Outsourced Medical Billing Services

We run your claims from the signed note to the deposit for 6% of collections, with a $1,000 monthly minimum, month-to-month and no setup fee.

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Outsourced medical billing services hand a practice’s whole claim cycle (eligibility, coding review, claim submission, payment posting, denials and A/R follow-up) to an outside team that is paid from what it collects. ClaimCarePro publishes its terms: 6% of collections, a $1,000 monthly minimum, month-to-month, no setup fee, and 10% contingency on aged and denied A/R.

Most practices start looking at medical billing outsourcing after something breaks: a biller leaves, A/R ages past 90 days, or a denial pile nobody has time to open. This page covers what the service includes, what it costs, what happens in the first week and the first month, and when outsourcing is the wrong call. If you are weighing the dollars of a salaried biller against a percentage, start with our cost comparison.

Last updated October 16, 2026. Reviewed by Jacob Greenberg, ClaimCarePro. Filing deadlines are checked against the regulator’s text, linked below.

What our outsourced medical billing services include

The full claim cycle: eligibility, coding review, submission, posting, denials, appeals and A/R follow-up.
Published price: 6% of collections, $1,000 monthly minimum, month-to-month, no setup fee.
Aged A/R at 10% contingency: old and denied claims worked, nothing owed if nothing is collected.
Your systems stay yours: clearinghouse, portals and deposits in the practice’s name, with a monthly report.
Credentialing from the same team: a flat $250 per payer application, so new providers are billable sooner.

What medical billing outsourcing actually covers

Who does what once the work moves out of the practice. The clinician still documents care; everything after the note is ours.

Medical billing outsourcing moves every step between a signed note and a deposit to an outside team: eligibility, coding review, claim submission, payment posting, denials, appeals and A/R follow-up. The practice keeps its payer contracts, its clearinghouse account and its bank account. That split matters: if you ever leave, nothing you need is in someone else’s name.

Billing tasks: what ClaimCarePro does and what the practice still does
Task	What ClaimCarePro does	What the practice still does
Eligibility and benefits	Checked before the visit where the practice sends us the schedule; inactive coverage and missing authorizations flagged.	Front desk collects the card and the copay.
Charges and coding	Charges reviewed against the note and the payer’s edits before they go out. No upcoding.	The clinician documents and selects codes; we query anything that does not match.
Claim submission	Electronic claims through the clearinghouse, rejections fixed and resent.	Nothing, once access is set up.
Payment posting	ERAs and paper EOBs posted line by line, underpayments against your fee schedule flagged.	Deposits land in the practice’s own bank account.
Denials and appeals	Each denial worked by reason code: corrected claim, records request or written appeal.	Answer our record requests.
A/R follow-up	Open claims followed by payer and age, oldest and largest first.	Read the monthly aging report.
Patient statements	Statements and balance questions handled after insurance has paid.	Collect at the front desk when patients are in.
Credentialing (optional)	CAQH, Medicare, Medicaid and commercial enrollment at a flat $250 per payer application.	Provide licenses and documents once.

What outsourced medical billing costs at ClaimCarePro

Every fee, published. No discovery call needed to find out what you would pay.

Full-service billing is 6% of collections with a $1,000 monthly minimum, month-to-month, with no setup fee. The percentage applies to money the payers and patients actually pay, not to billed charges, so we earn more only when you collect more. The minimum means a practice collecting less than about $16,667 a month ($1,000 divided by 6%) pays the $1,000 floor, which works out to more than 6%. We would rather say that here than on the first invoice.

ClaimCarePro published prices for billing, A/R recovery and credentialing
Service	Price	Terms
Full-service billing	6% of collections	$1,000 per month minimum, month-to-month, no setup fee. Charged on money paid to the practice, never on what was billed.
Aged and denied A/R recovery	10% contingency	Nothing collected, nothing owed. Works alongside full-service billing or on its own.
Credentialing, per payer application	$250 per provider	Medicare, Medicaid or commercial. Re-credentialing is the same $250.
CAQH setup	$250	Profile built or repaired, documents uploaded, payers authorized, attested.
New-practice credentialing bundle	$1,750 per provider	Additional providers $1,400 each.
Credentialing maintenance	$99 per provider per year	CAQH re-attestation and expiring documents tracked.

Want the full salary-versus-percentage comparison for your own numbers? Our in-house biller vs outsourced RCM cost comparison walks through payroll, benefits, software and turnover line by line. The same prices are on our pricing page.

Outsourced billing vs an in-house biller

The operational differences. For the dollar math, use the cost comparison guide linked above.

