Medical billing companies usually charge in one of four ways: a percentage of collections, a fee per claim, a flat monthly fee, or a hybrid. The right model depends on your claim volume, specialty and how much follow-up work you expect, and the quoted rate means little until you know exactly what it covers.
The four common models
| Model | How it works | Best suited to | Watch for |
|---|---|---|---|
| Percentage of collections | Fee is a share of payments actually collected | Practices that want the vendor’s income tied to results | Whether the percentage applies to patient payments, and how write-offs are treated |
| Per claim | Fixed fee for each claim submitted | Predictable, steady volumes | Whether resubmissions and appeals are charged again |
| Flat monthly fee | Set fee for an agreed scope | Stable practices that value budget certainty | Volume caps and extra charges above them |
| Hybrid | Base fee plus a smaller percentage or per-service charges | Complex scopes such as coding, credentialing and A/R recovery | Clear definitions for each component |
What should be included in the quote
- Charge entry, claim submission and payment posting.
- Denial management and appeals, and the time limits for working them.
- Patient statements and collections follow-up.
- Reporting: which KPIs, how often, and who reviews them with you.
- Onboarding, software, clearinghouse and any one-time setup fees.
- Contract term, notice period, data ownership and exit assistance.
How to compare quotes fairly
- Write down your annual claim volume, payer mix and average reimbursement.
- Ask every vendor to quote the same scope in writing.
- Convert each quote into an estimated annual cost, including fees that sit outside the headline rate.
- Compare against your current fully loaded in-house cost; see in-house vs outsourced billing.
- Check references and the exit terms before comparing price alone.
QWay Healthcare scopes pricing to the services you need, from medical coding to denial management. Request a quote for a written, line-by-line scope.
Frequently Asked Questions
Is a lower percentage always cheaper?
No. A lower headline percentage can be offset by add-on fees, narrower scope or slower follow-up. Compare the total annual cost for the same scope.
Can pricing change when I add providers or specialties?
It can. Ask how new providers, locations and specialties are priced before you sign, and get the answer in the contract.