CareCloud Medical Billing Review

Why CareCloud Is Best for Flexible Medical Billing

CareCloud is a medical billing service that can manage part or all of your revenue cycle. You can also opt in to CareCloud’s medical software and consulting services when you hire the company for revenue cycle management. Even better, CareCloud is unlike most medical billing services in that, as of its 2020 acquisition by MTBC, it doesn’t require its RCM clients to use its PM software. This PM-agnostic structure is exceedingly rare among medical billing services. These are the main reasons we’ve named CareCloud our top pick for flexible medical billing.

CareCloud Usability

If you use CareCloud’s electronic medical record (EMR) system or PM software alongside the company’s medical billing services, you’re likely to have a user-friendly experience. In previous years, when we were granted access to test the company’s software, we found it quite intuitive and user-friendly. All key features were within quick reach.

Providers can use talkEHR, an easy virtual visit solution, without requiring patients to download an app. Source: CareCloud

We were especially impressed with the extent of customization options, both on a practice-wide level and for individual users. This customization goes hand in hand with CareCloud’s flexible medical billing services. As you get started with CareCloud’s medical software, dedicated training is available as well, though at a steep setup cost. Other RCM services charge no such fees.

Because CareCloud doesn’t require you to use its PM software, CareCloud’s medical billing usability may depend primarily on your choice of EMR vendor. Our top pick for the easiest-to-use EMR and PM is Tebra. Read our Tebra medical software review to find out why.

CareCloud Features

CareCloud offers a comprehensive suite of RCM solutions designed to streamline administrative tasks, enhance billing efficiency and maximize reimbursements for healthcare providers. Below is an overview of key features that make CareCloud a trusted partner in medical billing.

Account Management Team

All CareCloud RCM clients get quick access to the company’s dedicated account management team to ask any questions and hear back almost instantly. CareCloud’s ethos is that no question is too small or too big, so you should feel free to fire away. This sort of hands-on customer service is par for the course with medical billing, but it’s especially important if you’re looking for the sort of flexible solutions CareCloud offers.

Benefits Verification and Prior Authorization

Before any patient encounters, CareCloud verifies that the patient’s insurance covers any medical procedures you expect to perform. CareCloud will also obtain prior payer authorization as necessary so you can be properly reimbursed for nonemergency procedures. This service is available by phone, fax and email. We like that variety because not all RCM providers work with all of these communication channels.

Credentialing

CareCloud can get your practice set up with government payers, commercial payers and managed care plans. It can also do all the legwork to secure your quarterly re-attestations for the Council for Affordable Quality Healthcare (CAQH). CareCloud is one of the few medical billing services we reviewed that offer this level of credentialing support.

Charge Entry and Coding

Billing starts with charge entry and coding, but not all medical billing companies offer these services. We like that CareCloud does offer charge entry and coding, further adding to its flexibility as a revenue cycle management provider.

If you want to outsource just the very start of your medical billing process, you can do that with CareCloud. That’s not quite the case with other providers, such as AdvancedMD, which doesn’t offer charge entry or coding. However, we do highly recommend AdvancedMD for large-practice medical billing. Read our AdvancedMD medical billing review to see why.

Claims Management and Submission

CareCloud quickly sends over 50,000 claims a day to payers. Before that, the company scrubs your claims for accuracy to minimize your chances of denials or rejections. These features are standard with revenue cycle management, and we like that CareCloud offers them with a 98.2 percent first-time pass rate. This is yet another way CareCloud can empower you to hand off as many parts of the billing process as you’d like.

The claims scrubber uses CareCloud’s CollectiveIQ rules engine to check your claims for potential denials or rejections. Source: CareCloud

EMR/PM Flexibility

Unlike nearly all other RCM providers, CareCloud doesn’t require you to use its PM software; you can use any other vendor’s PM while CareCloud oversees part or all of your revenue cycle. The flexibility to choose between CareCloud’s PM or another vendor’s platform is a standout feature that we were quite happy to see.

CareCloud’s PM software includes this color-coded scheduler that you can sort by location, provider, machinery, exam room and more. Source: CareCloud

Similarly, CareCloud doesn’t require you to implement its electronic health records (EHR) system to use its RCM services, though you can if you’d like. Admittedly, EHR-binding provisions are relatively rare among medical billing services. However, we still highly recommend DrChrono, especially for new practices. Read our DrChrono medical billing review to learn why.

Out-of-Network Billing

Working with out-of-network payers to get your reimbursements is a drain and a hassle. To offload your challenging medical billing tasks, CareCloud handles the entire process for you. From sending claims to posting and negotiating payment amounts, CareCloud covers you from start to finish when your patients use out-of-network insurers.

Patient Call Center

Your front-office staff is presumably busy scheduling patients and handling check-in. That means your staff might not always have the time to walk customers through their billing and payment questions. CareCloud handles this for you, adding to its flexibility. You can use CareCloud’s RCM services as your personal billing hotline to answer any patient billing questions. CareCloud can also collect payments from your patients over the phone, further assisting in payment flexibility.

Patient Statements

The more time your front-office staff can spend with your patients, the more your patients typically enjoy the experience of visiting your practice. Having to print and mail patient statements takes your front-office staff away from patients, thus lessening their interaction time. CareCloud will print and mail your patient statements instead. Notably, the company isn’t quite clear on whether it can email statements to patients, but we’re still impressed with this feature.

Payer Contract Negotiation

Another standout CareCloud feature is that it can negotiate your contracts with existing payers. CareCloud’s team will recommend appropriate fees for scheduling and reimbursement terms while tracking the negotiation progress. This feature is rare and another way CareCloud adds flexibility. With CareCloud, you can manage the amounts of money your practice can earn from payers. This was one of the features that impressed us the most.

