Understanding how medical billing companies charge is one of the first steps to deciding whether to outsource. Pricing varies by service level, specialty, claim volume, and the provider’s goals. Below you’ll find the most common pricing models, typical ranges, factors that affect cost, and tips to choose the right billing partner.
Common Pricing Models
1. Percentage of Collections (Most Common)
How it works: The billing company takes a fixed percentage of the money it successfully collects for you.
Typical range: 4% – 10% of net collections for general practices; specialty practices may pay 6% – 12%.
Best for: Practices that prefer pay-for-performance and want low upfront fees.
Pros: Aligns incentives; you pay only when revenue is collected.
Cons: Can be more expensive if your practice has high reimbursements; transparency on collections is crucial.
2. Per-Claim Fee
How it works: You pay a set fee for each claim submitted (accepted or denied).
Typical range: $0.50 – $5.00 per claim (depends on complexity and specialty).
Best for: Practices with predictable claim volumes and simpler billing needs.
Pros: Predictable billing per transaction.
Cons: Denials still cost you; not ideal if you have many corrections/resubmissions.
3. Flat Monthly Fee
How it works: A fixed monthly price for a bundle of services (claims, follow-up, reporting).
Typical range: $500 – $5,000+ per month depending on practice size and included services.
Best for: Larger practices wanting predictable expenses or fully managed RCM (Revenue Cycle Management).
Pros: Budgetable, often includes full-service options.
Cons: May include services you don’t need; quality varies by provider.
4. Hourly Rates
How it works: Billing specialists or consultants are billed by the hour for specific tasks.
Typical range: $25 – $100+ per hour (based on skill level and location).
Best for: Short-term projects, audits, or partial outsourcing.
Pros: Flexible for targeted help.
Cons: Costs can add up; not ideal for ongoing billing work.
5. Hybrid / Performance + Base Fee
How it works: Lower percentage of collections + a small monthly base fee or per-claim minimum.
Typical range: Base fee $200–$1,000/mo + 2%–6% of collections.
Best for: Practices wanting incentive alignment but with baseline cost coverage for the billing company.
Pros: Balanced risk for both parties.
Cons: Requires clear contract terms and metrics.
What Influences Pricing?
- Specialty: Cardiology, orthopedics, and specialties with complex coding charge more than primary care or behavioral health.
- Volume: High-volume practices often get discounted percentage or per-claim rates.
- Claim Complexity: Inpatient, surgical, and multi-procedure claims increase time and cost.
- A/R Age & Denials: If you have a large backlog or high denial rates, set-up fees or more aggressive follow-up costs may apply.
- Technology & Integrations: EHR/PM integration, credentialing, and custom reporting can increase pricing.
- Geography & Compliance: State-specific rules, licensing requirements, and payer mixes affect cost.
Extra/Optional Fees to Watch For
- Onboarding/setup fee (one-time): $250 – $5,000 (depending on backlog and integrations).
- AR cleanup or legacy claims handling: billed separately or as a larger one-time package.
- Credentialing / contracting fees: sometimes included but often charged separately.
- Monthly reporting or custom dashboard fees.
- Charge entry or eligibility verification (may be extra if not included).
How to Compare Offers (Practical Checklist)
- Ask for a sample contract — check minimum terms, termination clauses, and performance guarantees.
- Request real KPIs — average days in A/R, first-pass acceptance rate, denial rate, and net collection rate.
- Clarify what “collections” mean — gross vs. net collections, refunds, and adjustments.
- Check onboarding costs — does the price include clean-up of old claims?
- Confirm reporting frequency and access — do you get real-time dashboards?
- Ask about references & specialty experience.
Pros & Cons of Paying Percentage vs Fixed Fee
Percentage model aligns the vendor with your success but can be costlier if revenues rise.
Fixed-fee model is predictable but may reduce vendor motivation to maximize reimbursements unless KPIs/bonuses are included.
Quick Examples (Illustrative)
Small primary care clinic: may pay 4%–6% of collections or $800–$1,500/mo flat.
Multi-provider specialty clinic: might pay 6%–10% of collections or $2,500–$7,000/mo flat, depending on services.
Low-volume solo practitioner: per-claim pricing ($1–$3/claim) or small monthly fee may be better.
Final Tips
- Negotiate a trial period or short-term contract to evaluate results.
- Include service-level agreements (SLAs) for claim follow-up and denial appeals.
- Choose transparency: your billing partner should provide clear invoices and easy-to-read reporting.
Bttom Line
Choosing the right pricing model depends on your practice size, specialty, and tolerance for variable vs fixed costs. If you want a trusted partner who delivers transparent pricing, strong KPIs, and full-service medical billing across the USA, contact OrinSols today. Our experts will evaluate your needs and recommend a cost structure that maximizes revenue and reduces administrative burden.
+1 816-310-4080 | info@orinsols.com | orinsols.com