Outsourced medical billing compared with an in-house biller
	In-house biller	ClaimCarePro
How you pay	Salary, payroll tax and benefits whether claims are paid or not	6% of what is collected, $1,000 per month minimum
Vacation, sick days, resignation	Billing stops, or the owner does it at night	A bench of experienced part-time billers is scaled onto the account as needed
Knowledge of payer rules	Whatever one person has learned	Shared across every account we bill, payer by payer
Denial work	Often the first thing dropped when the phone rings	Worked by reason code on a schedule
Software	You buy and maintain the clearinghouse and tools	Our automation checks claims before they go out
Visibility	You can watch them work	Monthly report plus your own logins to every system
Leaving	Notice, hiring and training a replacement	Month-to-month

The row that decides most practices is the second one. An in-house biller who is good is hard to replace, and the week they leave is the week claims stop going out. An outsourced team does not have that single point of failure, because the account is not one person’s job.

What you get in week 1 and month 1

The order we work in when a practice starts. These are targets we aim to hit, not promises with a stopwatch: system access and payer enrollment set the pace.

Week 1: access, inventory, triage

Business associate agreement signed before any patient data moves.
Individual logins to your EHR or practice-management system, clearinghouse and payer portals.
An aged A/R pull sorted by payer and age, with anything near a filing deadline worked first.
A check that every provider is enrolled with every payer you bill, with effective dates on file.
Your fee schedule and payer contracts loaded so underpayments can be spotted.

Month 1: claims moving, first report

New claims going out through the clearinghouse, with rejections fixed and resent.
Electronic remittance set up, so payments post line by line instead of from paper.
First denials worked by reason code, and the repeat causes written down for the front desk.
A first monthly report: charges, payments, adjustments, denials and A/R aging by payer.
A written list of anything still blocking us, and whose move it is.

After month one the work is steady-state: claims daily, follow-up by age, and a monthly report you can check against your own deposits. On established accounts our first-pass clean claim rate runs ~95%. New accounts start lower while we fix the eligibility and enrollment problems we inherit, which is exactly what the first month is for.

The payer deadlines an outsourced team has to run on

Filing limits are the rules that turn a slow month into money a practice can never bill. Each row links the regulator’s own text.

Claim filing deadlines with sources
Payer	Rule	Source
Original Medicare	Claim filed no later than 1 calendar year after the date of service	42 CFR 424.44
Medicare, new enrollment	Services can be billed up to 30 days before the enrollment effective date, under the rule’s conditions	42 CFR 424.521
Florida-regulated commercial plans	Submit within 6 months of the date of service, or of receiving the insurer’s correct name and address	Fla. Stat. 627.6131(3)(b)
Florida PIP (auto no-fault)	Bill within 35 days of service, or up to 75 days when the insurer had notice of treatment within 21 days	Fla. Stat. 627.736

Here is why that table is on a sales page. We took on one practice that had a full year of Medicare claims that had never been billed; we recovered about $200,000 of a year's unbilled Medicare claims for the practice. Medicare gives a claim one calendar year from the date of service, so every week of that backlog was a week of visits aging toward the limit. The work was not clever: pull every unbilled visit, sort by date of service, and bill the oldest first, because those were the ones closest to being lost.

Commercial plans and auto insurers run on their own clocks. In Florida, a regulated commercial plan expects the claim within six months, and a PIP bill covers only the prior 35 days of services (75 when the insurer was notified of treatment within 21 days). A practice that bills in batches whenever someone has time will eventually miss one of these. Our guide to why medical claims get denied covers the other common causes, from eligibility to coding edits.

When outsourcing medical billing is the wrong call

Not every practice should outsource. These are the signs it will not pay off.

You have an experienced biller who is staying, your A/R under 90 days is small and denials are worked every week. Keep them. An outside company will not beat a good biller who knows your payers.
Your collections are far below the minimum and growing slowly. At a few thousand dollars a month, a $1,000 floor is a large share. Aged A/R recovery at 10% contingency, starting with a free A/R audit, may be the better first step.
You want someone in the building to check patients out, answer the phone and bill in between. That is a front-desk role that bills, not a billing service.
Your providers are not enrolled yet. Billing cannot fix a claim for a provider the payer does not recognize. Start with credentialing, then billing.

How to choose a medical billing outsourcing company

Six questions to ask any company, including us, before you sign.

