Medical Billing Company Pricing Models Explained: Percentage, Flat Fee and Per Claim

The most common model charges a percentage of the money the billing company collects for you. If you are not paid, they are not paid, which aligns their incentives with yours.

The percentage varies with your specialty, claim volume and the complexity of your payers. Higher-volume practices often negotiate lower percentages. The main risk is unclear definitions: confirm whether the percentage applies to payments collected, to charges billed or to adjusted amounts, and whether patient payments are included.

Some companies charge a fixed monthly amount, regardless of collections. This makes budgeting simple and can be cost-effective for high-revenue practices.

However, the billing company is paid even when results are poor, so the incentive to chase difficult claims is weaker. Flat fees also tend to come with limits on claim volume or services.

Per-claim pricing charges a set amount for each claim submitted. It works for practices with predictable volume and simple claims.

The drawback is that it rewards volume, not results. If denials are reworked or follow-up is billed separately, costs can rise quickly.

Ask the company to confirm in writing whether any of these cost extra:

Two quotes are only comparable if the scope is identical. A low percentage that excludes denials and AR follow-up may cost more in practice than a higher percentage that includes everything. Build a simple table listing each service and mark whether it is included, extra or not offered.

Then project the cost on your actual collections. Multiply the percentage by your expected monthly collections, and add any extra fees. That gives you a true comparison.

The cheapest billing company is rarely the most profitable. A company that raises your clean claim rate, shortens days in A/R and recovers denied revenue can more than pay for itself, even at a higher price. Focus on net revenue after fees, not just the rate.

Suppose three companies quote for a practice collecting a fixed monthly amount. Company A charges a lower percentage but bills extra for appeals, statements and credentialing. Company B charges a slightly higher percentage that includes appeals and statements. Company C charges a flat monthly fee that caps volume and bills per claim above it.

Add each company's extras to its base fee using your realistic volumes, and the ranking often changes. The lowest headline rate is frequently not the lowest total cost. Always build a side-by-side table with identical assumptions.

Ask these before accepting a price:

Pricing is only meaningful when scope and results are clear. Remember:

A fair agreement is clear about services, fees, performance reporting, data ownership and termination. You can reasonably ask for a defined scope of work, a statement that you own your data, a short notice period and regular performance reviews. If a company resists these reasonable requests, consider it a signal.

At Qurexa RCM Solutions, we provide a clear, itemized quote for your practice based on specialty, volume and services. We explain exactly what is included, and we do not lock you into long-term contracts.

Contact us for a free, no-obligation quote. We will also review your current billing to estimate where recovered revenue could offset the cost of our service.