective vendor in the state’s healthcare billing space. Headquartered in Dallas, Texas, MediBill MD is a trusted revenue cycle management (RCM) company. Its suite of medical billing services includes patient eligibility verification, medical coding, superbill generation, claims submission, denial management, payment posting, and even practice management.
The company was formed in 2023 to elevate medical billing excellence while keeping the costs as low as possible. It recently announced a promotional flat 1% price rate for new clients for the first month of service. The average cost of outsourcing medical billing is between 4% and 10% of the monthly collections. So, by that standard, MediBill MD has successfully become the most affordable medical billing company in Pennsylvania.
Here are a few reasons why choosing MediBill MD as your trusted billing partner in Pennsylvania could work in your favor.
- Tailored medical billing solutions across 45+ specialties
- A team of AAPC-certified professional coders and billers
- HIPAA-compliant and ISO-certified services
- Innovative and tech-driven solutions
- 24/7 medical billing assistance
- 98% clean claims rate
- Less than 30 days in AR
2. Medwave Billing and Credentialing
Located in Cranberry Township in the Greater Pittsburgh Area, Medwave Billing and Credentialing is the most renowned company in our ‘Best Medical Billing Companies in Pennsylvania’ listicle.
The privately held firm was founded in 2000 and currently has a staff of between 11 and 50 people, proficient in delivering medical billing, credentialing, and payer contracting services. Medwave caters to the unique billing needs of 21 listed medical specialties, including skilled nursing facilities, sleep study labs, telestroke/teleneurology, and genetic testing.
Saying that Medwave utilizes innovative tools and advanced software would be an understatement. It boosts medical billing efficiency through flawless HL7 integration and robotic process automation (RPA). While its RPA systems automate repetitive and rule-based tasks, such as retrieving patient data from electronic health records (EHRs) and tracking claims status, the HL7 integration ensures seamless data exchange between varying interfaces.
Partnering with Medwave Billing and Credentialing will result in the following benefits:
- GoodFirms-approved service (4.89 out of 5-star rating)
- Future-proof, technologically-driven solutions
- Over 2 decades of medical billing experience
- HIPAA-compliant processes
- 21+ medical specialties served
- Instant cost savings
3. Philadelphia Medical Billing
Philadephia Medical Billing is situated in Horsham, Pennsylvania. Founded in 1983, it is one of the oldest medical billing companies in Pennsylvania and primarily serves solo and group medical practices in the Philadelphia metropolitan area. According to GoodFirm’s listings, the company has 10 to 49 employees, and its core services are accounts receivable (A/R) management, medical billing, and practice management.
Philadelphia Medical Billing ensures effective communication between patients, healthcare providers, and insurance payers to resolve claim disputes, expedite reimbursements, and prevent bad debts and service disruptions. It continuously upgrades computer software and hardware and invests in employee education programs to comply with regulatory changes and optimize revenue cycles.
The company is a certified member of the Healthcare Billing and Management Association (HBMA), uses HL7 interfaces to procure data from EHR and EMR systems, and has developed an encrypted FTP site for the safe and electronic transfer of data.
Outsourcing medical billing services to Philadephia Medical Billing can help you avail of the following benefits:
- Practice-focused solutions
- HIPAA-compliant claims filing
- Certified HBMA management
- Secure and efficient data transfers
- Cutting-edge IT solutions
- Maximized cash flow
4. Nextus Billing Solutions
Nextus Billing Solutions is leading the health-IT revolution in the state with groundbreaking technology. It is the only name in our ‘Top 10 Medical Billing Companies in Pennsylvania’ list that has developed its exclusive software, Cereus, to interpret years of data, forecast trends in insurance payments, and mitigate financial risks.
The company was founded in 2015 and maintains two head offices – one in Philadelphia, Pennsylvania, and another in Boca Raton, Florida. With a staff of between 51 and 200 people, Nextus has curated its medical billing and practice management services for behavioral health practices. Its full-service revenue cycle management solutions include verification of benefits, claims management, utilization review, credentialing, and payment negotiations.
With an astounding 99% first-pass acceptance rate, the company secured over $500 million in paid claims for its clients. Nextus’ leadership includes directors of billing, client services, clinical services, and business process improvement, who ensure data-driven compliance and business excellence for their trusted clients.
