By Bilscure Editorial Team · Published · Last reviewed
Key takeaways
- Four models cover most quotes: percentage of collections, flat fee, per claim and hybrid.
- A percentage ties the biller's income to yours. A flat fee gives you a fixed bill.
- Compare what each quote includes, not only the headline figure.
- Ask how collections are defined, and whether there are setup fees, minimums or long contracts.
The four ways companies price
A quote can use one of these or combine them.
- Percentage of collections. The company keeps a share of what it collects for you.
- Flat monthly fee. A fixed amount, often linked to provider count or expected volume.
- Per-claim fee. A set price for each claim sent.
- Hybrid. A smaller percentage plus a flat fee, or a flat fee plus charges for extras.
Prices vary a lot, and a bare number says little. What it covers is the real comparison.
Percentage of collections
The company is paid only when you are, so it has every reason to work denials. Your cost moves with your revenue, which suits a growing practice.
The trade-off is that the fee grows with collections. A practice with very high and steady collections may pay less under a flat fee. Bilscure billing starts at 2.9%* of collections, and the final rate is based on average monthly collections, number of providers and number of locations.
Flat monthly fee
A flat fee gives a predictable bill and suits steady, high-volume practices. The risk is that the biller earns the same whether or not claims are collected. Ask what reporting you will get and what happens if volume jumps.
Per-claim fee
Per-claim pricing is easy to understand. It can punish a practice with many low-value claims, and it may leave out denial work and follow-up. Ask whether resubmissions and appeals are charged separately.
Hybrid pricing
Hybrids try to balance the others. They can be fair, but they are the easiest to misread. Ask for a worked example of a typical month.
Questions to ask before signing
- What counts as collections, and is it measured before or after adjustments?
- Is there a setup, onboarding or software fee?
- What is included: denials, appeals, statements, credentialing?
- Is there a monthly minimum or a contract term?
- Will they sign a Business Associate Agreement? The HHS sample provisions show what one should cover.
- Who owns the data, and what happens to it if you leave?
- What reports will you see, and how often?
If a company will not answer these plainly, treat that as its answer.
Costs outside billing
Billing is one stage of the revenue cycle. Credentialing and a virtual front desk are normally priced separately. At Bilscure, credentialing is from $100 per payer plan and a virtual front desk agent is $1,750 per dedicated agent, so the cost is clear before you start.
When a percentage is the wrong fit
If collections are very high and stable, a flat fee may cost less. If volume is so low that a percentage will not cover the work, per-claim pricing may be fairer, and we will say so. If you only want billing software and plan to keep the work in-house, you do not need a billing service.
Comparing quotes fairly
Ask each company to price the same month using your real collections, providers and locations. Then compare the total, the inclusions and the exit terms. The HHS HIPAA guidance for covered entities explains what you are entitled to ask of any vendor that touches patient data. See our pricing page, read what medical billing services include, or request a free billing audit to see where revenue leaks before you choose. For background on the whole cycle, read revenue cycle management explained.
This article is general information, not legal or compliance advice. Payer rules and regulations change, so confirm current requirements with the payer or the governing agency.