Medical Billing Pricing

How Fastora approaches medical billing pricing

Fastora's medical billing pricing is set per practice after a free billing assessment, not from a fixed rate card. Two practices with the same monthly collections can need very different amounts of work, depending on specialty, payers and how much old A/R is waiting, so a quote that ignores those factors is usually wrong in one direction or the other.

The process has three steps. First, a free assessment of your claims, denials, A/R and current workflow. Second, a conversation about scope: which services you want Fastora to own and which stay with your staff. Third, a written quote that names the pricing model, what is included, what is billed separately and the contract terms. You decide only after you have read it.

This page does not list prices, because any number published without seeing your data would be a guess. For the market ranges published in industry surveys, see our article on what medical billing costs.

Pricing models compared: percentage of collections vs per-claim vs hybrid

Fastora may quote one of three models, depending on scope. Each one spreads cost and risk differently between the practice and the billing company, so it helps to know how they behave before comparing medical billing rates from different vendors.

Model	How it is calculated	Works well when	Watch for
Percentage of collections	A set percentage of the payments actually collected on your claims	Collections vary month to month, or you want the fee tied to results	Which payments count toward the fee (patient payments, old A/R, refunds)
Flat fee per claim	A fixed amount for each claim submitted	Claim volume is steady and claims are simple and similar	Whether resubmissions, appeals and secondary claims count as new claims
Hybrid	A combination, such as a per-claim fee for core billing plus a separate fee for a project or add-on	Scope mixes routine billing with one-time work such as A/R cleanup or credentialing	How each part is defined, so nothing is billed twice

Percentage based medical billing

Under percentage based medical billing, the fee rises and falls with what is collected. That ties the billing team's income to getting claims paid, which is why it is the most common model. The key is the definition of the base: ask whether patient payments, capitation, payments on old A/R and refunds are included or excluded.

Flat fee medical billing

Flat fee medical billing, usually priced per claim, makes the monthly bill easy to predict from your visit volume. It suits practices with stable, simple claims. Read the definitions closely: a contract can count a corrected claim or a secondary claim as a separate billable claim, which changes the real cost.

Hybrid pricing

A hybrid model combines elements, for example core billing on one basis and a defined project such as legacy A/R recovery or a batch of payer enrollments on another. It is useful when the work is uneven: heavy at the start, then routine.

What drives your rate

Medical billing fees reflect the hours needed to get your claims paid. These are the factors that move a quote most, and the data the assessment looks at for each one.

Monthly collections and claim volume

Higher volume spreads fixed setup and management time across more claims. Very low volume has the opposite effect, which is why some vendors set a minimum monthly fee. Bring several months of claim counts and collections to the assessment so the quote reflects your real volume.

Specialty and coding complexity

A practice with time-based psychotherapy codes, therapy units or surgical global periods needs more coding review and payer-specific checks per claim than one with simple office visits. If you want coding as well as billing, medical coding services pricing depends on the number of charts, the codes involved and whether coders assign codes or review yours. Therapy and mental health billing is scoped the same way, with authorizations and time-based coding counted before a quote is given.

Payer mix

Medicare and large commercial payers with good portals are usually quicker to work than payers that need phone calls, paper appeals or frequent records requests. A high share of Medicaid managed care, workers' compensation or out-of-network claims tends to add follow-up time.

A/R backlog

Old claims take more work per dollar than new ones: they need research, may be near filing or appeal limits, and some cannot be recovered. A large backlog is often quoted as a separate cleanup project so the routine rate is not distorted.

Credentialing & A/R cleanup add-ons

Scope is the last big factor. Credentialing and payer enrollment, legacy A/R recovery, prior authorization and front-end tasks such as eligibility checks add work, so they change the quote. Each add-on is listed separately so you can see what it costs relative to core billing.

What's included (and what isn't)

Comparing medical billing company fees only works if the scope behind each number is the same. Fastora's quote lists the services included, so you can line it up against other offers item by item.

Usually part of core billing	Quoted as add-ons when you need them
Charge entry and coding review	Full coding from documentation, or coding audits
Advanced Pre-Submission Claim Review and electronic submission	Eligibility and benefits verification for every visit
Payment posting from ERA and EOB, with reconciliation	Prior authorization requests
Denial management and appeals	Legacy A/R cleanup for older claims
A/R follow-up on current claims	Credentialing and payer enrollment
Patient statements and balance questions	Underpayment review and fee schedule analysis

Every engagement includes a dedicated account contact, transparent dashboards, monthly performance reporting and a monthly review call. Fastora works inside your existing EHR/PM system, so there is no software to install.

Things that stay with the practice regardless of model: your EHR/PM subscription, clearinghouse fees if your contract with the clearinghouse is in the practice's name, and payer or state application fees during enrollment. Ask any vendor which of these they expect you to pay.

Setup fees, minimums and contract terms

A medical billing setup fee is charged by some companies to cover onboarding work. Fastora has no hidden setup fees: anything the onboarding requires is named in the written quote before you sign.

Minimum monthly fees and contract terms vary across the industry. Rather than assume, read these lines in any agreement:

• Is there a minimum monthly fee, and what happens in a month with low volume?
• How long is the initial term, and how much notice is needed to end it?
• Is there a fee to end the contract early?
• After the contract ends, who works claims that were submitted during the term, and on what fee?
• How are payments on old A/R charged, if at all?

Fastora's quote answers each of these in writing, so you can compare it fairly with other offers.

Medical billing outsourcing cost vs in-house billing

The fair comparison for any medical billing outsourcing cost is what your billing already costs, including the parts that do not show up on a single invoice. In-house billing costs include:

• Biller and coder salaries, benefits and payroll taxes
• Coding and payer-rule training, plus certification renewals
• Billing software, clearinghouse fees and statement printing and postage
• Office space, equipment and management time
• Cover for vacations, sick days and turnover, when follow-up often slows
• Revenue lost to denials nobody appealed and claims that passed the filing limit

The last item is often the largest and the hardest to see. A billing team that works every denial can change the revenue side of the comparison, not just the expense side. Our page on outsourcing medical billing compares the two models in more detail.

In-house billing cost calculator

Use the calculator below to enter your own staffing, software and collections figures and see what in-house billing costs you now next to an outsourced estimate built from the numbers you choose.

Revenue cycle management pricing for front-to-back service

Revenue cycle management pricing covers more than claims. When Fastora takes on the full cycle, the Virtual Assistant phase (scheduling, registration, insurance verification and co-pays collected upfront) and the Scriber phase (visit documentation in the EHR in real time) are scoped alongside billing. RCM pricing for that scope is usually a hybrid, because front-end work is driven by visit volume while billing is driven by claims and collections.

You do not have to choose the full cycle at once. Many practices start with core billing, review the monthly reports for a few months, then decide whether to move front-end tasks over.

Comparing medical billing services

The better comparison is total cost, including lost revenue, not the lowest headline rate. A lower rate can end up more expensive if denials go unworked, if old A/R is ignored, or if extras are billed one by one.

When you compare medical billing service fees, check three things side by side: what each fee covers, how each vendor defines the base the fee is applied to, and what reporting you will get to judge results. Our guide on choosing a billing company lists more questions to ask.

The free medical billing audit is the starting point for a Fastora quote. It shows where your claims stand today, which also tells you what any vendor's fee would be working against.