Is the fee a share of collections or of billed charges? A share of billed charges pays the company whether or not you get paid.
Is there a minimum, a setup fee or a term? Get all three in writing. Ours: $1,000 minimum, no setup fee, month-to-month.
Where does the performance number come from? A clean-claim rate with no qualifier is marketing. Ask which accounts it covers and over what period.
Who owns the clearinghouse and portal logins? The answer should be you, with the company added as users.
What is in the monthly report? Ask for a sample: charges, payments, adjustments, denials by reason and A/R aging by payer.
Will they sign a BAA before onboarding? Any company that has to think about it is the wrong one.

Who does the work

Billing people who have also run a practice, backed by automation.

The people who started ClaimCarePro ran two medical practices while doing the billing for them, spent about three months training one practice’s staff on its EHR, and installed EHRs in two more. Between them they bring 30+ years of combined billing experience. More on that on our about page.

The capacity model is simple: a large bench of experienced part-time billers is scaled onto each account as the work requires, and AI automation checks claims and posts remittances so people spend their time on denials and follow-up. Much of our book is chiropractic, physical therapy and injury care, where auto insurers such as Progressive, Allstate and USAA send electronic remittances we post daily. See chiropractic billing, physical therapy billing and personal injury and PIP billing. Florida practices can also read our Florida medical billing services page.

Outsourced medical billing: questions practices ask

Short answers to the questions practices search most before they outsource.

What is outsourced medical billing?

Outsourced medical billing means an outside company runs the practice’s claim cycle: eligibility checks, charge and coding review, claim submission, payment posting, denials, appeals and A/R follow-up. The practice still documents care and owns its payer contracts. Most companies are paid a share of collections, so they are paid only when the practice is.

How much does it cost to outsource medical billing?

Many companies charge a percentage of collections and do not publish it. ClaimCarePro charges 6% of collections with a $1,000 monthly minimum, month-to-month, no setup fee. Aged and denied A/R is worked at 10% contingency: nothing collected, nothing owed. Credentialing is a flat $250 per payer application.

Is outsourcing medical billing worth it?

It is usually worth it when claims sit unbilled, denials go unworked, A/R ages past 90 days, or one person holds all the billing knowledge. It is less likely to pay off for a practice with a stable, experienced biller and clean A/R. Our in-house vs outsourced guide runs the dollar comparison.

What are the disadvantages of outsourcing medical billing?

The real trade-offs: you no longer sit next to your biller, a percentage fee grows as collections grow, and a weak vendor can hide problems behind summary reports. Protect yourself with read access to your own clearinghouse and payer portals, a monthly A/R aging report, and a contract you can leave month-to-month.

How do I switch to an outsourced medical billing company?

Give the new company user access to your EHR or practice-management system and clearinghouse, a payer list with contracts and fee schedules, and an aged A/R report. Keep your current biller working open claims until the handoff date. Sign a business associate agreement before any patient data moves.

Will I lose control of my billing if I outsource?

Not if the arrangement is set up correctly. The claims, payer contracts, clearinghouse account and bank deposits stay in the practice’s name. You should keep login access to everything and get a monthly report showing charges, payments, adjustments, denials and A/R aging, so you can check the work, not just trust it.

Is it safe to outsource medical billing under HIPAA?

Yes, when the billing company signs a business associate agreement before it touches patient data, uses individual logins rather than shared ones, and limits access to the people working the account. ClaimCarePro signs a BAA with every practice. Ask any vendor how access is removed when a team member leaves.

What do outsourced medical billing services include?

Ours include eligibility and benefits checks, charge and coding review, electronic claim submission, ERA and payment posting, denial work and appeals, A/R follow-up by payer, patient statements and a monthly report. Credentialing and aged-claim recovery are priced separately, so you only pay for what you use.

How long does it take to switch billing companies?

There is no single number, because it depends on system access, clearinghouse enrollment and how much open A/R is in flight. Electronic remittance enrollment with each payer also has to move to the new setup. We aim to have claims going out in the first month and say what is blocking us in writing.

What happens to my old unpaid claims when I outsource?

They still count. Claims inside each payer’s filing limit can be worked, corrected and appealed. Medicare’s limit is one calendar year from the date of service, so older Medicare claims are usually past it. We work aged and denied A/R at 10% contingency, so you pay nothing if nothing is collected.

How to start

1
Get a free A/R audit
Send an aged A/R report. We show you what is still collectable and what is near a filing limit.
2
Sign the BAA and grant access
Individual logins to your systems, your payer list and fee schedules. Nothing moves before the BAA.
3
We take over the claim cycle
Claims, posting, denials and follow-up, with a monthly report you can check against your deposits.

See What Outsourcing Would Recover First

Start with a free A/R audit. We will show you what is still collectable, what is close to a filing limit, and what our fee would be. Call (727) 580-8186.