Questions
Questions buyers actually ask
66 questions on cost, choosing a vendor, offshore and HIPAA, AR and denials, prior authorization, credentialing and staffing, each answered in a few sentences first, then sourced in full, with a link to the seat that does the work.
6Cost and pricingWhat outsourcing actually costs, in the three ways vendors charge for it, with published numbers instead of a quote you have to request.7Choosing and switchingHow to compare billing companies on something other than a sales call, and how to leave one without losing the accounts receivable it is still working.6In-house or outsourceThe build-versus-buy decision for billing staff, and the numbers that actually settle it rather than a gut feeling about control.7Offshore and HIPAAWhat HIPAA actually requires of an offshore vendor, what offshore staff can touch, and why the price is lower.8AR and denialsAged accounts receivable and claim denials, what the published industry numbers say they cost, and what to do about both.6Prior authorization and eligibilityHow long prior authorization and eligibility checks take, whose job they are, and what changes under the 2026 CMS rule.7Credentialing and revalidationHow long payer enrollment takes, how often Medicare revalidation is due, and what happens when either one is missed.6Virtual assistants and staffingWhat a medical billing virtual assistant actually is, what one costs, and how that differs from a dedicated outsourced seat.6For billing companiesWhite-label capacity, overflow staff and volume pricing for a billing company or BPO buying seats to serve its own client book.7BasicsThe vocabulary, defined plainly once rather than redefined on every page that uses it.
Cost and pricing
- How much does outsourcing medical billing cost: per claim, percentage, or per seat?It depends on the model. Percentage vendors typically take a share of what they collect; published industry surveys put that share in the mid single digits to low double digits. Seat-based vendors, including us, charge one flat rate per person per month regardless of collections, with no per-claim fee at all.
- Is outsourcing medical billing worth it for a small practice?It depends on what staff time is currently costing you, measured against what a practice loses to denials and uncollected AR. For a small practice already struggling to keep up with claims, a dedicated outsourced seat is usually worth it once the admin burden exceeds a few hours a day; for a practice collecting cleanly in-house, it may not be.
- Is a percentage-of-collections contract actually cheaper than a flat fee?No, not usually, once collections grow. A percentage rises every time revenue rises, with no ceiling, while a flat seat price stays the same whether a practice collects more or less in a given month. A percentage can look cheaper on a slow month and becomes the more expensive model as soon as billing is healthy.
- What do medical billing companies charge, and how do they charge for it?Most charge in one of three ways: a percentage of what they collect, a flat fee per claim submitted, or a flat monthly rate per dedicated staff member. Some blend a lower percentage with a per-claim minimum. Ask which model a vendor uses before asking the number, because the model changes what you are actually buying.
- Why do offshore medical billing rates vary so much between vendors?Mostly because of what is actually included. Published offshore rates for a full-time billing or admin seat vary widely by seniority, by whether training and a signed BAA are included, and which country the staff sit in. A lower headline rate is often a part-time hour count or a junior tier rather than a cheaper version of the same job.
- What does a medical billing company's price actually include?It varies by vendor, so ask directly rather than assume. A published seat price should state hours worked per week, whether training and onboarding are billed separately, whether a signed business associate agreement is included before access, and what happens if the person assigned to your account leaves. Many vendor pages leave at least one of those unstated.
Choosing and switching
- Which medical billing company is best for a small practice?No single company is best for every practice, and we do not rank ourselves against competitors. What differs between vendors is published price versus quote-only pricing, minimum contract term, whether staff work inside your own system under your login, and whether the vendor will show you a real reference. Compare on those points, not a rating.
- What should I look for when choosing a billing company?Four things settle most of it: a published price you can see before a call, a short minimum term with real notice to leave, staff who work inside your own system under logins you control, and a signed business associate agreement before anyone touches patient data. A vendor that fails any one of those is worth a harder look.
- What are the top RCM companies in the US?There is no independent, audited ranking of RCM companies, so a confident top-five list is a marketing opinion, not a measured fact. A more useful question is what to compare: published price, minimum term, who performs the work, and whose system it runs in. /compare/ answers that for several named vendors, on their own published pages.
- How do I switch medical billing companies without losing AR already in progress?Keep the outgoing vendor working your existing AR through a defined run-out period while the new vendor starts only on new claims going forward. Get read access to the old system during the transition, confirm who owns the data and claim history, and set a specific handoff date in writing rather than a vague overlap.
