Owners of billing companies can grow fast by charging the right prices. Deciding what to charge for medical billing services takes more than guesswork. It should reflect pricing norms, your costs, and the value you deliver to medical practices and healthcare providers. Strong revenue cycle management enables you to collect more payments and establish a consistent income stream.

In a competitive market for outsourced medical billing, your numbers need to cover tools, staffing, and other medical billing service costs while staying fair for clients. The first step is choosing a clear pricing model that fits your services and goals.

This guide reviews common options, shows how they work in practice, and explains how to evaluate ROI without losing sight of what matters to your clients.

Most billing companies rely on 3 core billing models. Your choice should fit the services you provide, the clients you support, and the pricing structures you can manage without friction. The options include:

Each path affects how you forecast revenue, handle scope, and measure performance.

You’ll also make small but important decisions about fee structures. Some teams add a minimum fee to protect against low months. Others include setup fees when connecting systems or training staff. A light monthly fee can cover baseline support, and a flat fee often works for well-defined add-ons.

Think about how your mix of specialties, claim types, and payer rules shapes the real workload. Then choose the approach that aligns with client expectations and your capacity. 

The following 3 sections walk through each model in detail, with practical pros and cons and simple ways to pressure-test your numbers.

With a percentage-of-collections model, you invoice a fixed share of the money collected each month. It suits full-practice work and bundled services. Many teams quote a typical range of 4–10%. In Tebra’s survey, 24.5% of billing companies that used this model charged 6–7% in 2022.

This approach aligns your pay with results and can improve cash flow as volumes change. Larger practices often prefer clear ties to total collections, while small practices may want tighter guardrails. Track simple benchmarks, such as days in accounts receivable (A/R) and clean claim rate, to determine if the fee aligns with the work. Mix, payer rules, and expected denials all influence the true cost of reimbursement.

To manage variability, set a reasonable minimum monthly fee. Define what’s included and what triggers project pricing.

When setting your percentage, consider:

With per-claim fees, you charge for each submitted record regardless of outcome. Market medical billing service rates vary by specialty and documentation quality. The work behind clean claim submission drives the actual cost, not just the sticker price.

Revenue forecasting is straightforward. Back-solve from costs and billing volume. If your business needs $100,000 a year to serve a client that submits 30,000 medical claims, your target price is $3.33 per claim. Adjust for rework and edits so you don’t underprice complex files.

Account for operational variables. Clearinghouse fees, Electronic remittance advice (ERAs), and EFT enrollments, and resubmission efforts all affect staffing and tools. Track downstream impact on accounts receivable because avoidable errors slow payment and increase follow-up.

An hourly rate can help new practices get started when patient volume is low. It keeps scope flexible and lets you price short projects without lengthy contracts. As volume grows, you can move to per-claim or percentage pricing.

Use hourly work where tasks are discrete and time-bound. Credentialing, insurance verification, chart reviews, audits, training, and project-based customer support for portal setup or workflow cleanup are all suitable. Clients see progress and costs in real time, which builds trust.

Set a fair hourly fee by mapping hours required for each task and noting non-billable time for meetings and administrative tasks. Check local market norms for professional medical billing and adjust for complexity. Precise estimates and regular updates prevent surprises and protect margins.

Most billing teams do more than claims and receivables. A straightforward menu helps a service provider price fairly and explain value without confusion. Match the work to the model and keep scope definitions tight.

State exactly what the scope includes, what triggers change orders, and how to bill for overages. Simple rules make pricing transparent and easier to defend.

Choose a pricing path that reflects the work you will do and the client’s context. Different healthcare practices need different approaches. Your model should match practice size, provider mix, specialty, and real billing volume over time.

Decide where in-house billing ends and where outsourced medical billing services make sense. In-house teams can suit stable volumes and narrow specialties. Outsourcing can help when growth, turnover, or multi-state expansion increases risk. 

Map the true workload, including eligibility, edits, appeals, and reporting. Then select a model that covers effort without surprises and aligns with how the practice measures success.

Evaluating return on investment (ROI) helps you see whether your billing setup truly adds value. Follow these steps to test your assumptions and find the model that fits your revenue goals and workload:

Strong reimbursement depends on clean claims, consistent processes, and proactive follow-up. Use these practices to protect revenue and minimize denials:

Technology choices directly impact billing efficiency, accuracy, and overall margins. When evaluating your tech stack, focus on systems and integrations that simplify workflows and reduce manual effort:

Transparent pricing supports stronger RCM and better results for private practices. Pick the model that fits your scope, document inclusions, and review performance against simple benchmarks.

The right tools matter too, including your medical billing software. Strong integrations help you collect payments faster and reduce avoidable follow-up. Build your pricing on that foundation and adjust it as volumes, payers, and services change.