Guides Choosing a biller
Medical billing company fees: percentage, per claim or flat
The short answer
Most billing companies charge a percentage of collections, and some charge per claim or a flat monthly fee. The rate matters less than what it is a percentage of and which other fees sit around it, so get both in writing.
Most medical billing companies charge a percentage of what they collect for you. Some charge a fee per claim, and a few charge a flat monthly fee. There is no official, public survey of what billing companies charge, so any “typical range” you read online is somebody’s estimate. What you can check is the contract: what the percentage is a percentage of, and which fees sit around it.
This guide covers the three pricing models, the definition that moves your bill most, what the companies that publish prices actually list, and the fees to get in writing before you sign.
The three ways billing companies charge
| Model | What you pay | Fits best when | What to check |
|---|---|---|---|
| Percentage of collections | A share of the money collected on your claims | Volume and payer mix change month to month | What counts as “collections” (see below) |
| Per claim | A fixed fee for each claim sent | Claim volume is steady and claims are simple | Whether resubmissions, secondary claims and corrected claims count as new claims |
| Flat monthly fee | One fee per month, often tied to a volume band | Very steady, predictable volume | What happens when you go over the band, and what work is left out |
Contracts can mix these: a percentage with a monthly minimum, for example, or per-claim clearinghouse fees on top of a percentage.
Percentage pricing ties the company’s income to yours. If claims are denied and never fixed, the company earns nothing on them, which gives it a reason to work denials. The flip side is that the fee grows as your practice grows, even when the work per claim doesn’t.
Per-claim pricing is easy to forecast, but it pays the same for a claim that goes out clean and a claim that needs three appeals. Ask whether denial follow-up is included or billed separately.
Flat fees are the easiest to budget. They depend on a clear definition of what’s included.
What the percentage is a percentage of
This is the part of a billing contract that moves your bill most. Two companies both quoting “5%” can send very different invoices because they count different money.
Questions to settle for each type of payment:
- Payer payments on claims the company sent. These almost always count.
- Patient payments. Do payments on statements the company sends count? Do copays your front desk collects at the visit count, even though the company did no work for them?
- Refunds and recoupments. When a payer takes money back, is it subtracted from the collections the fee is based on? In which month?
- Run-out from your previous biller. Payments on claims your old biller sent, arriving after the switch. Does the new company charge on those?
- Old AR. Unpaid balances from before the company started. Is it charged at the same rate, a separate contingency rate, or not worked at all? Can the same dollar be charged twice?
- Payers the company doesn’t bill. If you keep billing some payers yourself, are those deposits excluded?
- Interest on late payments. New York requires insurers it regulates to pay interest on clean claims they pay late (Ins. Law §3224-a(c)). Ask whether interest counts.
Also check whether the base is collections at all. Some companies charge a percentage of billed charges, and some charge a percentage of the allowed amount (the rate the payer’s contract allows). One published price page we read in November 2026, for example, sets its fee as a percentage of “the contracted rate or allowed amount” and spells out that this is not the full fee you bill.
Example: one month, two definitions
The numbers below are invented to show the effect. They are not market rates.
| Example: money received in one month | Amount |
|---|---|
| Payer payments on claims the new company sent | $48,000 |
| Patient payments on statements it sent | $4,000 |
| Copays collected at the front desk | $3,000 |
| Run-out payments on claims the old biller sent | $6,000 |
| Old AR recovered | $5,000 |
| Refunds and recoupments taken back | −$1,000 |
| Net deposits | $65,000 |
At an example rate of 5%:
- If the contract counts all net deposits, the fee is $3,250.
- If it counts only payer and statement payments on claims the company sent, net of refunds, the base is $51,000 and the fee is $2,550.
Same rate, $700 a month apart, or $8,400 a year. Ask for the definition as a written list, not a sentence.
