The usual arrangement. We are paid on what actually lands in your account, so our incentive and yours are the same. The rate depends on specialty, claim volume and payer mix.
Predictable when reimbursements are high and volume is steady. Best for practices that already have clean documentation and want throughput rather than cleanup.
For one-off work: old A/R cleanup, a coding audit, or credentialing a new provider. Scoped and quoted up front, with a defined deliverable and an end date.
Every engagement includes denial management, A/R follow-up and weekly reporting. Ranges are typical, not quotes; your quote follows the free billing audit.
The fee is a fixed percentage of net collections posted in the month, invoiced after the month closes. If we post $70,000 in payments in March at a 5 percent rate, the March invoice is $3,500. If collections drop to $50,000 in April because a provider was on leave, the invoice drops to $2,500. Nothing is billed on charges, on claims submitted or on claims still in accounts receivable, so there is no incentive to submit claims that will not pay and no fee for work that produced nothing.
The rate is set once at the start of the engagement from four inputs: monthly claim volume, specialty, payer mix and the condition of the existing accounts receivable. Higher volume lowers the rate because the fixed work of setup, reporting and payer calls is spread over more claims. Specialties with heavy prior authorization or global-period work sit higher because each claim takes longer to get paid. A payer mix weighted toward Medicaid managed care means more eligibility checks and more coordination-of-benefits denials, which also pushes the rate up. Old A/R is priced separately, because chasing claims that are already past timely filing is a project with an end, not part of the monthly cycle.
The percentage covers the whole cycle from eligibility to patient balance: eligibility and benefits checks before the visit, charge entry, coding review by AAPC or AHIMA certified coders, claim scrubbing and submission within 48 hours, clearinghouse fees, payment posting, denial management and appeals, A/R follow-up including payer calls, patient statements, credentialing maintenance and the weekly and monthly reporting. There is no separate software fee, because we work inside the practice management system you already own, and no per-statement or per-call charge.
Three things are not in the fee. Old A/R cleanup at the start of an engagement is quoted as a project, priced either hourly or on contingency. Initial credentialing of a brand-new provider with every payer is quoted per provider, since it is several months of application work that happens once. Coding audits beyond the routine review of E/M levels are quoted as a defined sample size with a written report.
One page. The top line is net collections posted for the month, broken out by payer payments and patient payments, less refunds and recoupments. The second line is the rate. The third is the fee. Below that is a short reconciliation: the posted total on the invoice ties to the payment posting report in your practice management system for the same period, so your bookkeeper can check it in a few minutes without calling us. If a payer recoups money in a later month, the recoupment reduces that month's collections and therefore that month's fee. There are no other lines, because there are no other charges.
A per-claim fee of $3 to $6 suits a practice whose claims are high-value and whose documentation is already clean, such as a surgical group that wants submission, posting and denial rework but handles its own front desk and authorizations. The fee is predictable and does not rise with reimbursement. It fits badly where volume is high and claim values are low, because the per-claim fee becomes a large share of a $60 office visit, and it fits badly where the existing process produces a lot of denials, because rework is where the time goes.
Project pricing fits work with a defined end: recovering A/R older than 120 days, credentialing two new physicians with twelve payers, or auditing 200 charts against what was billed. Each project is scoped in writing with a deliverable and a price before it starts, and old A/R projects can be priced on contingency so the fee comes out of what is recovered.
Most pricing pages describe the rate on day one and say nothing about year three. Ours works like this. The rate is fixed for the initial 90 days and stays fixed month to month afterwards; there is no annual escalator clause. If your practice changes in a way that moves one of the four inputs, adding a provider, dropping a payer, opening a second location, either side can ask for a rate review, and the review uses the same inputs as the original quote. In practice a growing practice sees its rate go down over time, because volume is the input that moves most. A practice that shrinks does not see the rate go up unless the mix changes as well, because the fee already fell with the collections.
Ask what the fee base is. "Percentage of collections" should mean net payments posted, not gross charges and not payments plus adjustments. Ask whether clearinghouse fees, patient statements and software are inside the percentage or billed on top, because a 4 percent fee with $1,200 a month in pass-through costs on $80,000 of collections is a 5.5 percent fee. Ask about monthly minimums, which turn a percentage into a flat fee in exactly the month you can least afford it. Ask what happens to your data and your practice management system logins if you leave. And ask how denials are worked: by reason code with a named owner, or as a queue sorted by dollar value. The second is cheaper to staff and it is why some low quotes stay low. Our article on medical billing cost for a small practice lists the published fee ranges so you can see where a quote sits.
The quote comes after the free billing audit, not before, because a rate set without seeing your denial rate, payer mix and aging is a guess in both directions. Send a month of remittances and an aging summary through the free billing audit form. Within five business days you get the written audit and a quote that names the rate, what it includes and the 90-day initial term.
Typical annual figures for a practice collecting about $800,000 a year. Your numbers will differ; the free audit replaces these with yours.
| Cost line | One in-house biller | DyBilling at 5% of collections |
|---|---|---|
| Salary or fee | $51,140 to $58,000 | $40,000 |
| Payroll taxes and benefits | $14,100 to $18,900 | Included |
| Billing software and clearinghouse | $2,500 to $12,000 | Included |
| Coding certification and training | $500 to $2,000 | Included |
| Coverage for vacation and sick days | Claims wait | Included |
| Cost when collections fall | Fixed | Falls with them |
| Denial follow-up and appeals | As time allows | Every denial within 5 business days |
| Total | $68,200 to $90,900 | $40,000 |
Salary starts at the Bureau of Labor Statistics median annual wage for medical records specialists (occupation 29-2072), $51,140 as of May 2025 (bls.gov/oes/current/oes292072.htm), and runs to a typical experienced-biller rate. Payroll taxes use the 7.65 percent employer share of Social Security and Medicare; benefits are 20 to 25 percent of salary. Software, clearinghouse and training figures are published small-practice vendor list prices. Fixed costs stay the same when collections drop; a percentage fee does not.
Claim volume, specialty complexity, payer mix and the state of your current documentation. A high-volume primary care practice with clean notes and mostly commercial payers sits at the bottom of the range. A surgical specialty with heavy prior authorization work and a backlog of old A/R sits higher.
No. Onboarding, system access, payer setup and the parallel run are included in the monthly fee. Old A/R cleanup can be quoted separately as a project if the backlog is large, and we tell you before starting whether that is worth doing.
Money actually received for the claims we work, from payers and from patients, less refunds and payer recoupments. Collections your own staff bring in independently, such as copays taken at the front desk, are not part of the fee base unless we are posting and reconciling them for you.
An initial term of 90 days so the parallel run and a full billing cycle can play out, then month to month with 30 days written notice. There is no early termination fee, no annual rate escalator and no auto-renewing multi-year term.
It was always in your practice management system. We hand back working notes, close our access, and return or destroy any copies as the Business Associate Agreement requires. Claims already in process are completed during the notice period.
A percentage fee scales with what you collect and includes software, clearinghouse fees and coverage for staff absence. An in-house biller is a fixed cost whether claims are paid or not. The comparison table above puts typical figures side by side, and our article on in-house versus outsourced billing cost walks through the full calculation.