By partnering with Nextus Billing Solutions, you get:
- Concierge-level billing services for substance abuse treatment
- Comprehensive revenue cycle management services
- 99% first-pass claim approval rate
- Cereus-powered data analytics and reporting
- HIPAA-compliant solutions
- 5-star and user-recommended services
5. Medical Billing and Consulting Group LLC
If you are looking for another well-established medical billing company in Pennsylvania to partner with, then Medical Billing and Consulting Group LLC will not disappoint you. Established in 2003 and based in Jenkintown, Pennsylvania, Medical Billing and Consulting Group specializes in billing, scrubbing/submitting medical claims, insurance collections, and revenue optimization.
The company serves healthcare practices of all sizes in Eastern Pennsylvania, South Jersey, and Delaware. Apart from medical billing and financial reporting, Medical Billing and Consulting Group also handles patient billing and PPO contract management.
Some of the medical specialties that Medical Billing and Consulting Group are known to serve include dermatology, endocrinology, chiropractic, pain management, primary care, personal injury, neurology, and plastic surgery. You can contact the company via landline, fax, or email for pricing details or to schedule a free consultation.
We would recommend considering Medical Billing and Consulting Group for medical billing services because:
- It has a 4-star rating on Google reviews
- It is among the top 20 Pennsylvania medical billing companies on GoodFirms
- It can offer decades of experience in billing and RCM
- It provides multi-specialty medical billing solutions
- It ensures cloud-based practice management
- It guarantees regulatory compliance
6. AK Medical Billing Services
Founded by a husband and wife duo (Andrea and Kurt Tesche) in 2018, AK Medical Billing Services is a family-owned and operated medical billing company in Pennsylvania. The duo runs the company from their home in Leechburg, Pennsylvania.
After years of experience as a medical billing specialist, business development manager, and client service associate, Andrea decided to fill the market gap with modern, tailored, and tech-driven medical billing services. AK Medical Billing Services’ solutions include but are not limited to patient eligibility verification, claim submission, credentialing/re-credentialing, payment posting, patient payments, AR recovery, denial management, retrieving ERAs, and monthly mailing of patient statements.
Looking at their testimonials page, it seems that AK Medical Billing Services mostly serves psychiatric, behavioral health, and mental health practices in the Greater Pittsburgh area, as most of the clients seem to offer counseling and therapies. Nonetheless, we recommend opting for this medical billing company in Pennsylvania for the following reasons:
- Flawless 5-star Google rating
- Listed as one of the top 20 medical billing companies in Pennsylvania on GoodFirms
- Competitive pricing
- Quick turnaround
- Maximized collections
- Personalized solutions
7. Schmidt Medical Billing LLC
Schmidt Medical Billing LLC is another home-based medical billing company in Pennsylvania. Nancy Schmidt, owner of Schmidt Medical Billing, manages the company from her home in Pittsburgh, Pennsylvania. According to the company’s Better Business Bureau (BBB) profile, she started the business in 2002, offering full-stack medical billing services to private solo and group practices.
Some services listed on the company website include secondary and tertiary claims submission, EHR software integration, patient payment tracking, monthly practice analysis and reporting, denial follow-up, and credentialing. The company can handle medical billing for various medical specialties, such as behavioral health, family practice, geriatric medicine, pediatrics, and OB/GYN.
Besides serving healthcare practices in Pittsburgh, PA, Schmidt Medical Billing offers timely billing assistance to providers in Phoenix, AZ, Dayton, OH, and all over, as is evident by the testimonials. The company achieves this through its remote and virtual setup. If interested, you may contact its representatives on call or email and request a free quote.
Reasons for choosing Schmidt Medical Billing LLC include:
- 5-star Google and A+ BBB ratings
- 30+ years of industry experience
- Medical billing and coding expertise
- Proven RCM solutions for 13+ specialties
- Dedicated medical billing representative for each client
- Among the top 20 Pennsylvania medical billing companies on GoodFirms
8. Medical Billing Professionals
Breaking free from the ‘percentage of gross collections’ pricing model, Medical Billing Professionals is the only contender in our ‘Top-rated Medical Billing Companies in Pennsylvania’ listicle that uses the ‘cost per claim’ price structure. By partnering with Medical Billing Professionals, you can file error-free claims for as low as $1.75 per claim.
Now, a little about the Medical Billing Professionals. The company is based in Royersford, Pennsylvania, and owned by Steven Zats. It was founded in 1995 to provide the most affordable medical billing services to chiropractors and mental health professionals nationwide.