What published price pages say
Most billing companies don’t publish a price. We read the websites of several companies on November 9, 2026. The table lists the ones that print a rate on their own site, quoted as they state it, without their names. These are the companies’ own claims about their own pricing. They are not checked by us, not a market survey and not a recommendation.
| Company (page read Nov 9, 2026) | Published price | Base the percentage applies to | Other terms the page states |
|---|---|---|---|
| Company A | 2.7% | Monthly collections | No setup fee, no long-term contract |
| Company B | 3.9% | “Successful reimbursements” | No setup fee, no per-claim fees, no monthly minimum |
| Company C | 6.5–8%, by volume | Contracted rate or allowed amount | A $35 monthly fee per tax ID and rendering NPI for clearinghouse processing, waived in some cases; credentialing priced per application |
We don’t name the companies here. Two others we checked describe their pricing without a number: one says its rate is a percentage of money collected, quoted after a review, and the other says it does not publish a flat percentage and quotes each practice.
Three points from this small sample:
- The published rates sit far apart, and each uses a different base. A lower rate on a broader base can cost more than a higher rate on a narrow one.
- We found no published per-claim or flat-monthly price for a full billing service in this check. Those models exist, but you will usually get them as a quote.
- Billing software with a built-in clearinghouse is a different product, priced for practices whose own staff do the billing work. Don’t compare its per-claim price with a full service.
Fees to get in writing
None of these is wrong to charge. Each should be in the quote, with a number, before you sign.
- Setup or onboarding fee. One-time, or waived?
- Monthly minimum. What it is, and what happens in a slow month.
- Per-claim or clearinghouse fees charged on top of the percentage.
- Patient statements. Printing and postage, per statement or included.
- Credentialing and payer enrollment. Per provider, per payer, or included. Revalidations too.
- Old AR. Same rate, separate contingency share, or not offered.
- Software. Does the company require its own practice management system, and who pays the licence?
- Price changes. Can the rate change during the term, and with how much notice?
- Ending the contract. Notice period, any termination fee, who works the run-out and at what price.
- Your data on the way out. Which files you get back (claims, remittances, AR aging, patient balances), in what format and when.
Item 10 has a regulatory floor. A HIPAA business associate agreement must require the company to return or destroy your patients’ information when the contract ends, where feasible (45 CFR 164.504(e)(2)(ii)(J)). The format and timing of the files you need to keep billing are a contract term, so put them in writing.
Percentage pricing and coding
The HHS Office of Inspector General’s guidance for third-party billing companies notes a “longstanding concern that percentage billing arrangements may increase the risk of upcoding and similar abusive billing practices” (63 FR 70138, December 18, 1998). That doesn’t make percentage pricing improper. It means you should know who chooses the codes on your claims.
Ask whether the company assigns codes, changes codes, or only flags problems for your provider to decide. The practice is responsible for the claims sent in its name, so the safest setup keeps the final coding decision with the clinician who wrote the note. Our 12 questions to ask a billing company cover this and the rest of the vetting call.
How to compare two quotes
- Pull 12 months of deposits from your bank or practice system, split by type: payer payments, patient statement payments, front-desk copays, refunds.
- Apply each company’s written definition to the same 12 months. Leave out what it excludes.
- Multiply by its rate, then add every fee from the list above with a number on it. Use the monthly minimum for any month that falls below it.
- Compare annual totals, not rates.
- Then compare what’s included: denials worked, appeals, patient calls, reporting, credentialing.
If a company won’t give you its definition and its fees in writing before you sign, treat that as the answer.
Marlow publishes its own rate and its written list of what counts, what’s netted out and what doesn’t, on our pricing page.
Sources
- New York Insurance Law §3224-a, prompt payment and claim submission
- 45 CFR 164.504(e), business associate contracts (eCFR)
- HHS OIG, Compliance Program Guidance for Third-Party Medical Billing Companies, 63 FR 70138 (1998)
General information, not advice on a specific claim, contract or legal question. Rules and rates change; check the linked sources for the current version.