Outsourced Medical Billing Cost vs In-House: Calculator and Published Price
Short answer: ClaimCarePro charges 6% of what you collect each month, with a $1,000 monthly minimum, month-to-month and no setup fee. Your in-house cost is your biller's salary plus taxes, benefits, PTO, software and overhead. Put both into the calculator below and it shows which one costs less, by month and by year, including when the answer is in-house. If you are still setting up a practice, our guide to starting a medical practice in Florida shows where billing fits in the larger sequence.
What does outsourced medical billing cost?
Outsourced billing is usually priced as a percentage of collections. The percentage is often only given after a discovery call, which makes comparing vendors slow. Ours is on the pricing page:
- Full-service billing: 6% of collections, $1,000 per month minimum, month-to-month, no setup fee.
- Aged and denied A/R recovery: 10% contingency on what is recovered. No recovery, no fee.
What that works out to at different collection levels:
| Monthly collections | ClaimCarePro per month | Per year |
|---|---|---|
| $10,000 | $1,000 | $12,000 (minimum applies) |
| $16,667 | $1,000 | $12,000 (where 6% meets the minimum) |
| $25,000 | $1,500 | $18,000 |
| $50,000 | $3,000 | $36,000 |
| $100,000 | $6,000 | $72,000 |
The fee moves with collections. A slow month costs less; it never drops below $1,000. That is the whole price list for ongoing billing.
Calculator: your in-house billing cost vs ClaimCarePro
Use your own numbers. Nothing is filled in for you, and nothing you type leaves this page.
Fill in the first four boxes to see the comparison.
The ClaimCarePro figure is our own published price: 6% of collections, $1,000 per month minimum, month-to-month, no setup fee. It is not an industry average. This compares fees only. It does not estimate what either option collects.
What goes into the in-house number
The salary on the offer letter is only the first line. Pull each figure from a document, not from memory:
| Cost line | Where to get the real figure |
|---|---|
| Wages for everyone who bills | Payroll register, including the front-desk hours spent on claims |
| Employer payroll taxes, benefits, PTO | Your payroll provider's employer-cost report, or your accountant |
| Billing and clearinghouse software | The vendor invoices. Count only what would stop if billing moved out |
| Statements, postage, training, supervision | Last year's general ledger, divided by 12 |
Leave out anything you keep paying either way. If you would keep your EHR after outsourcing, its subscription belongs on neither side.
When in-house is the cheaper choice
A percentage fee grows with your collections; a salary does not. Divide your in-house monthly total by 0.06 and you get the collections level where the two are equal. Above that line, one experienced biller who keeps up with denials and follow-up costs less than 6%. The calculator prints that break-even point for your numbers. If you are above it and your A/R is current, keeping billing in-house is a reasonable call.
What a fee comparison does not show
Fees are half of the decision. The other half is what each option collects: denials nobody appealed, claims that aged past timely filing, patient balances never sent. Those are lost revenue, not expenses, so they never appear on a cost line. Before you decide, measure them. A free A/R audit shows what is sitting in your receivables now, and the billing leak checklist lists the four numbers to ask your current biller for. If denials are the worry, the denial cost calculator puts a yearly figure on them.
What is included in the 6%
- Eligibility verification
- Medical coding
- Claim submission
- Denial management and appeals
- A/R follow-up
- Patient statements
- Reporting
Details are on the medical billing services page, and the full revenue cycle management scope is listed there too.
Five questions to ask any billing company about price
- Is the percentage charged on collections or on gross charges?
- Is there a setup, onboarding or implementation fee?
- How long is the contract, and what does cancelling cost?
- Is there a monthly minimum, and at what collections level does it apply?
- Is working old A/R included, or priced separately?
Our answers: collections; no; month-to-month, nothing; $1,000, below $16,667 collected; old A/R recovery is a separate 10% contingency.
Frequently asked questions
How much does outsourced medical billing cost?
Most outsourced billing companies charge a percentage of collections, and many only quote it after a sales call. ClaimCarePro publishes its price: 6% of monthly collections with a $1,000 per month minimum, month-to-month, no setup fee. Aged and denied A/R recovery is 10% of what is recovered, and nothing if nothing is recovered.
Is outsourcing cheaper than an in-house biller?
It depends on your collections and your biller's fully loaded cost. Add salary, payroll taxes, benefits, PTO, billing software and other overhead, then compare that monthly total to 6% of your collections (or $1,000, whichever is higher). The calculator on this page does it and tells you plainly when in-house is cheaper.
At what point does an in-house biller cost less?
When 6% of your monthly collections is more than your in-house monthly cost. Divide your in-house monthly total by 0.06: that is the collections level where the two fees are equal. Above it, in-house costs less on fees alone.
Is there a setup fee or long-term contract?
No. ClaimCarePro full-service billing is month-to-month with no setup fee. The $1,000 monthly minimum applies when 6% of collections comes to less than $1,000, which is any month under $16,667 collected.
Is the fee charged on billed charges or on collections?
On collections: money that actually lands in your account, never on what was billed. Ask any billing company the same question, since a percentage of gross charges costs more than the same percentage of collections.
What does the 6% include?
Eligibility verification, medical coding, claim submission, denial management, A/R follow-up, patient statements and reporting, as listed on the ClaimCarePro pricing page.
Related: outsourced medical billing services · medical billing services · pricing · free A/R audit
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