What to decide first
- Which services are included in the quoted price
- Whether pricing changes by volume, specialty, or payer mix
- Which setup, software, or project fees may apply
- How pricing aligns with accountability and performance
Pricing model comparison
Use this as a scope checklist before comparing quoted fees. It does not state current market rates.
Percentage
- Confirm included services
- Ask about old AR and denials
- Clarify refunds and write-offs
Flat or monthly
- Check volume assumptions
- Separate setup from recurring fees
- Ask what triggers a change
Hybrid or project
- Define project boundaries
- List excluded workflows
- Confirm reporting cadence
Percentage of Collections
Many billing companies charge a percentage of collections, especially for ongoing outsourced billing.
- Often aligns vendor compensation with collected revenue.
- Percentages can vary by specialty, complexity, and volume.
- Confirm whether patient collections, denials, and reporting are included.
- Ask how refunds, write-offs, and old AR are handled.
Flat or Hybrid Fees
Flat, per-claim, monthly, or hybrid fees may be used for specific workflows or predictable volumes.
- Useful for defined services like coding, credentialing, or AR projects.
- Can make budgeting easier when scope is stable.
- May not include every workflow unless stated in the agreement.
- Compare setup fees, minimums, add-ons, and cancellation terms.
Common Add-Ons And Exclusions
A quote can look competitive until excluded work appears later. Ask what is outside the base model before comparing vendors.
- Coding, coding review, credentialing, and prior authorization may be separate services.
- Old AR cleanup, denial projects, patient collections, and reporting may have separate fees.
- Some vendors may charge implementation, data migration, software, or minimum monthly fees.
- Ask whether pricing changes for high-complexity specialties, low volume, or unusual payer mix.
Small Practice Cost Checks
Small practices usually need to compare billing cost against staffing capacity, management time, software work, and the risk of slow follow-up. A vendor quote is easier to evaluate when the same scope is requested from each company.
- Ask whether the quoted price assumes a minimum monthly volume, a minimum fee, or a specific number of providers.
- Separate ongoing billing from setup, old AR cleanup, credentialing, coding review, patient statements, and denial projects.
- Confirm which EHR or practice management work is included and which work stays with your team.
- Use public pricing clues in provider profiles as a starting point, then verify current terms directly before signing.
Questions Before You Compare Quotes
Use the same questions with each vendor so pricing is comparable.
- What services are included in the quoted price?
- What fees are one-time versus recurring?
- How are refunds, write-offs, patient balances, and old AR treated?
- What happens to pricing if our volume, locations, providers, or scope changes?