- What is a run-out clause, and should my billing contract have one?Yes. A run-out clause states what happens to claims your current vendor already started when the contract ends: who keeps working them, for how long, and at what cost, if any. Without one in writing, a vendor can simply stop on the termination date and leave aged AR with nobody assigned to it.
- What should I measure in the first month with a new billing vendor?Four numbers, taken before the switch and again thirty days in: days in AR, the clean-claim rate, the denial rate, and how much of the prior backlog actually got worked rather than left untouched. A vendor who improves none of the four in month one is unlikely to improve them in month six.
- How do I know if my current billing vendor's performance is actually good or bad?Compare your own days-in-AR and denial-rate trend over the last six months against your own history, not a number borrowed from somewhere else. A rising trend in either number, a shrinking share of claims resolved under ninety days, or a vendor who cannot produce that history on request are each a real warning sign on their own.
In-house or outsource
- Should I hire an in-house biller or outsource billing?It depends on volume and how much management attention billing can absorb. Hiring in-house gives direct control but means covering salary, benefits, training and turnover yourself; outsourcing trades some control for a dedicated person at a flat rate with no hiring risk. Most small practices find the breakeven favors outsourcing below a handful of staff.
- What's the real cost difference between in-house and outsourced billing?A US in-house hire's salary is only part of the cost once payroll taxes, benefits and overhead are added; those employer costs typically add a meaningful amount on top of base wages, and the exact share varies by state, benefits package and job type. An outsourced seat is priced as one flat number that already includes all of that.
- At what point does outsourcing billing make sense for a growing practice?Usually once billing work exceeds what one in-house person can keep current, or once the practice cannot justify a full in-house hire for the volume it has. A practice drowning in denials, or one without the headcount to hire a dedicated biller yet, is typically past that point already.
- Can I outsource just AR follow-up, and keep the rest of billing in-house?Yes. AR follow-up, calling payers on aged and denied claims, is commonly sold as its own seat separate from charge entry, coding or payment posting. A practice can keep submission and posting in-house and add a dedicated AR caller only for the aged bucket that is not getting worked.
- Is billing eating into my clinic's time enough that outsourcing makes sense?If front-desk or clinical staff are regularly interrupted by billing calls, denial follow-up or payment posting, that time is being taken from patient-facing work, which is the real cost outsourcing addresses. Track how many hours a week go to billing tasks for one week and compare it against a dedicated seat's cost.
- What's the breakeven point between hiring a biller and outsourcing a seat?Compare the fully loaded cost of an in-house hire, salary plus benefits and payroll taxes, against the published monthly rate for an outsourced seat doing the same work. Where the loaded in-house cost is close to or above the seat price, and management time is scarce, outsourcing usually wins on both cost and capacity.
Offshore and HIPAA
- Is offshore medical billing safe and HIPAA compliant?Yes, HIPAA allows a business associate to process or store patient data outside the United States provided a signed business associate agreement is in place and the HIPAA Rules are otherwise met; location itself is not the barrier. No federal regulation bans offshore processing, though a handful of states carve out exceptions for their own Medicaid work.
- What can offshore billing staff actually access of my patient data?Only what their role needs, if the vendor is run properly: an AR caller typically needs the claim, the payer and the balance, not the clinical note. Ask any vendor for the specific access level each role is given, in writing, rather than accepting a general assurance that access is limited.
- Is there such a thing as a billing company that is "HIPAA certified"?No. There is no government body, and no official federal process, that issues a HIPAA certification to a company or a vendor. A page advertising one has either bought a private training provider's certificate of completion or is simply making a claim with nothing behind it. What matters is a signed business associate agreement and verifiable controls.
- Why is offshore medical billing so much cheaper, and what is the catch?Mostly because wages and the cost of living are genuinely lower where the staff live, the same reason any offshore service costs less. The real catch, when there is one, is usually hidden in what is not included: hours, seniority, training, or a shared rather than dedicated person, not a secret quality gap by default.
- Do offshore billing staff work during my practice’s own US business hours?It depends on the vendor; ask directly rather than assuming. Some offshore staff work their own local daytime, overnight relative to the US; others are scheduled specifically to work US daytime hours. A vendor's shift schedule, stated in writing, is the only reliable way to know which you are buying.