You can choose between Premium Medical Billing Service (starting at $1.75 or $2.45 per claim), PremiumPlus Medical Billing Service (starting at $2.19 per claim), or Platinum Medical Billing Service (starting at $3.35 per claim) to choose the services that best meet your practice’s needs.
By choosing Medical Billing Professionals, you will unlock the following perks:
- 2 months of free service and no setup fee
- On-demand webinars and virtual meet-and-greets
- Affordable and accurate medical billing and coding
- Weekly AR reports and monthly financial reports
- A 60-day money-back guarantee
9. Alpha Billing Solutions, LLC
Based in the Pittsburgh area, Alpha Billing Solutions is another top medical billing company in Pennslyvania. The company has offered medical billing services to mental healthcare providers for over 16 years. During this time, it leveraged several billing software to make the processes more efficient and ensure HIPAA compliance.
According to the web results, Erin Nowakowski is the founder and CEO of Alpha Billing Solutions and employs between 2 and 10 people. The company primarily provides medical billing, credentialing, and consulting services to mental health experts for quick and accurate reimbursements and financial stability.
Unlike other prominent medical billing companies in Pennsylvania, Alpha Billing Solutions is transparent about its pricing. It is clearly stated on the website that the company charges $190 per insurance payer for getting a provider credentialed. Similarly, the consulting fee is $60 per hour, and the initial registration fee for solo practices is $200 and $300 for group practices, after which a small percentage of monthly income will be charged.
Reasons for choosing Alpha Billing Solutions are stated below:
- Provides full-stack medical billing services
- 5-star rating and verified reviews
- Decades of experience in medical billing and practice management
- Free client intake screening and 30-minute consultation
- Transparent pricing
- A dedicated account manager
10. TJ Billing
TJ Billing is a woman-owned chiropractic, physical therapy, and podiatry medical billing company in Pennslyvania. With its headquarters in Lafayette Hill, Pennsylvania, TJ Billing has offered outsourced medical billing solutions for over 15 years. Its small yet dedicated team of certified professional coders and billing specialists have inside knowledge of the three medical specialties (most being chiropractors themselves) and utilize industry best practices to resolve billing disputes and maximize reimbursements.
The home-based company’s multi-specialty medical billing services are not limited to Pennsylvania. TJ Billing leverages remote operability to provide billing expertise in “several states”, increasing the bottom line of chiropractic, physical therapy, and podiatry practices of all sizes. The company uses cloud-based systems, practice management software, and medical billing tools to file accurate and complete claims. Moreover, its services are in line with the latest industry guidelines, payer policies, and federal/state laws.
You may consider outsourcing medical billing to TJ Billing for the following reasons:
- Specialty-focused billing solutions
- 5-star rating and reviews
- HIPAA-complaint operations
- Technologically advanced systems
- Clearing house enrollments
- Comprehensive financial assessments
Comparing the Best Medical Billing Companies in Pennsylvania
So, now that you are aware of the top 10 medical billing companies in Pennsylvania, how will you choose the one that works best for your healthcare practice? The answer is not simple yet logical. You must analyze and evaluate each medical billing company on our list based on the metrics stated below.
Billing Expertise in Your Specialty
There is no point in partnering with a medical billing company in Pennsylvania if it does not cater to the billing needs of your medical specialty. For example, approaching Alpha Billing Solutions, LLC will be futile if you own a private orthopedic practice and are in need of reliable orthopedic billing services. This is because Alpha Billing Solutions specializes in mental health billing and may not have the expertise to handle your claims.
Service Fee that Suits Your Budget
Whether you are a small private practice or a large managed healthcare organization, opt for a medical billing company that offers services within your budget. Most medical billing companies in Pennsylvania will charge between 4% and 10% of your net collections. However, some, like MediBill MD, can get the work done at half the rates without compromising quality.
Verified Reviews and Testimonials
Hear what verified clients have to say about the company you are targeting. You can always check the company’s reviews and ratings online on platforms like Google Reviews, GoodFirms, Trustpilot, etc. It will give you an insight into whether or not the company holds true to its promises.
Effective and Timely Communication
Lastly, before getting on board, making payments, or signing contracts, request a free demo, consultation, or audit with the chosen medical billing company in Pennsylvania. It will help you gauge the company’s customer service and give you an idea of how effectively they manage communication.
We hope these guidelines will help you select the best medical billing company in Pennsylvania for optimized revenue in the 2024 fiscal year.
