Understanding what is a reasonable amount to pay for medical billing services is an important starting point for pricing out and comparing these types of services. The actual amount billed is going to depend on a wide range of factors. The service offerings included from the medical billing company, the size of your practice, and the features that you opt for will all influence these numbers. However, these general guidelines should provide you with a starting point for assessing the fees that may be charged by your potential medical billing services.
Medical Billing Administrative Fees in 2023
Medical billing administrative fees are the costs associated with managing the billing process for healthcare services. This can include a range of activities, such as submitting claims to insurance companies, following up on unpaid claims, billing patients for unpaid balances, and maintaining patient billing records.
These fees can be a significant portion of a healthcare provider’s overhead costs. They cover the salaries and benefits of billing staff, the cost of billing software, training for billing staff, and other related expenses.
In some cases, healthcare providers may pass these administrative costs on to patients in the form of a separate charge. However, this practice is generally not well-regarded and in many places, it’s regulated or prohibited. Typically, these costs are integrated into the fees charged for medical services, so patients may not see a separate line item for “administrative fees” on their bills.
The specific tasks involved in medical billing can include:
- Verification of patient insurance coverage and benefits
- Coding of procedures and diagnoses
- Creation and submission of claims
- Posting of payments
- Following up on denied or unpaid claims
- Patient billing and collections
- Compliance with regulations
The process is complex and requires specialized knowledge of healthcare reimbursement, insurance policies, and regulations. Consequently, many healthcare providers outsource their medical billing to specialized companies, which can handle these tasks more efficiently and effectively.
The overall fees charged for administration by a billing service will typically add up to several thousand dollars a year. A good average is to assume $3,000 to $6,800 in administrative fees depending on the size of your practice. This information is offered upfront and is generally very transparent.
Many of the companies in this industry also charge start-up fees when you first start utilizing their services. A normal amount here is roughly $300 per practicing doctor in an organization, although for larger practices billing services will typically cap this after a certain number of practitioners. In other cases, there may be a general start-up fee that is charged regardless of the number of physicians in the practice. In these cases, an amount of $1,400 to $1,900 would be expected. Learn More about how medical service bills are calculated.
Fees to Avoid
Here’s a list of fees to try to avoid paying for when picking a medical billing service.
• Up-gradation charges
• Post-sale customer support expenses
• Avoid hidden costs buried in the contract
Extra Fees For EHR / EMR
Another thing to keep an eye on is the wide-ranging additional fees that different companies may tack onto your regular bills. For instance, some companies charge as much as $99 in clearinghouse fees, while others charge for each statement they send to a patient. It is important to get all these fees clearly laid out beforehand. While they might seem like a very small amount in isolation, over the course of a month with a large number of patients these fees can quickly mount.
Monthly Minimums For Medical Billing Services
Another consideration when pricing out these types of services is what types of monthly minimums they might charge. This is particularly important for people working in very small or independent practices where these monthly minimums might not be met in the course of normal billings, in which case the remainder would be tacked on to the top of the existing invoice.
While the fees and numbers listed above should give you some idea of what to expect when it comes to your medical billing service’s fees, ultimately most companies are going to charge you a percentage based on the billings that you outsource to them. In most cases, this number will range somewhere between 3% and 10%, with most falling more in the 5% to 7% range. Companies that are at the extreme ends of this range may have a reason for their deviation from the mean: either they offer a bare-bones, stripped-down service, or they have some huge value-adds that are worth considering. If a company bills at the low or high end of this range without meeting either of these criteria, it is certainly worth doing some further research into their model to see why it deviates from the norm.
Medical Billing Software Fees in 2023
Currently ranging from $8500 to $30,000, Medical billing software fees are the costs associated with using a software solution to manage the medical billing process. These solutions typically automate and streamline tasks such as patient registration, appointment scheduling, medical coding, insurance claim submission, payment processing, and reporting. They also help to ensure compliance with healthcare regulations and standards, including those related to patient privacy and security.
The cost of medical billing software can vary widely, depending on the features offered, the number of users, whether it’s a cloud-based or on-premises solution, and other factors.
Typically, there are several types of costs associated with medical billing software:
- License fees: This is often a one-time cost for purchasing the software, especially if it’s an on-premises solution. For cloud-based solutions, this might be replaced by a subscription fee.
- Subscription fees: These are ongoing costs, typically paid monthly or annually, for using a cloud-based solution. The fee often depends on the number of users or the volume of transactions processed.
- Implementation fees: These are the costs associated with setting up the software, including data migration, customization, training, and other startup activities.
- Maintenance and support fees: These are ongoing costs for software updates, technical support, and sometimes for additional training.
- Integration fees: If the medical billing software needs to integrate with other systems (like Electronic Health Records, or EHRs), there might be additional costs.
In addition to these direct costs, there may be indirect costs related to using medical billing software, such as the time staff spend learning to use the new system, or potential disruptions to operations during the implementation phase. These costs should be considered when evaluating the total cost of a medical billing software solution.
Some healthcare providers choose to outsource their medical billing to a service that includes the use of their software in their fee, avoiding the need to pay for and manage the software themselves.