- What happens if my offshore biller quits or is out sick?That depends entirely on the vendor's own policy, so get it in writing before signing. A vendor should state a specific replacement timeline and whether coverage continues during a short absence; a vague assurance with no stated number is a sign the question has not been thought through.
- Does an offshore billing company need to already know my EHR or PM system?Not necessarily, but it changes onboarding time either way. A vendor already trained on your specific system can start faster; one that is not will need roughly a week or more of training before working live claims. Ask which practice-management systems a vendor currently supports before assuming either answer.
AR and denials
- How much of my AR should be over 90 days, and how do I fix it if too much is?There is no single sourced benchmark we can quote for the right share, so track your own trend rather than a borrowed number. Our own published guidance is that a practice calling its aged accounts keeps days in AR under forty; past sixty usually means nobody is working the old end of the bucket at all.
- How do I recover unpaid insurance claims that are sitting in AR?Call the payer on every claim past the normal payment window, in age order starting with the oldest, and document the reference number for every call. Most unpaid claims are not actually denied; they are simply sitting in a queue nobody has followed up on, and a phone call resolves a large share of them.
- How can I reduce my medical claim denial rate?Fix eligibility and authorization before the claim is submitted, since most denials trace back to something that was wrong before the claim ever left the building. Track denials by reason code rather than treating them as one problem, because eligibility, authorization and coding denials each need a different fix.
- What are the most common reasons medical claims get denied?Eligibility and coverage issues, missing or absent prior authorization, and coding or documentation errors account for most denials industry-wide. Individual denial codes vary by payer, but these three categories, checkable before a claim is ever submitted, explain the majority of what gets rejected.
- Should I appeal a denial or file a corrected claim?File a corrected claim when the original had an error you can fix, such as a wrong code or missing field; appeal when the claim was accurate and you are disputing the payer's decision, such as a missing-authorization denial you believe should be covered. CO-197, missing prior authorization, is the clearest worked example of the difference.
- When do I write off an unpaid balance versus send it to collections?Write off a balance only when it is a true contractual adjustment your payer contract requires, shown as a CO group code on the remittance; a PR-coded balance is the patient's responsibility and can legitimately be pursued or sent to collections. Mixing the two quietly loses money that was actually billable.
- Is AR-follow-up-only outsourcing something I can actually buy, without full billing?Yes. AR follow-up, calling payers on aged claims and working denials to resolution, is sold as its own dedicated seat, separate from charge entry, coding or payment posting. A practice keeps the rest of its billing workflow exactly as it is and adds one person for the aged queue specifically.
- What does it actually cost to fight a denied claim?A national provider survey put the administrative cost of fighting a single denied claim at roughly fifty-seven dollars in 2023, up from under forty-four dollars the year before, and found a denied claim typically goes through about three rounds of payer review at forty-five to sixty days each round.
Prior authorization and eligibility
- How long does prior authorization actually take?It varies by payer and service, from same-day to several weeks under current practice. Under a 2026 CMS rule, impacted payers must decide expedited requests within 72 hours and standard requests within seven calendar days; that is a ceiling on the decision itself, not on submitting a complete request in the first place.
- Does outsourcing prior authorization reduce denials?It can, mainly by making submissions complete and tracked the first time rather than by any special leverage over the payer. Most prior-authorization denials trace back to a missing field, the wrong code, or a request nobody followed up on before it expired; a dedicated seat focused only on this queue catches those before they become a denial.
- Who is responsible for getting prior authorization: the practice or the payer?The practice or the ordering provider is responsible for requesting prior authorization before the service is delivered; the payer is only responsible for deciding the request, within the timeframe its own rules or CMS-0057-F now set. A service delivered without a required authorization is usually the practice's financial risk, not the payer's.
- What is eligibility verification, and why does it prevent denials?Eligibility verification confirms a patient's active coverage, plan type, benefits and expected patient responsibility before the visit happens. Checking it upfront catches inactive coverage, a wrong plan on file, or a coordination-of-benefits problem before a claim is submitted, which is the cheapest point in the entire cycle to catch any of them.
