Outsourced Medical Billing Services: From 5.0%, $0 Setup

When to outsource medical billing

Practices hand off their medical billing when claims stop moving. Five moments signal it is time:

• Your biller quit or went on leave. Unbilled visits run against each payer's filing limit, and a late claim is usually a total loss: a Medicare timely-filing finding is not subject to appeal, and Cigna's contract prohibits balance billing your patient on those denials.
• Denials sit unworked. Nobody reads remittances line by line.
• A/R keeps aging. Claims past 90 days when you start go to our aged A/R recovery service, priced separately.
• Your billing company stopped answering. You cannot see what was submitted, paid or still open.
• You are adding clinicians. New providers need payer enrollment before their claims pay.

So we work the claims closest to a deadline first. To see where your unpaid claims stand, request The Free A/R Deadline Map; it needs your claim-level aging export and a signed BAA. Weighing a hire instead? Our guide to hiring a biller or outsourcing compares both on cost and risk. Biller just left? See the first-week checklist.

Outsourced medical billing services: what we take over and what you keep

Outsourced medical billing services move every step between a signed-off encounter and a closed balance to our team, while you keep the clinical and financial decisions. Our medical billing and coding services run as one: every claim gets a coding check against the clinician’s note before release.

What stays with your practice?

Your clinicians keep the documentation and the final say on every code. We check every code against your clinician's documentation and never change a code without the clinician's sign-off. The physician carries the risk, because HHS-OIG's guidance for physician practices says it is no defense for the physician if the physician’s billing service improperly bills Medicare. Your practice also keeps write-off approval, its financial policy, front-desk copay collection and every login.

Where practices lose billing revenue, and what we do about it

Billing revenue leaks at six points between the visit and the deposit; here is what our service does at each one.

• Charges that wait. A visit never billed is never paid. New claims go out within 1 business day of complete charge data.
• Rejections nobody resends. A rejection never enters adjudication. We fix and resend every rejection and log it in your system.
• Denials left in the remittance. Each denial has its own appeal window. We work every denial within 2 business days of posting and send the root cause to whoever can fix it.
• Underpaid lines that post as paid. The electronic remittance advice reports the reason for each adjustment, and the value of each adjustment. We post every line with its adjustment reason. The Complete RCM tier adds a monthly underpayment check.
• Paper claims. Medicare's payment waiting periods are 13 days for electronic claims and 26 days for paper claims. We file electronically.
• Authorizations that run out. We keep a list of authorizations close to their visit or date limit, updated as visits post.

Denials and old balances have their own pages: how we work denials and insurance A/R follow-up.

Read the workflow as text

1. Agreement and BAA — Service agreement and business associate agreement signed before any data access. Owner: Practice + our team.
2. Near-deadline claims first — Inherited claims closest to a filing or appeal deadline are worked first. Owner: Our billing team.
3. Go-live — First new claims go out from your system and clearinghouse. Owner: Our billing team.
4. Daily claim cycle — Claims checked and sent; rejections fixed; remittances posted line by line. Owner: Our billing team.
5. Denials and follow-up — Denials corrected or appealed; unpaid claims worked in deadline order. Owner: Our billing team.
6. Monthly KPI report — Formulas, open items and next actions, by the 10th of each month. Owner: You review.

How we start, whether you bill in-house or switch from another company

1. Agreement and BAA. Billing is on HHS's list of business-associate work (claims processing or administration, data analysis, billing, and practice management), so the business associate agreement is signed before any login reaches us.
2. Access and kickoff. We work from logins to your practice-management system and clearinghouse, so every claim and denial note stays in your system.
3. The One-Week Deadline Sweep for Specialty Practices. Every inherited claim within 30 days of a filing, corrected-claim or appeal deadline is worked within 5 business days of access. Starts at access; covers up to 250 claims (more gets a day-1 deadline schedule); worked means submitted, corrected, appealed or returned with the fix.
4. First claims out. Go-live, when your first claims go out, comes within 5 business days of access; any unbilled backlog follows within 10 business days of access. Clock starts with your signed agreement, signed BAA and working system logins; it extends day for day while we wait on access.

Switching from another billing company? Our switching guide lists what to collect from the outgoing company, and our system access page shows what to have ready.

What do we need from your practice?

Sign the service agreement and BAA, give us logins to your practice-management system and clearinghouse, join one 45-minute kickoff call, sign off encounters so charges are complete, and answer our documentation questions within 5 business days.

What our outsourced medical billing costs

Our outsourced medical billing costs 5.0% to 8.5% of insurance payments, set by your specialty segment and practice size, with 0% of patient payments and $0 setup.