Payer Follow-Up

As is par for the course with medical billing services, CareCloud follows up with payers that owe your practice money. This follow-up can take two forms. First, if payers deny your claims, CareCloud will follow up to find out why. Second, if approved claims go unpaid, CareCloud will keep following up until you get paid. Although these features are standard for medical billing services, we like that CareCloud won’t rest until you get the money you deserve.

Robust Consulting and Reporting

Alongside your revenue cycle management, you can add CareCloud consulting and reporting services. CareCloud’s professional consultants can keep you aware of industry changes so your practice remains ahead of potentially revenue-boosting shifts. The consulting team can also keep you compliant with regulations such as ICD-10, MACRA and MIPS.

You can also use CareCloud to obtain reports and analytics that keep your RCM accountable and efficient and ensure that your data is accurate. Although many other RCM services offer reporting and consulting, we like that CareCloud’s approach is comprehensive, covering both your practice and the world beyond it.

In the CareCloud reporting suite, you can see the trends that are shaping your patients’ healthcare and wellness. Source: CareCloud

cirrusAI

Through CareCloud, you have the option to use cirrusAI, the company’s generative artificial intelligence (AI) service. cirrusAI offers four products: cirrusAI Appeals, cirrusAI Chat, cirrusAI Notes and cirrusAI Guide. 

We like how cirrusAI Appeals analyzes patient claim details, the appeal’s reason and the specific payer involved, and then creates personalized appeal letters for healthcare workers to send. cirrusAI Chat is an AI-powered chatbot that streamlines training, reduces response wait times and helps navigate EHR workflows. CareCloud says cirrusAI Notes saves 20 percent of your time each day by generating clinical documentation and supporting multiple languages. Lastly, cirrusAI Guide automates clinical data input, assists workflow tasks, and provides real-time and evidence-based recommendations as clinical decision support.

CareCloud Cost

Like many medical billing companies, CareCloud doesn’t list its prices on its website. However, we previously spoke with company representatives, who gave us some insight. In previous years we’ve reported on medical billing services, CareCloud reps told us that the company keeps a percentage of your monthly collections as payment for its RCM services. This model is standard for outsourced medical billing.

CareCloud’s monthly collections fees range from 3 to 7 percent, which is competitive on the low end and standard on the high end. CareCloud can calculate your rate based on the same factors as other RCM providers. These factors may include billing complexity, average claim value, average claim volume, practice specialty and practice size. As with most RCM providers, a free CareCloud trial is not available, although you can request a free demo to see the ins and outs of how CareCloud can help your company.

There’s a one-time implementation fee associated with starting your CareCloud RCM subscription. CareCloud charges a flat fee of approximately $1,000 to set up its EMR and PM software. It is unclear if this rate applies to the RCM setup too and how the parts of the EMR and PM process you outsource to CareCloud affect your monthly costs.

We also previously reported that CareCloud may require you to sign a three-year contract (though a one-year contract might be offered). We were unable to determine whether these contract terms have changed. Assuming they remain true, this part of CareCloud’s cost structure is among its drawbacks. If you wind up unhappy with CareCloud’s services, you can’t easily back out of your arrangement — and that’s the opposite of flexibility.

CareCloud Setup

On the EMR and PM side, CareCloud previously told us that customers often need 90 days to fully set up the system. However, the company’s website states 60 to 80 days. CareCloud also told us that customers can receive hands-on EMR and PM training for the proprietary CareCloud platform. For clients that use a different platform, CareCloud will need access to the medical practice management software to conduct billing transparently. The setup fee of at least $1,000 per office also may apply. This is a major drawback of CareCloud, as many other medical billing vendors don’t charge setup fees.

CareCloud Customer Service

CareCloud prides itself on keeping its medical billing account management team accessible via phone, email and live chat at no extra cost. The hours of operation for CareCloud’s customer service phone line are from 8 a.m. to 9 p.m. ET. 

When we reached out to CareCloud via all of its channels, we were pleased to hear back quickly with detailed, helpful responses to our questions. The overall experience was roughly standard for the medical billing services we reviewed.

CareCloud Drawbacks

CareCloud’s most obvious drawback is its high setup costs. It may cost around $1,000 to get started with the company, whereas many other medical billing services don’t charge at all for setup.

Additionally, we were disappointed that CareCloud binds its customers to long-term contracts. This provision goes against CareCloud’s flexible RCM model and is perhaps the only strict limitation of the company’s medical billing services. If this condition is a dealbreaker and you’re looking for another consultation-heavy medical billing partner, read our athenahealth review. At no point in our research on athenahealth did we encounter rigid contracts.

Methodology

We spent hours researching medical billing services and maintained contact with medical billing vendor representatives, who sat us down for guided demonstrations. Beyond that, we reached out to the companies’ customer service teams to test their support options, and we also read customer reviews, such as those on the Better Business Bureau website. We supplemented this research with everything available on the companies’ websites.

When looking for our best pick for flexibility, we considered how well the medical billing services we reviewed could cover a practice’s revenue cycle. We also considered the services that practices could add or subtract from their list. Because CareCloud can manage your revenue cycle end to end and you can pick from its offerings, we’ve named it our top pick for flexibility.

Overall Value

We recommend CareCloud for …

• Practices that are looking to outsource some or all of their medical billing processes.
• Practices that need extra assistance in negotiating payer contracts.
• Practices that are already dedicated to another vendor’s EMR and/or PM software.

We don’t recommend CareCloud for …

• Practices that are looking to avoid costly setup fees.
• Practices that want flexible contracts.