- What changes to prior-authorization timelines under the 2026 CMS rule?CMS-0057-F requires impacted payers, including Medicare Advantage plans, to decide expedited prior authorization requests within 72 hours and standard requests within seven calendar days, beginning 1 January 2026. It also requires faster electronic processes by 2027, but the decision-time requirement is already in effect.
- Can a virtual assistant handle prior authorizations and eligibility checks?Yes, these are among the most commonly delegated tasks for a medical billing virtual assistant, since both are rules-based, repetitive and do not require being physically present. What matters is the same as for any outsourced role: named access, a signed BAA, and a stated process for following up before deadlines pass.
Credentialing and revalidation
- How long does medical credentialing take?Commercial payer enrollment commonly takes ninety to one hundred eighty days from a complete application; Medicare can be faster when the application is clean and considerably slower when it is not. The single biggest factor is not the payer but whether the source documents were complete on the day the application was submitted.
- How often is Medicare revalidation required?In general, providers and suppliers revalidate every five years; DMEPOS suppliers revalidate every three years. It is not automatic. CMS sets the date, and a provider is responsible for tracking and submitting it on time regardless of whether a reminder notice ever arrives.
- What happens if a practice misses its Medicare revalidation deadline?CMS states plainly that failing to revalidate on time can result in a hold on Medicare reimbursement or deactivation of billing privileges. A deactivated provider has to submit a full new enrollment application to restore access, and Medicare will not reimburse services delivered during the deactivated period.
- Can a billing company help with Medicare revalidation?Yes, a billing or credentialing partner can prepare and submit a revalidation filing on a practice's behalf, the same as any other enrollment paperwork. What matters is whether the service is priced and scoped clearly: a per-provider filing fee is a different purchase than an ongoing credentialing seat, and the two should not be confused.
- How do I look up my Medicare revalidation due date?CMS publishes a revalidation due-date list searchable by NPI, and the quickest check is a direct lookup rather than waiting for a mailed notice. A due date showing within the next several months is worth acting on immediately, since the filing itself, and any payer follow-up, takes real time to complete.
- How much do credentialing services cost?An ongoing credentialing seat is priced as a monthly rate, published alongside every other role on /pricing/; a one-off Medicare revalidation filing is priced separately as a flat, prepaid per-provider job rather than a monthly rate, since it is bounded, one-time work. Ask which of the two a quote actually covers before comparing prices.
- What's the difference between credentialing and payer enrollment?Credentialing verifies a provider's qualifications, license, education and history; enrollment is the separate process of registering that provider with a specific payer so claims can actually be paid. The two are usually done together and talked about as one thing, but a provider can be fully credentialed and still not enrolled with a given payer.
Virtual assistants and staffing
- What is a medical billing virtual assistant, and what do they do?A medical billing virtual assistant is a remote staff member, usually offshore, handling billing tasks such as eligibility checks, prior authorization, claim follow-up or payment posting inside your own systems. The term covers everything from a part-time generalist to a full-time dedicated specialist, which is why the price and scope vary so widely by vendor.
- How much does a medical billing virtual assistant cost?Published offshore rates vary widely by hours, seniority and what is included; a part-time arrangement is priced well under a full-time one, and a full-cycle or bilingual specialist costs more than a junior generalist on most vendors' own pages. Compare published vendor pricing directly at /compare/ rather than a single average figure.
- Is there such a thing as a HIPAA-compliant virtual assistant?Yes, in the sense that matters: a virtual assistant can be engaged under a signed business associate agreement with role-based access to only the data their task needs, which is what HIPAA actually requires. There is no government certification that labels a person or company HIPAA compliant; the agreement and the controls are what make the arrangement compliant.
- What's the difference between a virtual assistant and a full outsourced billing seat?The terms overlap in practice, but 'virtual assistant' often implies a more generalist, sometimes part-time role across several tasks, while a dedicated seat, our term for it, is a full-time person doing one defined job, priced and scoped the same way every month with no ambiguity about hours.
- Do virtual medical assistant companies work full-time or part-time?Both exist, and vendors publish either or both options; a part-time arrangement covers fewer than forty hours a week at a lower monthly rate, while a full-time arrangement assumes a standard working week. The only way to know which a specific quote covers is to ask for the stated hours directly.