Example: 3 therapists with $30,000 of insurance payments in a month pay 7.5%, or $2,250. That month's cap would be $2,700. Invoices 1–3: only percentage fees on that month's insurance payments, plus any statements or add-ons you order. Percentage fees and mailed statements are capped at 9.0% of that month's insurance payments; from invoice 4, the $400 minimum applies even in a month when the cap comes to less.

The Complete RCM tier, 9.0% of insurance payments, adds aged A/R, credentialing and prior authorizations; see our RCM services or the full rate card. Market rates are compared in our medical billing cost guide.

Why do your payments never pass through us?

Your payments stay in your account because HHS-OIG's physician guidance says a percentage-based billing service cannot directly receive the payment of Medicare funds into a bank account that it solely controls. Every payment goes straight to your practice's own bank account. We never receive, deposit or endorse your payments; we invoice you once a month. Claims go out under your name and tax ID. Check where payer payments land with any company you compare.

What we report to you every month

By the 10th of each month you get a KPI report listing open items and next actions, with each measure defined in writing so you can recompute it from your own system:

• Clean claim rate: the share of claims the payer adjudicated on first submission.
• Rejections and denials, counted apart: a rejection is fixed and resent; a denial is corrected, reconsidered or appealed.
• A/R days: total accounts receivable ÷ average daily charges.
• Aged A/R: balances older than 90 days, as a share of total A/R.
• Net collection rate: payments ÷ (charges − contractual adjustments), on a closed group of dates of service.

Compare any report with what a monthly billing report should show. We publish client results only with written permission. Until we have them, judge us by the guarantees and the free Deadline Map.

Which practices and specialties we bill for

We bill five specialty segments, each on the rate card above, and check each claim where that specialty's claims go wrong:

• Mental & behavioral health: we bill each psychotherapy session by the time documented in the note (mental health billing services).
• ABA therapy: we track every client's billed units against each payer's authorization (ABA billing services).
• PT, OT, speech & chiropractic: we bill timed services in units counted from the minutes documented (physical therapy billing services).
• Primary care, pediatrics & urgent care: we bill each visit at the level the signed note supports (primary care billing services).
• Specialist physician groups: from cardiology billing to orthopedics, we bill each procedure with its report on file.

16+ clinicians, or anesthesia, radiology, DME, lab and home health: written quote within 1 business day, same fee base, cap and terms. Every specialty is listed on our specialty billing pages, and every service in our billing services directory.

Our contract terms and guarantees

No billing company can make a payer approve a claim; the payer decides. What we guarantee, in writing, is a payment when a deadline is missed on our watch and a credit when we miss our claim or denial clock. The table puts each guarantee beside its full terms, then every other term, one row each.

To test any billing contract, ours included, use the contract checklist for billing companies. To see your open claims before you decide, request The Free A/R Deadline Map; it needs your claim-level aging export and a signed BAA.

Common questions

How much does it cost to outsource medical billing services?

Outsourcing your medical billing to us costs 5.0% to 8.5% of insurance payments, set by specialty and practice size, with 0% of patient payments and $0 setup. Every band is on the rate card.

What do your outsourced medical billing services include?

Claim scrubbing and submission, payment posting, denial work and appeals, insurance A/R follow-up, eligibility checks, authorization tracking, coding checks against your documentation, patient statements and the monthly KPI report, all inside your own system under a business associate agreement. The table of what we take over shows what you keep.

Is there a long-term contract or a termination fee?

No. Month to month. Leave with 30 days' written notice. No termination fee. Run-out and handover terms are in the Clean-Exit Terms row of our terms table.

How soon do claims go out after we start, and when does money arrive?

Go-live, when your first claims go out, comes within 5 business days of access; any unbilled backlog follows within 10 business days of access. Clock starts with your signed agreement, signed BAA and working system logins; it extends day for day while we wait on access. Payment timing after that is set by each payer.

Does your outsourced medical billing include coding?

Yes. We check every code against your clinician's documentation and never change a code without the clinician's sign-off. Coding is not sold apart from billing; our medical coding service page shows how each check works.

Which practice-management systems and EHRs do you work in?

We work inside your existing practice-management system and clearinghouse; tell us which ones and we confirm in writing within 1 business day. Our EHR and practice-management compatibility page lists the logins we need to start.

Do you take a percentage of copays or receive our insurance money?

No to both. We take 0% of patient payments and copays. Every payment goes straight to your practice's own bank account. We never receive, deposit or endorse your payments; we invoice you once a month.

What happens to claims our last biller left behind when we switch?

When you switch to ClaimPillar, claims under 90 days past the date of service are billed at your plan rate. Older claims go to A/R Recovery: 15% of the insurance payments that post after we work them, $0 if a claim never pays, inside your monthly fee cap. Deadline Claims at Your Plan Rate: Inherited claims within 30 days of a deadline when you start are worked at your plan rate, not the 15% A/R Recovery rate. The guide to switching billing companies covers the handover.