- Can a virtual assistant work inside my own practice-management system?Yes, this is how it should work: the assistant logs into your existing practice-management or EHR system under credentials you control, rather than asking you to send data into a separate system the vendor owns. A vendor who instead wants your data moved into its own platform is a materially different, and riskier, arrangement.
For billing companies
- Do you offer white-label or overflow billing capacity for billing companies, not just practices?Yes. A billing company or BPO can buy seats as overflow capacity for its own client workload, or as white-label staff presented under its own brand to its clients, rather than buying a seat for its own direct use. Terms and volume pricing for this are published separately from the single-practice rate.
- How do billing companies scale using offshore staff without losing quality?By treating offshore staff as dedicated seats inside the billing company's own quality process, not as a cheaper, looser version of it: the same training, the same role-based access, the same supervision and reporting cadence applied to in-house staff, applied to the offshore seat as well.
- Can a billing company buy seats in bulk at a lower price than a single practice pays?Yes. A practice buying one or a handful of seats pays the same published rate as every other practice, with no volume discount; a billing company or BPO buying seats in bulk to serve its own client book is priced from a separate, published volume table instead.
- What's the difference between hiring overflow staff and reselling a seat under my own brand?Overflow staffing means the seat works your backlog under our name, as straightforward staffing augmentation; white-labeling means the same seat works under your brand, invisible to your clients as a third party. Both are available; which one fits depends on whether your clients should ever know offshore staff are involved.
- How is working with an offshore partner different from hiring a remote freelancer directly?A partner provides supervision, replacement coverage, a signed BAA and continuity if one person leaves; a freelancer hired directly gives you none of that structure unless you build it yourself. The tradeoff is price against risk: a freelancer is often cheaper per hour and carries all of the continuity and compliance risk alone.
- What should a billing company check before handing a client's AR to an offshore partner?The same four checks any buyer should run: a signed BAA before access, named individual logins rather than a shared account, a stated replacement process if staff leave, and whether the partner works inside your own systems or asks for data to move into theirs. A partner failing any one of these is a real risk to your client relationship.
Basics
- What is revenue cycle management (RCM)?Revenue cycle management is the full process a healthcare provider uses to get paid for care, from scheduling and eligibility checks before the visit, through coding and claim submission, to payment posting and AR follow-up after. Medical billing is one piece of RCM, not the whole thing.
- What's the difference between medical billing and revenue cycle management?Medical billing is coding a visit and submitting the claim; revenue cycle management is everything financial that happens before and after that, from eligibility and authorization beforehand to payment posting, denial management and AR follow-up afterward. Billing is one stage inside the larger RCM cycle, not a synonym for it.
- What does a medical billing company actually do?A medical billing company handles some or all of the revenue cycle on a practice's behalf: typically coding and claim submission, payment posting, denial management and AR follow-up, and sometimes eligibility verification and credentialing. Exactly which tasks are included varies by vendor, so it is worth confirming scope rather than assuming it.
- What is RCM outsourcing?RCM outsourcing means handing some or all of the revenue cycle, billing, coding, AR follow-up, denial management, eligibility or credentialing, to an outside vendor rather than staffing it entirely in-house. It ranges from outsourcing one narrow task, such as AR follow-up only, to a full end-to-end arrangement covering the whole cycle.
- What is denial management?Denial management is the ongoing work of identifying why a claim was denied, correcting or appealing it, and tracking the pattern across denials to prevent the same reason from recurring. It is reactive, fixing claims already denied, and preventive, feeding what is learned back into eligibility, coding or authorization workflows.
- What is payment posting in medical billing?Payment posting is recording what a payer actually paid against each claim line, including the adjustment, deductible, coinsurance and copay amounts shown on the remittance, so the patient's account reflects the real balance. Posted incorrectly, it hides money that is actually still owed or still collectible.
- What is accounts receivable (AR) in medical billing?Accounts receivable is money that has been billed but not yet collected, usually tracked in ageing buckets of zero to thirty, thirty-one to sixty, sixty-one to ninety and over ninety days. An AR caller is the staff role, in-house or outsourced, whose job is working that aged balance toward payment rather than letting it sit.
Where a question is already fully answered elsewhere on the site, a specific denial code, a state's prompt-pay deadline, a named competitor, this hub links there instead of restating it. See /answers/ for the full answer corpus and /faq/ for pricing, HIPAA and contract questions about Soft Home Global specifically.
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